When seeking compensation for an injury after any type of accident, you are most likely dealing with an insurance company. For example, if you are in a car accident, you (or your attorney) can negotiate a settlement with the at-fault driver’s auto insurance company. If you file a personal injury claim after a slip and fall, your property insurance or homeowner’s liability insurance will likely kick in. therefore, it is important to understand how insurance adjusters work.
understand the motivation of the insurance adjuster
When an insurance policy covers an incident and a claim is filed, an “adjuster” (an employee of the insurance company) is assigned to investigate what happened and find out how much the claim is worth. It’s important to remember that the adjuster works for the insurance company, not you. The adjuster’s approach is always to keep any payments as low as possible to make the insurance company more profitable.
While insurance adjusters want to pay as little as possible, they also want to avoid a personal injury claim. if a case is not settled out of court, and the lawsuit goes to trial, the judge or jury will make a decision about who is at fault (“liable”), whether compensation (“damages”) is appropriate, and if so how much This is risky territory for an insurance company, as an award for damages can end up being very high if the jury is sympathetic to the plaintiff. Legal fees and other costs associated with a lawsuit can also add up quickly, expenses that don’t help the insurance company’s bottom line.
Then, the insurance adjuster usually has the job of getting the claimant to accept the lowest possible settlement offer, without filing a lawsuit.
how an insurance adjuster decides on an offer
In personal injury cases, insurance adjusters generally consider the same factors that juries would consider in deciding the value of the claim. These factors include:
- actual expenses (i.e. medical bills) incurred and those to be incurred in the future
- loss of income or loss of ability to earn a living
- “pain and suffering”, and
- other negative effects of the claimant’s injuries.
Some of these damages (those for actual expenses and lost income) are fairly easy to determine. Losses like “pain and suffering,” on the other hand, are much more subjective. Learn more about “pain and suffering” in a personal injury case.
Insurance adjusters also consider two other key factors: policy limits and the strength of the plaintiff’s case.
the limits of the policy.
an insurance company will never pay more than the maximum amount of the insurance policy. For example, if the at-fault driver had $50,000 in liability insurance, the maximum the insurance company will pay in connection with the accident is $50,000. If your damages exceed the at-fault person’s coverage limits, you’ll need to collect the difference directly from them.
the strength of the plaintiff’s case.
If the plaintiff has a really strong case (such as a medical malpractice claim in which a doctor left a surgical instrument inside the plaintiff), then the insurer is more likely to offer a larger settlement, because the plaintiff’s victory in court will almost certainly be. . If a plaintiff’s case is pretty weak, the insurer is likely to offer much less, since the plaintiff is likely to go to court and get nothing.
See also: What is Data Breach Insurance?
learn more about how the insurance adjuster determines a settlement offer.
deal with an insurance company
Once you understand how insurance companies work and what the insurance adjuster’s motivation is, you can use that information to your advantage to negotiate the best possible personal injury settlement. there are a few key things to consider.
Consider hiring an attorney.
This lets the insurance company know that you take your rights seriously and will file a lawsuit if you don’t receive a fair settlement. Your attorney also knows how to determine what your specific case should resolve and can use their experience to get the best result. Learn more about hiring a personal injury attorney.
make sure you have clear proof of fault and the extent of your injuries.
Photographs, diaries, medical records, and itemized statements of all paid bills and missed work are essential to maximizing your recovery.
Consider sending a demand letter.
This is a letter that explains your side of the underlying incident and states what you will agree to in order to resolve the case. If you submit a personal injury demand letter, negotiations with the insurance adjuster may begin with a number you think is fair, not a number the insurance adjuster deems appropriate. Learn more about when the adjuster must respond to your personal injury claim letter.