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When you’ve been injured in an accident, one of the first things you’ll likely do is file a claim with your insurance company or the at-fault party’s insurer. However, understanding how insurance companies evaluate personal injury claims can help ensure you receive the compensation you deserve. Insurance companies employ a variety of strategies and factors when reviewing claims. Scott Scherr at The Payne Law Group can teach you what they look for, help you protect your rights, and improve your chances of getting a fair settlement.
What Does Insurance Look for in a Personal Injury Claim?
Insurance adjusters evaluate personal injury claims by assessing several key factors. The goal is to determine the extent of your injuries, the damages you’ve incurred, and how much compensation you are entitled to receive. Here are some of the factors they focus on:
Liability and Fault
One of the most important factors insurance companies evaluate is who is at fault for the accident. Proving the other party’s negligence is essential in personal injury claims. Insurance adjusters will investigate the details of the incident to determine whether the other driver, company, or individual is responsible. This might involve reviewing police reports, witness statements, and photographs from the scene of the accident.
Insurance companies may offer a lower settlement if liability is unclear, and you may need legal assistance to prove fault.
The Extent of Injuries
Insurance companies also assess the severity and type of injuries sustained. The more serious the injury, the higher the compensation you may be entitled to. They will look at medical records, treatment plans, and the prognosis for recovery. Injuries like broken bones, head trauma, or spinal cord damage are typically assigned higher settlement values than minor injuries such as sprains or bruises.
However, the insurance adjuster may scrutinize your medical history to check for any pre-existing conditions. If your injury is found to be related to an earlier condition, the insurer may argue that the injury was not caused by the accident.
Medical Expenses
Insurance companies evaluate the medical expenses that arise from the accident, including hospital bills, surgery costs, rehabilitation, therapy, and prescription medications. It’s important to keep track of all medical expenses to ensure you can prove the financial impact of your injury.
If you’ve missed work due to your injury, your lost wages will also be factored into the compensation calculation. If the injury results in long-term or permanent disability, the insurance company will assess the long-term effects on your earning potential.
Impact on Daily Life
Insurance companies also consider how the injury has affected your daily life. Adjusters will ask questions about your ability to work, participate in hobbies, and perform normal household tasks. This is especially relevant in cases of severe injuries that limit mobility or cause ongoing pain.
For example, if you’re unable to return to your job or must modify your lifestyle to cope with the injury, this could affect the settlement amount.
How Insurance Companies Calculate Compensation
Insurance companies use a variety of methods to calculate compensation for personal injury claims. The primary types of damages they look at are:
Economic Damages
Economic damages are those that have a clear, verifiable monetary value. These include:
- Medical bills (past and future)
- Lost wages (both past and future)
- Property damage
- Rehabilitative costs
Insurance adjusters will review your records to ensure all expenses are properly documented and accounted for.
Non-Economic Damages
Non-economic damages are more challenging to quantify because they represent intangible losses such as:
- Pain and suffering
- Emotional distress
- Loss of enjoyment of life
To evaluate non-economic damages, insurance companies typically look at the severity of your injuries and how they affect your quality of life. They may use a multiplier method to calculate compensation, multiplying the amount of economic damages by a set number depending on the severity of your injury. However, a simple math multiplier does not usually take into account how your injuries truly affected your life and may not accurately reflect the amount of a proper recovery.
Punitive Damages
In rare cases, an insurance company may agree to pay punitive damages, which are meant to punish the at-fault party for particularly reckless or malicious behavior. This is not common in personal injury claims, but it could be relevant if the accident was caused by gross negligence, such as driving under the influence.
The Insurance Adjuster’s Role in Your Claim
Insurance adjusters are responsible for reviewing claims and offering settlements. However, their job is to minimize the amount the insurance company pays out. Here’s how they work:
- Investigation: The adjuster will gather evidence to evaluate the claim. They may contact witnesses, review police reports, and obtain medical records.
- Settlement Offers: After evaluating the claim, the insurance adjuster will make a settlement offer. The offer may be low initially, as the adjuster expects the claimant to negotiate.
- Negotiation: If you’re unsatisfied with the initial offer, you can negotiate. This process may involve back-and-forth communication to arrive at a fair settlement.
Working with an experienced personal injury attorney such as Scott Scherr can help you negotiate effectively and avoid accepting an unfair offer.
Tips for Dealing with Insurance Companies
When dealing with insurance companies, there are several important steps you should take:
- Document Everything: Keep records of all medical treatments, expenses, and lost wages. Also, photograph the accident scene and any visible injuries.
- Don’t Accept the First Offer: Insurance companies may offer an initial settlement that seems reasonable but is usually too low. Before accepting any offer, consult with personal injury attorney Scott Scherr to ensure it adequately covers your damages.
- Consult Personal Injury Attorney Scott Scherr: Having legal representation can be crucial in securing a fair settlement. Scott Scherr can help protect your rights, gather evidence, and negotiate on your behalf.
- Avoid Speaking to the Insurance Adjuster Directly: Insurance companies may attempt to get you to make statements that could undermine your claim. It’s best to let your attorney handle communication with the insurer.
Your Trusted Claim Lawyers
Insurance companies play a pivotal role in the personal injury claim process, and understanding how they evaluate claims can help you achieve a fair settlement. By knowing what factors insurance adjusters consider, keeping thorough documentation, and consulting with an experienced personal injury attorney, you can better navigate the claims process and ensure you receive the compensation you deserve.
Scott Scherr at The Payne Law Group is dedicated to helping personal injury victims in College Station, Bryan, and surrounding areas. Contact Scott Scherr today for a consultation and let us help you with your claim.