After an injury, one of the most crucial steps in the claims process is the insurance adjuster’s evaluation. When you file a claim, it is the adjuster’s job to determine how much compensation you should receive. At Hepworth Holzer, LLP, we understand that this process can seem overwhelming, but knowing how insurance adjusters evaluate injury claims can help you secure a fair settlement. Here’s an in-depth look at how they assess your case and what you can do to improve your chances of receiving the compensation you deserve.
What Does an Insurance Adjuster Do? 
An insurance adjuster plays a central role in the claims process. They are hired by the insurance company to evaluate the details of an accident and determine the amount the insurer should pay. They work on behalf of the insurance company, which means their main goal is to protect the company’s financial interests. However, adjusters are also trained to review and assess claims fairly based on the provided evidence.
The role of the adjuster involves several key tasks:
- Reviewing Medical Records and Evidence: They scrutinize your medical records, bills, and statements from healthcare professionals to understand the extent of your injuries and the necessary treatments.
- Determining the Cause of the Accident: Adjusters investigate the circumstances surrounding the accident, including determining who is liable. This can involve speaking with witnesses, reviewing police reports, and sometimes even inspecting the scene of the accident.
- Evaluating Damages: They assess both economic and non-economic damages. Economic damages include things like medical expenses and lost wages, while non-economic damages might involve pain and suffering.
- Negotiating the Settlement: Once the adjuster has all the necessary information, they will make an offer. This offer will reflect their assessment of your damages, fault in the accident, and the terms of the insurance policy.
What Factors Do Insurance Adjusters Consider When Evaluating a Claim?
There are numerous elements that an adjuster considers when evaluating a claim. Each of these factors can impact how much compensation you may receive. Below, we dive into the key aspects that adjusters examine:
- Severity of Injuries
The severity of your injuries is one of the most important factors for an adjuster. More severe injuries, especially those that require long-term treatment or cause permanent disability, are more likely to result in a higher payout. Adjusters look at your medical records to assess the types of injuries sustained, the treatments required, and the long-term impact these injuries will have on your life. For example, if an accident causes a permanent disability, the adjuster will factor in the cost of ongoing medical treatment and the impact on your ability to work. - Documentation and Evidence
Proper documentation is essential to ensure that your claim is evaluated accurately. Without strong evidence, adjusters may question the legitimacy of your injury or the extent of the damage. Important documents include:- Medical Bills and Records: These provide a clear record of the medical treatments you’ve received.
- Accident Reports: A police report or accident report is crucial for establishing the details of the incident and fault.
- Witness Statements: Eyewitness accounts can add credibility to your version of the events.
- Photos: Pictures of injuries, damages, and the accident scene can provide valuable visual evidence.
- Pre-Existing Conditions
If you had any pre-existing medical conditions before the accident, the insurance adjuster will review them to determine how much they contributed to the injuries sustained. If your pre-existing condition worsened as a result of the accident, the adjuster may only offer compensation for the exacerbated condition rather than the condition itself. It’s essential to understand that while pre-existing conditions may affect the payout, they do not disqualify you from receiving compensation if the accident worsened the condition. - Liability and Fault
One of the first things an adjuster will assess is who is at fault for the accident. If the other driver or party is entirely at fault, you may receive a larger payout. However, if both parties are partially to blame, the adjuster will assess the degree of fault for each party involved and reduce the compensation accordingly. In cases where liability is disputed, adjusters will conduct further investigations and review evidence to establish fault. In some states, comparative fault laws may apply, which can impact your settlement if you are found partially at fault. - Insurance Policy Limits
The amount of compensation you can receive is also constrained by the limits of the insurance policy. If the person responsible for the accident has a limited amount of insurance coverage, the adjuster will offer a settlement based on that limit, even if your damages exceed the coverage. In such cases, you may be able to seek additional compensation through your own uninsured/underinsured motorist coverage, if applicable. - Non-Economic Damages
Unlike medical bills or lost wages, non-economic damages are harder to quantify. These damages are related to the pain, suffering, and emotional distress caused by the injury. Adjusters will consider how your life has been affected by the injury and use factors like the severity and permanence of the injury, as well as your age, to assess these damages. Although non-economic damages are more subjective, they are an important part of any injury claim.
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How Do Insurance Companies Calculate Settlement Offers?
Once all the relevant information is gathered, the insurance adjuster will calculate a settlement offer. The calculation is typically based on the following:
- Medical Expenses: This includes hospital bills, doctor’s fees, physical therapy costs, medication, and any future medical care you may require.
- Lost Wages: If you missed work due to your injuries, the adjuster will calculate your lost income and factor it into the settlement offer.
- Pain and Suffering: For more serious injuries, adjusters will assign a monetary value to your pain and suffering, based on how the injury has affected your quality of life.
- Property Damage: If your vehicle or property was damaged in the accident, this will be evaluated and included in the settlement.
- Future Damages: If you have long-term or permanent injuries, the adjuster may consider your future medical costs, lost wages, and other potential damages.
How to Maximize Your Settlement
While insurance adjusters are trained to evaluate claims fairly, there are steps you can take to improve the chances of getting a fair and adequate settlement:
- Keep Detailed Records
Be sure to keep a record of all your medical treatments, doctor visits, and any other relevant documents related to your injuries. The more evidence you can provide, the stronger your case will be. - Consult an Experienced Attorney
Insurance adjusters may offer quick settlements, but these offers often do not fully account for all of your losses. It’s beneficial to have a personal injury attorney review your case before accepting any offer. At Hepworth Holzer, LLP, we are committed to ensuring that our clients receive the compensation they deserve. An experienced lawyer can negotiate with the insurance company on your behalf and may be able to secure a higher settlement. - Don’t Settle Too Quickly
It’s tempting to accept the first offer you receive from the insurance adjuster, especially if you’re struggling with medical bills. However, it’s important to understand the full extent of your injuries and their long-term impact before settling. Settling too quickly could mean leaving money on the table for future medical expenses or lost wages.
Final Thoughts on Injury Claim Evaluations
Understanding how insurance adjusters evaluate injury claims can help you navigate the claims process more effectively. While adjusters work within a structured process, there are various factors that can influence your settlement. At Hepworth Holzer, LLP, we are dedicated to helping injured parties in Boise and surrounding areas secure the compensation they deserve. If you’ve been injured in an accident, contact us today for a free consultation and let us guide you through the claims process.