When an insurance adjuster reviews your file, what factors does he consider in putting a dollar value on your claim?
Here a few key items an adjuster will consider in every personal injury case, regardless of the specific facts giving
rise to the injury:
Medical Bills—Past and Future
As a general rule, the higher your medical bills, the greater the value of your claim. However, not all doctors or
treatments are created equal. For example, insurers place a lower value on treatment by a chiropractor than treatment
by a medical doctor. You can be sure that the adjuster will closely examine your medical bills (and medical records),
looking for red flags that might lower the value of your claim.
Lost Wages and Anticipated Future Wage Loss
How much time did you lose from work due to your injuries? What did that lost time cost you in terms of income and benefits? What is the anticipated impact of your injuries on your future earning capacity?
“Liability” is the legal term for “fault.” Is it clear that the insured is to blame for your injuries? Can the adjuster make
a claim that you or some other third party is even partially to blame?
Will a jury like you and be sympathetic to your situation? Conversely, will jurors dislike the insured? Was the insured
under the influence of drugs or alcohol at the time of the incident? Does the insured have a criminal history or an
unfavorable litigation history? Has the insured been investigated by or cited by the government?
Your Attorney’s Reputation
Does your attorney take cases to trial? Does he win? Do local adjusters believe that if they wait long enough or push back
hard enough, your attorney will eventually back down?
Your First Report Of Injury
How much time passed between the incident and your first report of injury? The more time has passed, the more skeptical the adjuster will be of your claim. If you refused treatment at the scene, be prepared to explain why and how your injury is related to the accident. If you did not mention the accident to the first doctor you went to see following the accident, or if you mentioned a previous injury, expect this to lower the value of your claim in the eyes of the adjuster.
Your Claims History
Multiple prior injury claims raise suspicions. A long claims history increases the likelihood that you will be placed under surveillance and your claim scrutinized as potentially fraudulent.