How Do Insurance Adjusters Settle Cases?

Documentation, documentation, documentation. Insurance companies require a lot of documentation before they offer to settle a case. This documentation may be in the form of witness statements, accident reports, other insurance policies, and medical records and bills. It is important to understand the process used by adjusters to evaluate cases if your goal is to settle the case.

Without written proof of the loss, insurance companies will not offer to settle the case. It is simply not enough to claim that an injury caused you severe pain which limited your ability to work, but you failed to see a doctor about the pain. In some instances, the excuses used to justify not going to the doctor for a serious injury may work at trial, but it will not work with an insurance adjuster in considering settlement.

Thus, if your injuries are serious enough to warrant medical care, then you should go to the doctor for treatment. That treatment not only helps you get better, it is an objective written documentation that an insurance adjuster will consider in evaluating your case. Missing scheduled doctor's appointments will hurt you in two ways. First, your injury recovery time may be prolonged, and second, it sends the message to the insurance adjuster that your injuries and pain are not as bad as you claim.

In considering amounts for pain and suffering, insurance adjusters usually have some preset formula they utilize. For instance, some companies will routinely only offer between $1,000-$1,500 per month for every documented month of pain and suffering caused by the injury.

By documented month, they mean every month a document visit to your physician for treatment can be proven. By this formula, if you have a documented 10 month soft tissue injury, they may offer you $10,000 plus your out of pocket medical expenses and wages to settle the case.

Other insurance companies use sophisticated computer generated models to settle cases. The adjuster plugs in the particular documented information in the case and the computer spits out an offer of settlement. Companies that use these programs usually make low offers of settlement.

Items such as lost wages can also present problems to adjusters during settlement negotiations. If the nature of your income is commission based or based on some other incentive, adjusters have a difficult time paying for wages that are not clearly documented as being lost. It is important to provide your attorney with all potential information regarding your lost wages if you intend to claim a loss of wages. W-2 forms, tax returns, pay check stubs and any other historical earnings records should be reviewed.

Keep track of prescription records and bills. Hospital and physician charges and records should also be kept from the very first treatment. It is not enough to tell the adjuster about the bills and treatment without providing the written documentation which will prove your claim.

Once you have all of the available written documentation which will prove your claim, a settlement brochure can be forwarded to the adjuster by your attorney to the insurance adjuster. This will give that adjuster a complete set of records in one package which will make it easier for them to review and evaluate. A settlement offer should then be forthcoming from the adjuster.