How Will The Insurance Company Evaluate My Claim?










One of the most common questions personal injury victims have is “how will the insurance company evaluate my claim?” Many insurance companies evaluate claims utilizing a computer software program called Colossus. The insurance adjuster will input information about your accident and injury into the computer program and the computer then spits out a numeric range where your claim should supposedly be settled. The computer program takes into consideration factors such as the type of injury (soft tissue versus broken bones), property damage to the vehicle, the amount of pain and suffering that usually accompanies your type of injuries, and a host of other factors. One of the other major factors is the skill and competence of the attorneys who are handling the case and the attorney’s record of taking cases to trial. Essentially, this software allows the insurance company to “steamroll” unrepresented injured individuals and individuals who are represented by attorneys whom the insurance company knows will probably not take a case to trial and will be willing to settle for the highest amount they can get.

Whether a claim is being evaluated by a combination of human beings and computer or just computer, the biggest factor that weighs into the amount of compensation a person will receive is the type of injuries in question and the medical care that those injuries require. The amount of economic loss (usually represented by medical bills and lost wages) that can be clearly demonstrated is the biggest factor. After that, pain and suffering and other factors are considered. Somebody who has suffered a broken femur will likely be entitled to more compensation than that of somebody who sustained a soft tissue injury that can be brought back to 100% health relatively quickly.

Insurance companies may also do background investigations on an injured party/potential plaintiff in order to determine the amount of money that a jury may award at trial. For example, a jury would be likely to award more money a horrifically injured teacher and mother of three who has a spotless criminal history as opposed to an injured repeat felon who has never worked a day in his life and is currently out of jail on parole for a felony conviction.

It is also important to remember that in evaluating a claim the adjuster’s number one goal is to save the insurance company money. The adjuster will do this in a number of ways. First of all, the adjuster may try to delay the claim in the hopes of wearing you down such that you might simply want to give up the claim. The adjuster may request unnecessary information or other “documentation” even if it has little or no relation to your case. Again, the adjuster’s hope is that this will be a frustrating process and that you will become worn down and accept a low-ball settlement offer. The insurance company may dispute the medical treatment and try to minimize the value of your claim by arguing that the medical care that you received was not necessary, even if the treatment was prescribed by your own doctor. The insurance company may dispute the medical charges and argue that they are excessive and the actual fair value of those charges is actually much lower. This makes it more difficult to continue with your treatment.

For injured individuals who have not yet retained an attorney, the insurance company will likely to tell you that you don’t need to get an attorney. We have heard stories of individuals being told that if they hire an attorney the insurance company will simply deny the claim and that even if there is a recovery, all the money will go to the lawyer. This is obviously not true, but insurance companies say these things because they know that once an attorney comes on board, it is likely that the insurance company will have to pay a substantially higher sum. The adjuster will try to act as your friend and make it appear as though he or she is looking out for your best interests, but nothing can be further from the truth. Rather, the adjuster’s main goal is to save the insurance company money. Oftentimes, adjusters receive bonuses based on how much money they are able to save a company – and they save money for the company by settling claims for as little as possible.

In sum, dealing with an insurance adjuster throughout a personal injury claim can be an extremely difficult, tedious, and time-consuming process. This is why it is important to retain an experienced and competent personal injury attorney who can navigate the difficult waters of the claims process and make sure the value of your case is maximized. If you have any questions or concerns about an accident that you or a loved one were involved in, call the Charles E. Boyk Law Offices, LLC today at 419-241-1395 or at toll free 800-637-8170.

Charles E. Boyk Law Offices, LLC