How Does the Insurance Company Figure out What Is a Fair Claim?

By on February 27th, 2016

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Like all businesses, insurance companies are in business to make a profit. Generally, the insurance company’s profit is the difference between what it collects in premiums and what it pays out in claims. Therefore, the insurance adjuster’s job is to settle your claim for as little as possible to maximize the company’s profit. Your lawyer’s job is to settle your claim for its maximum value.

There are basically five steps an insurance adjuster must take in handling a personal injury claim:

  1. Collecting Information – Since the adjuster must collect information needed to understand your claim, your lawyer should provide all the required information to validate the claim to the adjuster and their company. Sometimes insurance adjusters are so busy looking for damaging information about you or your claim that they miss favorable information. Your attorney should collect and highlight that favorable information, such as witness statements, photographs of the collision and your injury, opinion letters from experts in medicine, and accident reconstruction or economic loss. When your attorney presents the claim to the adjuster, he is more likely to understand the significance of your claim.
  2. Setting Reserves – When a claim comes in, the company must set reserves, an accounting entry, to assure government regulators that the company has adequate money to pay the claim. If initial reserves are set too low, when the time comes to settle the claim, the adjuster will sometimes be too limited in the amount of money he can offer in settlement. Your attorney must get the appropriate information to the adjuster as soon as possible to assist the company in setting high enough reserves that the ultimate settlement can be for the full claim value.
  3. Evaluating Damages – Since the adjusters must evaluate the claim value, your attorney should provide them with all relevant information, including comparable cases from state, regional and national publications and computerized databases, and our own evaluation of the claim’s value to assist the adjuster in coming to a full and fair evaluation.
  4. Negotiating Settlement – Negotiating a settlement can be tricky. Often times a personal injury victim who attempts to negotiate a settlement with a professional insurance adjuster is likely to recover far less than the claim’s true value. We recommend the professional advice of a qualified attorney.
  5. Defending in Trial if Necessary – If a settlement cannot be negotiated, the insurance company must defend its position in court. To improve your chances for compensation at trial, your attorney must have a quality reputation, proven credentials, a fair but firm settlement posture that refuses to settle for less than a full claim value, and the ability and resources to prepare for an aggressive litigation of your claim.

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