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How Do Insurance Companies Value A Bodily Injury Claim?

Top-Rated Houston, TX Personal Injury Lawyers

Liability insurance policies are intended to provide individuals and companies with financial protection when an accident occurs.  Ideally, the insurance company would use the premiums it collects to fully compensate a victim for all injuries and damages their policyholders caused.  However, that isn't always the case.  Plain and simple - insurance companies are in the business of making money.  They simply couldn't survive if they fully paid out every claim.  Their goal is to limit, or even eliminate, legitimate bodily injury claims caused by their policyholders.  To accomplish this goal, the insurance companies employ a wide network of well-trained claims adjusters, investigators, experts and seasoned lawyers who work together to limit your claim.

Valuing a bodily injury claim is complex and varies depending on specific circumstances.  However, knowing the factors an insurance company uses to value a bodily injury claim can make a difference in how much you receive in financial compensation.

The personal injury lawyers at Hernandez Redden Sunosky, LLP include former insurance company lawyers who fight insurance companies on behalf of injury victims.  We use 40+ years of collective knowledge learned from insurance companies to maximize your financial compensation.

What is a Claims Adjuster?

Before understanding the major factors involved in valuing your bodily injury claim, it's important to understand the role and objective of a claims adjuster.  A claims adjuster is either directly employed or contracted to work for a particular insurance company.  However, in some instances where a company may be self-insured, the claims adjuster may be employed by the company.  In each capacity, the claims adjuster represents the company and will evaluate and value the claim with their financial interests in mind, not yours.

A claims adjuster will investigate the claim with the objective of “adjusting” it to what the insurance company deems, in their assessment, to be an appropriate amount.  They assess the financial risk to the policyholder and work hard to pay out below the number they have determined to be the potential “risk.”   As such, oftentimes the “adjustment” is a lower amount than the particular insurance policy limits covering the accident.

Claims adjusters typically conduct their own investigations, including, but not limited to:

  • Speaking to the policyholder
  • Inspecting property damage
  • Reviewing photographs
  • Speaking with witnesses
  • Reviewing accident reports
  • Reviewing medical records

However, claims adjusters will also rely upon their network of investigators, experts and panel lawyers to provide information to them so they can adjust the claim lower.

The claim assessment is complex and includes consideration of a multitude of factors.  To get this information, insurance companies require extensive, in-depth, analyses that consider the following major factors, among others:

Who is at Fault:

One of the most important factors in evaluating the value of a bodily injury claim is the extent each person is at fault for the accident.  Under Texas law, if you're found by a judge or jury to be more than 50% responsible for an accident, you recover nothing because you're deemed to have been a substantial factor in causing the accident.  Anything below 50%, your damages will be reduced in proportion to your fault.  For example, if you are determined to be 10% at fault, your total financial recovery will be reduced by 10%.

A claims adjuster will attempt to argue you were the primary cause of the accident or will likely be determined to be in part responsible.  This is the insurance company's effort to adjust your claim down.  Any potential settlement by the insurance company will take this arbitrary percentage of fault into account.  This is why you need to hire an experienced personal injury lawyer to educate the claims adjuster why the arbitrary percentage won't fly at the time of trial.  

Injuries and Medical Treatment:

A major factor considered in valuing your bodily injury claim is the scope of your injuries and medical treatment.  Insurance companies will evaluate the severity of your injuries and critique the extent, frequency and duration of medical treatment you have received and what will be needed in the future.  Whether you timely received medical treatment after the accident (e.g., went to the emergency room or urgent care), made all your doctor's appointments or will require surgery are just a few factors insurance companies consider.  Insurance companies will use the absence or limited and delayed medical treatment against you to “adjust” the value of the bodily injury claim down.  That is why it's critically important to not only seek an immediate medical evaluation, but also follow and complete the treatment plan prescribed by your doctor.  Doing this will protect your health and help preserve the value of your claim.

If you're worried about the cost of seeing a doctor, give us a call at (713) 981-4100 and our lawyers will do our best to find you a doctor who will agree to see you for no out-of-pocket cost.

Medical Bills:

Even if you have health insurance, your medical bills are considered in valuing your bodily injury claim.  However, it's not as simple as adding up the medical bills that were incurred as the result of accident.  Factors such as health care liens or certain medical care received may not be deemed “reasonable and necessary” by the insurance company and their doctors.  Also, there may be an additional calculation of future medical bills that need to be considered.  That' s why it is important to have the experienced lawyers at Hernandez Redden Sunosky, LLP on your side to present the correct calculations to the insurance company for consideration.

Assessment of Witnesses:

As part of its investigation, insurance companies and their lawyers will identify and speak to any witnesses.  An assessment will be made as to how the individual will present as a witness should your claim proceed to trial. Questions such as: Did the individual actually witness the accident? Is the witness account consistent with your version of the accident? Is the witness an unbiased, third-party witness or a family member? are just a few that are considered in assessing your claim.  In some instances, a case will require expert witnesses to be hired.  It's critically important they are highly educated, skilled and present well as a witness on your behalf.  Failing to identify supportive witnesses or those who make poor witnesses can impact the value of your case.  Having an experienced personal injury lawyer to identify the right witnesses or challenging others through cross-examination can help preserve the value of your claim.

Venue:

Venue is the location where your injury claim will go to trial if you file a lawsuit.  Claims adjusters take this into account when assessing the value of your claim because some places are more favorable than others.  Some claims adjusters may factor this component higher than other evaluation components in valuing a claim.  Texas law is typically stringent on where a suit may be filed, but certain choices exist depending on the circumstances.  An experienced personal injury lawyer can identify the best venue that is allowed by law and which will maximize the value of your claim.

The personal injury lawyers at Hernandez Redden Sunosky, LLP have handled cases throughout Texas.  We are intimately familiar with the counties and can identify the best venue that will help maximize your financial compensation.

Assessment of Your Lawyer:

Claims adjusters know an experienced personal injury lawyer can help an injury victim navigate through the complexities of personal injury law and expose the true motive of the claims adjuster – to save money for the insurance company.  Claims adjusters also know that an experienced personal injury lawyer who has tried cases and is willing to take your case to trial will add more value to your claim.  Questions such as: Who is the claimant's lawyer? Is he/she experienced in personal injury law? Has he/she tried cases? are often asked and evaluated.  Claims adjusters want to know if your lawyer knows personal injury law or not, and if they are willing to take the case to trial, thereby potentially increasing their risk of an adverse judgment.

The personal injury lawyers at Hernandez Redden Sunosky, LLP, including Board Certified Lawyer Ian Hernandez, have tried many cases to verdict and handle each case as if it will go to trial.  We know that's the only way to maximize your financial compensation.

Other Factors:

The factors discussed above are intended only to highlight some of the major factors claims adjusters use to “adjust” your bodily injury claim.  Additional factors such as the impact of certain legal codes, statutes and other laws on the claim as well as legal theories and potential defenses are also assessed.  Insurance companies try to twist information in their favor.  Our ex-insurance company lawyers are well-versed in defense tactics and strategies and can anticipate how the insurance company will react. We know what information they'll need and know how to present it to maximize your financial recovery. 

Contact Hernandez Redden Sunosky, LLP For Help. Free Consultation.

Hernandez Redden Sunosky, LLP can help you after an accident. Call 713.981.4100 for a free, no obligation consultation with our top-rated ex-insurance company lawyers.

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The top-rated lawyers at Hernandez Redden Sunosky, LLP will fight for you after an accident. We use our 40+ years of experience to maximize your financial compensation. Call for a FREE case evaluation. We don't get paid unless you get paid. Se Habla Espanol

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