How Insurance Adjusters Determine Your Settlement Offer

Negotiating a settlement with an insurance company may seem like an uphill battle but with a little knowledge, understanding your insurance adjuster’s role in your settlement offer makes it easier when you are drafting your written demands.

At Lapeze & Johns , our Houston car accident lawyers want to give our clients the edge over their adversaries in the courtroom, especially when it comes to auto-insurance companies acting in bad faith.

In short, an insurance adjuster investigates the claims made by the plaintiff, analyzing the facts of the car accident and the damages that the plaintiff is claiming – the plaintiff being you. The main purpose of the insurance adjuster is to examine the facts to see if they all add up to a valid claim.

It isn’t unusual, in certain cases, that the insurance adjuster has as thorough an understanding of the accident than the plaintiff’s own attorney.

Bottomline, an adjuster wants to get to know your story intimately, and they have several methods in which they can do so including but not limited to:

With all of these resources at hand, it is vital that you be honest with the insurance adjuster. Any lie, exaggeration, or falsified info can be used against you. Always keep your story factual.

Adjusters have access to the insurer’s databases where they can view if the plaintiff has submitted a personal injury claim before.

At the same time, any insurance adjuster worth his or her salt will comb through Google with your name, looking for any specific dirt about you and/or about the car accident. Because of this, it wouldn’t be wise to mention anything about the car accident, how you feel about it, or the insurance company on any social media profile you may have. Your post can be used against you in court.

In this instance, an adjuster will contact your lawyer and request documentation concerning your claim. These documents can include:

If the initial medical records sent suggest that you had an injury before the accident, then noted that the body part was also injured in your claim, the adjuster will pick up on this. At that point, they can request that you provide all medical records indicating any treatment that you’ve ever had for that body part or condition. If you are self-employed and claim lost earnings, the adjuster can also request that you submit business records that indicate this loss of income.

Again, adjusters are thorough. They will read entire medical records and bills to see if something doesn’t add up. They will sniff out any details that may indicate that you were suffering from an injury before the accident or if you are exaggerating about the severity of your injuries.

Only when everything has been analyzed will an adjuster consider making a settlement offer or respond to a settlement demand.

Once an adjuster has received and reviewed all of the necessary documents—like medical bills or property damages to name a few—he or she will determine the overall value of your case.

To do so, the adjuster has to consider two things:

As an example, if you – the plaintiff – had a case where you could potentially earn millions but the chances of winning the trial are low, the adjuster will lowball you a settlement offer.

Once the adjuster has considered what your chances of winning the case are, they will consider your damage claim. In personal injury claims, damages are classified into two categories:

Simply put, for exact calculation damages the adjuster will add them together, contingent if the medical expenses were “soft.”

For example, if you were billed $10,000 in medical expenses, and $8,900 of those expenses were for physical and chiropractic therapy, the total amount may be adjusted down to about half of the initial medical bill claim made for valuation purposes.

Insurance adjusters also determine the value of your pain and suffering claim. This is the tough part for both parties involved. Unique formulas and specialized software are available for calculating a value to assign for pain and suffering claims.

Once everything has been accounted for and the settlement value has been determined, the adjuster will decide what to offer. Initially, the adjuster will offer a percentage of what he or she believes is the full value of the case. If you have a case valued at one million dollars, he or she may offer around 40 percent of the total value. But not all insurance companies value cases as such.

Different insurers use different protocols,  procedures, and software. It is important to note, however, that adjusters often do have leeway to make adjustments to the offer, depending on who he or she is dealing with.

If the plaintiff is underrepresented, the first offer will usually be lower in value than if the plaintiff had a lawyer. The same result would stem from a plaintiff that had a poor quality lawyer or a lawyer that never goes to trial.

On the other hand, if the adjuster is dealing with a high quality lawyer, like Houston’s own Keith and Chris from Lapeze & Johns, the offer may be higher than average.

Information is a powerful resource in a court of law, and knowing how an insurance adjuster values your case gives you the insight you need to make sure that you awarded the compensation you legally deserve.

With Lapeze & Johns’ 35 years of legal experience coupled with their 98 percent success record, you’ll have more than just a fighting chance. Contact us today at (713) 739-1010 for your free legal consultation.

How Insurance Adjusters Determine Your Settlement Offer

Lapeze & Johns