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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.
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