How An Auto Insurance Adjuster Evaluates Your Injury Claim

If you have never been injured in a car accident, count your blessings.  If you have, or if you are injured in the future, there are some things you should know about how a claims adjuster will evaluate your insurance claim if the other driver was at fault.  Your friends may tell you that you need a lawyer, but if you are not seriously injured, and it is clear it was the other guy’s fault, there is no reason why you cannot handle your own claim without the assistance of an attorney.  It is important, however, that you understand how an insurance adjuster determines the value of your claim so you provide him with everything he needs to give you the compensation you deserve. 

Adjusters are well-trained to evaluate accident claims.  Here are some tips on the factors the adjuster will consider and the things you need to think about, write down, and, when requested, be able to prove.  As an adjuster, I learned the acronym FLICSAN and you should, too.

F - Be clear on the facts.  It is important to be consistent when answering questions about what happened.  Consistency makes you more credible.  Write down what took place so you don’t forget.

L - Is liability an issue?  If it was the other driver’s fault and he admitted it, or the police officer said so, there is usually no issue.  If it could be partially your fault, find out about the laws in your state.  In some states, your “contributory negligence” will bar you from recovering any money at all.  In other states, you can get a percentage of your damages, referred to as “comparative liability”.  If liability is not clear, do consider hiring an attorney if your injuries are fairly substantial.

I - What are your injuries?  You must be able to prove what injuries you sustained, the treatment you received, what the prognosis is for your recovery and any temporary or permanent disability you have as a result of the accident.  You will need to provide the adjuster with copies of medical reports from the hospital, your treating physicians and from any other health care providers who treated you.  Sometimes the adjuster will even ask for records from previous years to determine if your injury might be related to a pre-existing injury or condition.  As long as the requests are reasonable, be cooperative.

C – What are your claimed expenses? This is probably the most important factor the adjuster relies on in evaluating your claim.  You will need to clearly state what all of your expenses are as a result of the accident and provide bills or receipts.  Include ambulance, hospital, doctor, physical therapist, transportation, medical equipment, prescriptions, etc.  Did you miss work?  Provide proof from your employer of how long you were out and how much salary you lost.  Will there be future expenses?  Did you have to hire a housekeeper, a nanny?  Did your spouse have to stay home and care for you and miss work him or herself?  Prove it all with documentation.

S - Are there any special factors that you would like the adjuster to consider when evaluating your claim? Perhaps you care for your young children and are now unable to do that.  Or maybe you have to sit all day at work and now that hurts your injured back.  How the accident effected your individual circumstances could add value to your claim.

A – What will the Adjuster’s Recommendation be to his or her superiors? Adjusters have no specific formula to figure out the value of your pain and suffering, the amount you will receive over and above your claimed expenses, but a good place to start is in the neighborhood of two to three times your reasonable and necessary medical expenses.  If you are convinced your claim is worth much more, talk to an attorney for advice on value.  The adjuster’s job is to be fair, but he does not want to pay more than he believes your claim is worth.

N – Negotiate!  Adjusters expect claimants to negotiate.  Don’t just roll over and accept what is offered unless you find it fair.

Now that you know what factors the adjuster will use to evaluate your claim, that should help you evaluate it, as well.  Be reasonable, be patient, and ask for what you think is appropriate.