How Insurance Adjusters Investigate and Value a Claim
In an injury case, the victim has a right to compensation based on the physical injuries, emotional strains, and financial losses incurred from the accident. While you and your attorney will work to pursue the maximum compensation you deserve, the defendant’s (or even your) insurance company will begin an effort to curb or deny any claims that will ultimately cost the agency money. At Cohen & Newmark, PLLC, our attorneys understand the tactics insurance companies use to delay and invalidate claims. Further, we know how to manage and deny these attempts on behalf of our clients. However, it is important you understand the process, so you can navigate your way through the claims process with confidence.
Below are the following steps insurance adjusters use to minimize or deny claims.
- Contact the claimant
Once a file is opened by an insurance agency, the adjuster, or the person who will investigate the accident and negotiate the settlement, will contact the claimant to discuss the incident. Speaking to the adjuster is your choice, though we recommend having an attorney take the call on your behalf.
If you decide to speak with the adjuster, stick with the facts. Keep your answers short and precise. Do not speculate or admit any wrongdoing, and do not give the adjuster permission to record your statement.
- Request records
The adjuster will seek to receive any and all records related to the case. This includes accident reports from law enforcement, medical records, and repair invoices.
If the adjuster requests access to your medical records, the personal injury lawyers at Cohen & Newmark recommend NOT giving permission or signing any medical authorization forms. Adjusters commonly request and access full medical histories, giving them evidence for pre-existing conditions and reasons to nullify claims.
- Investigate the injured individual
Part of an adjuster’s efforts to deny your claim involves searching for incriminating evidence against you. The adjuster will research your background for previous property damage claims or personal injury suits. They will even look through your social media accounts for proof of destructive or dangerous behaviors. If the information is public, they will likely find it.
- Perform an physical inspection
The insurance adjuster will also perform a physical evaluation of the property. For example, in a car accident claim, the adjuster will inspect the damaged vehicle, take photographs of the damage, and compare what they find to what was originally reported in the claim. This report, on the insurance company’s end, is used to estimate the value of the claim.
- Determine the value of the claim
Once the investigation is complete, the adjuster will submit a full report to the insurance company – which will include their assessment of the situation as well as their recommendation to deny or accept the claim. If the adjuster recommends approving the claim, he or she will provide an estimate of the claim’s value – meaning they will provide a sum that they believe should be paid to you, the injured party. You will receive notification of this decision once it’s made.
- Begin Negotiations
The initial settlement offer is rarely enough to adequately cover damages. Remember, the agency is attempting to manage their losses – not yours – and they expect you to negotiate.
This is where an attorney who specializes in insurance negotiation truly helps you receive the best outcome possible. Negotiations can be lengthy, burdensome, and difficult for an injured party to participate in. A legal professional can level the playing field – representing your interests and ensuring your needs are met, even if that means taking your case to trial.
If you were recently injured in an accident, the insurance company may have already opened their file and are building their case against your claim. This is why it is imperative to call an injury attorney as soon as you are able after an accident. With the proper guidance and representation, your injury claim can receive the compensation you are entitled to. The lawyers and professionals at Cohen & Newmark are experienced in personal injury claim management and litigation and committed to helping their clients achieve settlements that allow them to fully recover and recuperate from their accidents. To speak with an attorney today, dial 1-800-CALL-LEE to set up your free consultation.
