Every year, millions of Americans file personal injury claims after accidents, workplace incidents, and other unforeseen events. In 2023 alone, 62 million Americans sought medical attention for preventable injuries, and the personal injury industry was valued at $57.3 billion in 2024. According to the Insurance Information Institute, the average bodily injury liability claim amounts to around $26,501, yet roughly 95% of personal injury lawsuits settle before ever reaching trial. These numbers highlight just how central insurance adjusters are in determining outcomes for claimants across the country.
Insurance adjusters evaluate each claim through careful assessments. Their decisions have consequences for the claimant and the insurance company. This means examining every piece of evidence before a settlement is made. When claimants know this process, it can allow them to prepare and know what to expect with each step. Working with an experienced legal team like Viles & Beckman can also help claimants understand how adjusters think and what evidence matters most.
Initial Claim Evaluation
Whenever a claim for an injury arrives, the adjuster examines the claim form in the beginning. This document outlines the foundational facts of the incident. The adjuster analyzes the claimant’s statement, which includes a log of significant dates and descriptions. They need to see that the information is clear and consistent. Questions may be asked about anything unclear or missing.
Gathering Supporting Documents
The next step is to assemble supporting papers. Typical examples are medical reports, photographs, repair bills, and police reports. Adjusters check and see if the materials line up with what the claimant has said. They also confirm the authenticity of each evidence piece. The process gets delayed if there is any discrepancy or if any document is missed.
Interviewing Relevant Parties
Adjusters frequently communicate with individuals involved in the incident. The discussions might involve the claimant, eyewitnesses, and even healthcare professionals. Each interview gets closer to resolving confusing elements of the case. The adjuster listens for any inconsistencies or new information that parties may offer.
Reviewing Medical Reports
Medical records reveal the extent and severity of injuries. Adjusters review doctors’ notes and hospital records. They look for detailed accounts of injuries and treatments recommended. They care about timelines, including when care was sought, milestones in recovery, and ongoing treatment. The claim is bolstered when there is consistency between the reported injuries and the care documented. The National Association of Insurance Commissioners (NAIC) also notes that claimants should document all losses thoroughly, as adjusters rely heavily on this documentation when assessing claims.
Assessing Photographic and Physical Evidence
Images may provide useful visual context. Adjusters review images related to injuries, crash locations, or destruction of property. They measure these images against written statements to make sure they are accurate. They may also look for physical evidence that could include anything from clothing to vehicle parts. This physical inspection aids in verifying the extent of damage or injury and what may have caused it.
Examining Police and Incident Reports
Official reports often provide an unbiased account of what happened. Adjusters will study these documents for objective data and facts. People who have made statements to police or other authorities, or who have been able to provide other information, can bolster or undermine the claimant’s side of the story. These reports might even mention contributory factors like weather conditions or breach of traffic laws.
Evaluating Previous Claims and Background
An adjuster might pull the claimant’s record with the insurer. This provides insight into trends or claims made multiple times. A prior claim does not bar another associated claim, but it may affect the interpretation of the evidence. The adjuster is impartial; their decisions are based on what is known, not assumed.
Comparing With Policy Terms
All claims are compared to the policy provisions. Once the report is filed, adjusters decide if it was a covered event. They identify any exclusions or limitations that may impact the settlement value. Knowledge and understanding of policy language helps ensure that the rules remain fair and that both sides are bound and accountable to what they agreed upon in advance.
Calculating Damages and Losses
After viewing the evidence, the adjuster determines the cost of losses. This encompasses damages such as medical costs, lost income, and property damage. Depending on the facts, pain and suffering may also be compensated. The adjuster plugs in numbers using standard formulas and guidelines to determine an appropriate amount. They aim to strike a balance between the claimant’s need and the insurer’s obligation.
Negotiation and Settlement
The adjuster then evaluates all the evidence and makes a first settlement offer. The claimant could either agree to the offer, refuse it, or negotiate to receive a higher amount. The adjuster provides reasoning for the offer and leaves the door open for new facts. A fair settlement reflects both sides’ understanding of the claim’s value.
Conclusion
Reviewing is a meticulous and detail-oriented undertaking. Insurance adjusters systematically examine each part of an injury claim. Knowing this, claimants can prepare their documentation and communication accordingly. A sound review process helps ensure fair outcomes for those involved.