May 25, 2018 Last Updated 3:19 PM, Oct 3, 2017

How Your Settlement is Determined


If you have been hit and hurt in an accident, chances are you have or soon will be dealing with an insurance adjuster in order to work out what you are owed for damages incurred from the wreck, injuries, and possible lost wages. 

Before you accept their first offer or demand more, it is important to know just how the insurance adjuster comes to their “fair” settlement offer. It may be helpful to understand how he or she operates before you make your written demand, and certainly before you accept (or reject and counter) a settlement offer.

An insurance adjuster acts much like an attorney in that they will attempt to seek out every tiny detail and fact possible on your accident and the events that followed.

Their goal, in short, is to create an argument that states the wreck wasn’t that terrible and any injuries you or your party sustained were minor are worst. This is why it is so difficult to go toe-to-toe with an insurance company alone. They understand how to play the game and manipulate those they are “helping” in order to give you the least amount possible. The less the give out, the more money the company saves which is their true goal. In such instances, hiring an attorney can greatly improve your chances at receiving the compensation that you are entitled to. Brian Mincher and Ryan Rogers, attorneys at Godsey Martin law firm, have the experience and expertise to deal with these insurance adjusters. They will build a strong case on your behalf and fight to get you the money you deserve.

Let’s take a moment and examine what steps the insurance adjuster will go through before sending you their initial offer.

Just the Facts, Ma’am

The insurance adjuster is first going to sort out all the facts from the case including what the other party involved recall from the accident. They will read all police reports and accident reports that are relevant to the case. The adjuster will read any written police report or accident report from the accident. They will likely talk to you as well to hear how you remember the event taking place.

Checking Your History

Most insurance companies are able to access a claims database. This allows the insurance adjuster to see if you have ever filed for a personal injury claim previously. More than likely, they will also search online for any information they can use against you. Anything that can be found via a search engine or on your social media sites is up for grabs as it is public information.

Request Documentation of the Claim

If you have, wisely, hired an attorney, the adjuster’s next step will be to contact them. They will usually write them in order to introduce themselves and then request that you send any and all documentation related to your claim to them. This is a good time to remind you that, if you have been injured in an accident, it is of the upmost importance to save everything related to your accident. All receipts, medical documentation, reports, and anything else you think may be useful – save it.

Documents requested usually include medical records and related bills, proof of income, possibly tax returns, and proof of any property damage. If the preliminary medical records suggest that the you may have had prior injuries or issues with the are of the body that was hurt during the wreck which has led to this claim, then they will likely request all previous medical records to see what diagnosis and treatments you have had for that pre-existing condition.

When it comes to lost earnings, if you are self-employed, the insurance adjuster will probably request business records and bank statements in order to prove lost income.

Good Adjusters Review Documentation Methodically

The insurance adjuster will pour over all of this documentation meticulously, trying to find even the smallest detail that they can use against you. They are specifically looking for prior injuries that they will use to negate your injuries from the wreck (even if it aggravated said prior injury) along with discrepancies with your lost wages. The insurance company won’t offer their initial settlement nor respond to a demand until they have thoroughly examined every line of documentation.

Settling on the Settlement Amount

After reviewing all of the documentation and all other relative information and interviews, the insurance adjuster will determine the value of the claim.

In order to come to this conclusion, the insurance adjuster will determine two things: 1) if you have a chance of winning should the case go to court, and 2) what amount might a judge or jury award you?

For instance, if you are seeking $50,000 in damages, but the insurance adjuster doesn’t believe you have a shot at winning in court, then they will offer you a very low amount.

After determining your odds of winning, the adjuster will focus on the damages. In a personal injury case, damages are usually split into two categories: damages capable of exact calculation (medical bills and lost wages), and damages not capable of exact calculation (pain and suffering). Generally, when it comes to medical bills and lost wages, the adjuster will just add the two together.

That said, the insurance adjuster usually deducts from the medical bills if they look "soft". Most of the medical bills are from health care providers other than doctors or hospitals.

Let’s say that you incurred $8,500 worth of medical bills, but $7,200 of the bills was for a specialist such as a neurologist and physical therapy. The adjuster will more than likely cut the medical bill claim in half for estimation purposes.

Pain and Suffering

The hardest part for both an insurance adjuster and an attorney is placing a monetary value on your pain and suffering. Many adjusters now use a formula and technical computer software to assign a value to your pain and suffering. Let’s say that one more time…a math formula and a computer program determine what your pain and suffering is worth.

The First Settlement Offer

When the insurance adjuster arrives at their determined settlement value, then they must decide what to actually offer you. Usually, their initial offer is simply a percentage of what the insurance company believes the final value of the case should be. So the first offer you receive may only be 35% of the value of the case. Different insurance companies handle this with their own methods; there is no standard.

It is important to point out that insurance adjusters have a lot of wiggle room in adjusting their initial offer based on who they are dealing with. If an attorney is not representing you, then that first offer will be extremely lower. If they are dealing with a high-powered attorney, then the offer will be much better.

Let our Attorneys Help You

Many believe they can handle their personal injury claims on their own without the help of an attorney. As we have examined, however, you stand a much better chance at receiving more money for damages when you bring on a high-powered lawyer like Brian Mincher and Ryan Rogers. They understand the ins and the outs of these big insurance companies and will make sure the offer you’re given is exactly what you and your family need.

Call Godsey Martin law firm today at 877-IGOTHIT or visit us online and fill out our quick, no obligation case evaluation form. A member of our legal team will contact you shortly.

Gary Arsenault

“Simply put, I want to make a difference and to help others.”

“I don’t have any free time. I have teenage twins that keep me completely immersed in their activities and competitions around the country. I am apparently a great Taxi driver. That said, I am considering a future career with UBER.”

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