An Overview of the Car Accident & Personal Injury Insurance Claims Process

A car accident or other personal injury case can travel through a number of stages before it reaches a final resolution. A trial is one of the later stages that only a very small percentage of cases ever reach.

The vast majority of cases settle during the “claims” stage of the process — when your opponent is usually an insurance company, rather than a lawyer hired by the insurance company. Below is a general overview of the insurance claims process.

Expect a Call from an Insurance Adjuster within a Few Days after the Accident/Incident

Shortly after you suffer an injury due to the negligence of another person or entity, you will likely be contacted by an insurance adjuster. Sometimes, that person has the title of “claims specialist,” “claims representative,” or “claims analyst.” The title doesn’t matter. The person is an insurance claims adjuster.

So, what is the role of an insurance adjuster in the claims process, and why would that person persistently try to reach you?

When you are injured by a person or entity in a car accident or other incident, it is likely that the at-fault party is covered by a liability insurance policy. When the accident or incident is reported to the insurance company, the company will assign a claims adjuster to handle your claim.   The adjuster is usually an employee of the insurance company.

What Is The Role of An Insurance Claims Adjuster?

An insurance claims adjuster’s role is to:

• Determine if the accident was a “covered event” under the insurance policy;
• Investigate the accident/incident;
• Determine if the insurance company is liable for the accident/incident;
• Determine how much the claim is worth;
• Pay you as little as possible to resolve the claim.

Sometimes Your Injury Will Involve Multiple Claims Adjusters

In some cases– particularly car accident cases– multiple adjusters from the same insurance company will be assigned to handle different aspects of your claim. For example, if you are carry auto insurance with State Farm, and are injured in a car accident, you may be contacted by a State Farm Personal Injury Protection (“PIP”) adjuster, and a State Farm adjuster handling the collision damage to your vehicle.  You could also—for the same accident—be contacted by a GEICO bodily injury adjuster, if, for example, the driver of the at-fault vehicle was insured with GEICO.

Sometimes the Claims Process Can Be Overwhelming

If all of this sounds overwhelming, the truth is that it certainly can be. You should seriously consider hiring an experienced Palm Beach County car accident and personal injury lawyer to handle the claims process for you, and look out for your interests.  That will enable you to spend your time and energy focusing on your healing and other important aspects of your life.

An Insurance Claims Adjuster Can Set Traps for an Unwary Person without A Lawyer

It is always important to remember that a claims adjuster works for the insurance company, not for you! This holds true even if the adjuster is from your own insurance company. All insurance companies have one thing in common: to pay out as little as possible on claims, in order to maximize their profits. Period. That’s their business model, and they aggressively pursue it.

No matter how friendly and personable a claims adjuster may seem when talking to you, always keep in mind that he/she is an employee of the insurance company. As such, the adjuster’s objective is to protect the insurance company’s interests—not yours.

Many times an adjuster will speak to you politely, hoping that his/her pleasant demeanor will prevent you from hiring a lawyer. That tactic is commonly used to induce you into accepting a settlement offer for an amount much less than the full value of your claim.

Don’t fall for it!  If you have suffered a significant personal injury due to another’s negligence, then you would be wise to hire an experienced and compassionate Palm Beach County car accident and personal injury lawyer, to look out for your interests.

The Claims Adjuster Will Request A Statement From You: Don’t Do It Without Legal Guidance!

The claims adjuster handling your injury claim will want to take an oral statement from you, in detail, about:

• The accident/incident (exactly how it occurred);
• Your injuries, and other accident-related losses; and
• Your prior health conditions or injuries.

The adjuster will also likely request your permission to record the statement. You should never agree to this, because your statement can later be used against you. Many claims adjusters use recorded statements to try and trip up claimants, getting them to say things that will hurt their claim. You may be:

• Presented with questions that are purposely phrased to illicit responses harmful to your claim; or
• Be pressured into agreeing to an inaccurate statement.

If the statement you give to the adjuster conflicts– even in a minor way— with another statement you gave—or will give– at another time, that inconsistency could be used to question your credibility, and damage your case.

The Bottom Line: Secure Legal Counsel before Giving a Statement to an Insurance Company

It would be unwise for you to give a statement—even an unrecorded one—-to an adjuster, without first consulting with an experienced Palm Beach County car accident and personal injury lawyer. A good lawyer can tell you whether or not you are required to give the requested statement.

If you are dealing with your own insurance company, and your insurance policy requires you to cooperate with your insurer by giving a statement to your company’s adjuster, then your lawyer can properly prepare you to give it.

The bottom line: you have a lot to lose, so secure legal representation before you give a statement to an insurance company.

How an Experienced Palm Beach County Car Accident & Personal Injury Lawyer Will Handle the Claims Process for You

During your free consultation with a Palm Beach County car accident and personal injury lawyer, you will be asked a series of questions. You should ask your own questions, too.

The lawyer will explore a number of matters with you, including:

• The negligence of the other party/other parties involved in the accident/incident;
• The extent and severity of your injuries;
• Whether the at-fault party/-parties carried liability insurance;
• Your medical costs;
• Your legal options

Your Lawyer’s Investigation of Your Case

If and when you retain a Palm Beach County car accident and personal injury lawyer, that lawyer should:

• fully and independently investigate your personal injury claim, including:
• Police reports;
• The accident scene;
• Photographs;
• Witness testimony;
• Medical records;
• Medical bills;
• Your prior medical history;
• Your employment history
• Time lost from work, because of your injuries

Your Lawyer Will File Your Claims with the Insurance Company/Companies

Filing a claim is usually the next step in trying to resolve your car accident or other personal injury case. Filing a claim means that your lawyer notifies the responsible party/parties and their respective insurance company/-ies that you are asserting a claim seeking damages (compensation) for your injuries. If you were contacted by an insurance claims adjuster before seeking a lawyer, your lawyer will start handling all contact with the adjuster.

Your lawyer will gather and present the adjuster with:

• Documentation and other evidence showing the adjuster why his/her insured is at fault for causing your injuries;
• All the evidence proving the losses you have suffered, such as:
  • Your physical and emotional injuries;
  • The damage to your vehicle (in a car accident case); and
  • Loss of income and loss of future earning capacity

Steps the Claims Adjuster May Take In Investigating Your Palm Beach County Car Accident or Personal Injury Claim

Steps the claims adjuster may take in investigating your car accident or personal injury claim, include:

• Visiting the accident scene;
• Evaluating the car, product, or other item involved in causing your injury;
• Obtaining, requesting, and reviewing your medical records and bills;
• Reviewing your employment records, regarding any lost wage or future earning capacity claim;
• Interviewing you, its insured (the at-fault party), and any eyewitnesses;
• Consulting expert witnesses

After completing the investigation, if the adjuster determines that:

• The accident/incident is covered under the policy; and
• Its insured was at fault,

then he/she must then calculate the value of your claim.

Many factors help determine the value of a claim, including:

• The severity of your injury;
• Your out-of-pocket costs;
• The amount of your medical bills;
• Property damage;
• The length of your recovery; and
• Whether you suffered any permanent impairments.

The adjuster will file a report with the insurance company detailing:

• His/her determination of fault; and
• His/her opinion as to the value of your claim

That report is only for the insurance company’s internal use. You and your lawyer will not get to see it.

Pre-Suit Settlement Negotiations

When You Reach “Maximum Medical Improvement”

During the claims process, you will likely be treating with one or multiple healthcare provider (physician, physical therapist, etc.) for your accident-related injuries.  Your main treating physician will determine when you reach the point of “maximum medical improvement” (“MMI”).

MMI is the point in your treatment where your treating physician states that further improvement in your medical condition is no longer possible. That does not mean that you are completely healed, or that you are as “good as new.” Rather, MMI simply means that your condition has reached the point where it is as good as it is going to get.

It would be unwise to attempt to resolve your case before you have reached MMI, because:

• You may still be healing;
• You, your lawyer, and the insurance adjuster may lack a good understanding of what your medical condition will be like, moving forward.

When you settle your case, in exchange for the compensation you will receive, you will most likely be required to sign a release in which you will give up all future rights to make any claim for your injuries. You can never come back and demand more money, even if your injuries worsen, or you later discover new accident-related injuries.  For that reason, it is prudent to wait and see how your injuries develop.

What Is A Demand Package?

When your main treating physician determines that you have reached MMI, your lawyer will send a “Demand Package” to the insurance adjuster. That Demand Package will formally start settlement negotiations with the adjuster.

The Demand Package will consist of a cover letter to the adjuster demanding that the insurance company settle the case for a certain amount of money. You and your lawyer should have previously agreed upon the amount of your first demand, and your negotiation strategy. In deciding the amount of that first demand to the insurance company, it’s always a good idea to leave room to negotiate further, since the adjuster will almost certainly reject the demand and offer a lower– and often, significantly lower—amount to settle.

The Demand Package should include:

• All the information pertaining to the accident/incident, such as an explanation of the circumstances that led to it;
• Identification of the parties involved;
• A description of your injuries from the accident/incident, and their effect on you.

The Demand Package should also:

• Present all the evidence of fault gathered during the investigation stage, clearly showing why the other party should be held liable for your injuries;
• Enumerate your financial losses;
• Itemize your general damages, such as your pain and suffering; and
• State the total amount of compensation you are demanding from the insurer.

The Claims Adjuster’s Response to The Demand Package

After the claims adjuster receives your Demand Package, he/she will likely:

• Make a counteroffer; and/or
• Attempt to dispute the facts of your claim, in order to justify the adjuster’s (often much lower) counteroffer.

Responding to the Claims Adjuster’s Counteroffer

In consultation with your lawyer, you can:

• Accept the adjuster’s counteroffer;
• Reject the adjuster’s counteroffer, and make a counteroffer of your own;
• Stop the negotiation, and decide with your lawyer whether to proceed to the next stage, which is to file a lawsuit.

With most car accident and personal injury claims, the negotiation process goes back and forth for quite some time, until:

• Both sides agree to a settlement amount; or
• One side refuses to budge any further

The Effect of Accepting The Insurance Company’s Settlement Offer, and Signing a Release and Settlement Agreement

Again, you must understand that once you accept the adjuster’s settlement offer, the claim will be concluded forever. In just about every claim, the insurance adjuster will insist that you execute a release and settlement agreement, in exchange for the settlement funds.  After you sign a release and accept the settlement funds, you will not be permitted to go back to the insurance company to request additional compensation, even if you discover additional injuries or require additional medical treatments. This is why you should consult with an experienced Palm Beach County car accident and personal injury lawyer before you accept a settlement offer.

How Long Does The Car Accident/ Personal Injury Claims Process Last?

No Set Time Limit for Claim Resolution- It Varies

There is no set time for how long it takes to settle a car accident claim.  Each claim has its own set of circumstances and facts that will determine how long the claim takes to be resolved. Typically, though, a car accident or other personal injury claim will settle anywhere twelve to eighteen (12 to 18) months after your lawyer files a claim with the insurance company.

What If Your Case Does Not Settle During The Claims Process?

If the insurance company is unwilling to settle the claim, or refuses to reasonably compensate you for your injuries and related losses, then you and your lawyer will decide together whether it’s appropriate to take the next step, which is filing a lawsuit in a court of law. Filing a lawsuit moves your case from the “claims” stage of the process to the “litigation” stage.

In the litigation stage, the insurance company will be represented by a lawyer. Litigation is a formal process, driven by court rules, procedures, and deadlines.  Lawsuits can be litigated for years– over and above the time taken for the claims process.

Typically, a car accident or personal injury case takes one to two years after a lawsuit is filed, to be fully litigated and resolved. However, your case still has a chance to settle during the litigation process, shortening the timeframe for resolution.

Palm Beach County Car Accident & Personal Injury Attorney. Call Us Today To Discuss Your Claim

If you were injured in a Palm Beach County car accident or other personal injury incident, you do not have to handle the claims process alone.  Andrea McMillan, with the Law Offices of Andrea McMillan, is an experienced Palm Beach County car accident and personal injury lawyer, who  once worked for insurance companies defending such cases. She knows the ins and outs of insurance company tactics, and knows how to effectively deal with adjusters, in order to maximize the recovery in your case.

he Law offices of Andrea McMillan works on a contingency fee basis. This means you are charged no upfront fees. In fact, you pay us no fee, unless we win. We have the experience and resources to handle your case with skill and determination. Call us today at (561) 612-5700 for a free consultation.