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  • Writer's pictureDavid Gagné

How Insurance Adjusters Deal With Your Personal Injury Claim and Why You Need Psych Assessment.

We all pay liability insurance one way or another. And we expect insurance to pay for what the claim fair value is in case we injure someone. But when you are the victim and you file an injury claim with an insurance company, the company delegates an “adjuster” to work on your file.

When you're a victim of personal injury and you seek compensation after an accident, you (or your attorney) will need to negotiate and deal with an adjuster.

Here's how insurance companies approach your personal injury claim.

Understand The Insurance Adjuster's Role, Intention and Goal

When you file a claim, an employee of the insurance company called “the adjuster" is appointed by the company to analyze, investigate, scrutinize and evaluate your file to see what exactly happened and to figure out the claim value (how much the company should give you).

It's essential and critical to understand that the adjuster doesn’t work for you or for your benefit. The adjuster works for the insurance company and his goal is always to find ways and details to keep the compensation you will receive as low as possible. Let’s be honest, the insurance company’s adjuster hidden role is to keep the company’s profit as high as possible (and to keep shareholders happy).

But even though the adjuster seek to keep the pay out as small as possible, the insurance company strongly desires to prevent lawsuit and trial. It wants first to solve the case out of court. Why? Because the court is precarious territory for them. If you have a valid case, the insurance company knows it will be cheaper for them to pay you out of court. Taking a lawsuit against them means the judge would decide who is at fault (“liable") and if the compensation to you ("damages") is enough, and if not, how much it should be. These are unwanted risks for the insurer because the pay out to you can be much higher if the judge is more sympathetic to you (the plaintiff) and your evidences.

Also, Insurance company avoid lawsuits because of all the expensive legal fees and variable costs associated with them —expenses that don't contribute to the insurance company's profit margin.

So by now you probably understand that the adjuster’s job and intention is to get you to agree to receive lower compensation than you deserve without going to court.

How The Adjuster Will Decide on his Offer

For personal injury cases, the adjusters will estimate your claim the same way and with the same elements than a judge would do. These elements are but not limited to:

  1. All actual expenses incurred, like medical bills, and expenses that will be incurred in the future

  2. lost of income or lost of the ability to make a living cause by the accident

  3. The "pain and suffering", physical and psychological and

  4. the other negative effects of the claimant's injuries.

The first 2 expenses above are fairly easy to estimate by the adjuster. He will get receipts and employment information easily. However, number 3 and 4 are much more subjective and closely related to your physical and psychological condition after the accident. That’s when doctors and psychologists step-in to evaluate your pain, your injuries and your psychological state.

The insurance companies also have their own health professionals working for them specifically hired to seek inconsistencies in reports fight when needed the health assessments of your evaluators. Therefor, the quality and the experience of the doctors and psychologists your lawyer hires to assess you will directly affect the result of your compensation regarding the element of pain and suffering.

Doctors and psychologist provide impartial diagnoses and reports. They practice their profession under strict regulations and protocols to proceed to your evaluation. However, they are still humans and mistakes and omissions can be made. It happens.

In this world you have good plumbers and bad ones. Good teachers and bad teachers. Good lawyers and bad ones. Same goes for health professionals. Make sure your assessments are made by health professionals with extended experience regarding personal injury claims and insurance matters.

The adjusters also look at 2 more key factors:

The strength of the claimant's case.

If your case is strong and solid, then the insurer will tend to offer a bigger settlement because your victory in court will be almost certain. If your case is weak, then the adjuster will offer much less, since you are likely to go to court and get nada…

The policy limits.

You will never get more from the insurance company than the maximum available on the policy. In the event that your damages surpass the “at-fault” person's insurance coverage limits, you will have to get the difference directly from them and probably take them to court separately to collect them.

More on Dealing With an Insurance Company

By now, you probably better understand how insurance companies work, what the adjuster role is (and intentions are), the importance of not only hire a good lawyer but that good physical and psychological assessments are mandatory to the success of your case.

That said, consider the following:

Hire a good lawyer.

By hiring a lawyer you will send a message to the insurance company: “I take my rights seriously and I won’t accept unfair settlement”. Your lawyer will look at your case and be on your side. He will get medical reports, send you for psychological assessment, determine the true value of your claim, and evaluate the best outcome for you.

Collect clear evidences of fault and of the extent of your injuries.

Medical records, Psychological Assessments, Statements of Bills, Pictures, Work lost evidence, personal journal are all crucial to maximize your compensations.


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