Knowing how insurance companies handle personal injury claims is invaluable to increasing the settlement value of your claim as well as reducing the stress and anxiety of the process. Insurance companies and adjusters have far more knowledge and expertise in handling personal injury claims than the average claimant (i.e. YOU). You, on the other hand, just want a fair and reasonable settlement.
A tension arises because you have no way of knowing whether you are getting a good settlement. This asymmetric knowledge and expertise makes it naturally hard to trust an adjuster, and rightly so.
Additionally, the average person doesn’t know or recognize all the factors and “data points” that are used to push a personal injury claim to its maximum value. Adjusters certainly do not volunteer this information because it would cause them to pay out more money.
How to Get the Most Out of the Claims Process
Know How to Navigate the Claims Process
Personal injury claims move in a predictable manner. At the highest level, you open the claim with the insurance companies involved, get medical treatment for your injuries, prepare a demand, negotiate, and then settle if you are able to get a fair offer. Obviously, there is much more to each aspect. This resource will help you understand the nuances, pitfalls, and opportunities at each stage of the process.
Increase your Chances of the Best Settlement
Being comfortable and confident with the process will enable you to maintain control over your own claim. Much of what happens in your interaction with your insurance company derives from control and respect.
Personal injury claimants who do not understand the process end up relying on the adjuster for advice on how to handle and document their personal injury claim. That is a classic conflict of interest. You should not rely on a person whose job, performance rating, and bonus are all tied to closing as many claims as fast as possible for the least amount of money. Knowing the process will avoid this trap.
Be Comfortable Talking to Insurance Adjusters
Insurance adjusters use a certain vocabulary that the average person won’t understand. You, on the other hand, are going to be comfortable with all concepts of the claims process after reading our deep and transparent resources such as these articles. You will not be nervous or think you are in over your head. You are also going to understand their job. At certain points in your claim’s process, you are going to signal to them that you know how they work and strategically offer them information that will make their job easier. This will tap into the powerful psychological tactic of reciprocity. It is human nature to want to return a favor.
Reduce your Stress and Anxiety over your Claim
There is always stress and anxiety over the unknown, especially when you are injured and your goal is to get your life back and to get fairly compensated. Dealing with insurance companies can bring a whole host of emotions – frustration, anxiety, and uncertainty to name a few. Knowing the entire process will eliminate these concerns and put you in a comfortable, professional place from which to handle your own personal injury claim.
Insurance Companies and Claims
Once you contact your insurer and the other driver’s insurance company, the company’s claim manager will assign your claim to an adjuster. In many instances, the company will assign one adjuster for your property damage claim and one for your personal injury claim.
Introduction Questions for Claims
Generally, the adjuster or customer service representative opening your claim will walk through the following topics with you:
- Description of the Accident
- Your Information
- The Other Driver’s Information
- Your Injuries
- Your Medical Treatment so far
- Property Damage to Your Car
CAUTION: While it is okay to tell the adjuster about what medical treatment you have received so far, DO NOT tell them with any specificity what your injuries are. The safest answer is to tell the adjuster you are just beginning medical treatment and you don’t yet know what all your injuries are – that you are waiting for the doctors to evaluate and diagnose you. The reason you want to be cautious is sometimes you forget to mention a pain/injury that later becomes a big deal. Some adjusters will “box you in” during your initial conversation with a list of injuries and then not acknowledge other injuries later because you did not mention it during your first call. So, you want to be vague enough to leave yourself room to identify and claim injuries that your doctors diagnose after this initial call.
Claims Index Search
One of the things the insurance company will do as part of opening your claim is run an ISO Claims Index search on you. Homeowner insurance companies and auto insurance companies maintain a joint database where they share information on all their claims. The insurance company will always run your name, date of birth, and SSN if they have it, through the ISO claim database to see if you have any other claims.
Reserving Money for Claims
Adjusters do what is known as “reserving” a claim. A claim reserve is an estimate of what a claim will cost. The reserve represents money that is pulled out of investments and set aside for the eventual payment of your personal injury claim. Precisely when in a claim’s timeline a case reserve is established varies by company and by line of insurance. Some companies require that case reserves be established immediately after the initial investigation is completed or within 30 days from notice of claim. Other companies defer setting case reserves for as long as three or even six months, so that sufficient information can be obtained to set a relatively realistic reserve. Until that time, these claims usually carry an average reserve.
Reserve stepping is when the adjuster reserves must be adjusted up or down after the initial reserve is set because the adjuster miscalculated your claim’s value. This is one of the reasons a claim adjuster will not want to settle a claim for $10,000 if she had set the reserve at $9,000. She would fight very hard to settle the claim for under $9,000 so she doesn’t have to adjust the reserve, explain to her supervisor why she was inaccurate, and be penalized in her performance review later on. If the claim adjuster makes a mistake when reserving bodily injury claims, then the settlement negotiations will drag for a long time. Why is this troubling? The answer is quite simple. The claim adjuster is not looking at the severity of the injury and/or the facts of the accident. They are looking to settle the claim within the amounts he/she decided in the first seven days of the life of the claim.
- You should immediately contact the Adjuster if your injuries or their diagnosis change so the Adjuster can change their Reserve to reflect the change in the nature of your claim. For example, you may have started your claim thinking you only strained your neck. But, 6 weeks into treatment and after an MRI you now have a herniated disc. This changes the value of your case substantially so you need to proactively update the adjuster and make sure they change their reserves AND have the authority to continue to handle the claim given its change in value.
- Ask your adjuster on the first phone call when they will set their Reserve. This shows that you understand the process (how else would you know what reserving is?). It will also give you a timeframe in which you can provide them documentation or evidence to support setting a good reserve so the adjuster does not get into reserve stepping.
While there are lots of little things insurance companies need before they will close a personal injury claim, the two BIG things are:
- Proof of Liability
- Proof of Damages
The take away here is that documentation is everything. The more thoroughly documented and packaged your claim is, the more “acceptable” information the adjuster has to support making you a fair and reasonable offer.
Value of an Offer
Active vs. Passive Treatment
It is thought that adjusting software gives more value to active medical treatments, such as physical therapy, as opposed to passive treatment, like chiropractic care.
Length of Treatment and Number of Visits
These are known variables used by adjusting software. Your Demand Letter should break down these statistics for each person who treated you.
This is thought to act as a multiplier to your claim’s value. If you are not completely healed at the end of your treatment, you need to ask your doctor to evaluate you for a permanent impairment rating.
Use of “Devices”
Claims software looks for data wherever possible. Just like your medical treatment (duration and number of visits), you should clearly identify any “thing” you used during your treatment and how long you used it. For example: TENS units, home traction units, cervical collars, and even prescription medication are all objective data points. You will learn how to spot and document these data points when you learn how to dissect your medical records.
Property damage is one of the only objective pieces of evidence the software has to gauge the severity of impact, which in turn would justify your pain and injuries.
Familiarizing yourself with these items will go a long way toward helping secure a fair settlement. However, there are additional nuances to each stage that will be discussed throughout our resource center. Read through the relevant articles and please contact us if you have any questions about your claim.