Personal Injuries and Case Adjusters


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When a person has been injured in an accident where the fault falls on someone else, insurance settlements are often the first means of compensation available to recover from the incident.

However, this does mean that the victim must deal with the insurance company that doles out the allotted funds provided through the settlement with the case adjuster. This person is usually the first and primary contact when an investigation is ongoing for a claim due to injury because of an accidental circumstance. Often, this adjuster is also the interviewer for the case to document the situation from the person that was harmed after he or she has left the treatment center or healthcare facility.

During the investigation into the incident, the case adjuster for the insurance carrier must determine if the claimed individual or entity is responsible for damages and liable to the victim of the accident. No matter who is held accountable, the insurance adjuster for the company to that professional or individual is who shall lead the examination into the documentation and evidence that the person or entity is truly responsible. Because of these circumstances and that the insurance carrier is the main point of contact, it is important to know how to talk to them and understand what processes someone must go through to obtain the settlement after an offer has been accepted. Before everything has been completed and the settlement has been accepted, it is vital to seek legal consultation with a lawyer first to determine if the offer is sufficient and acceptable.

The Motivation of an Insurance Adjuster

It is the job of an insurance or case adjuster that has been assigned to the case to examine all factual data and make a determination about how much should be offered for the incident. While this individual works for the insurance carrier, their primary concern is to ensure the payouts provided to the victim of the incident are as low as possible so the company that provides the policy is making a profit. Fortunate for the person that was injured, the adjuster must ensure a lawsuit is avoided as much as possible. This means a settlement should be settled out of court if it can be. This is because if the situation is taken out of the hands of the carrier, a judge or jury panel makes a determination about who is liable for damages and how much is owed to the injured party.

How an Offer is Decided by the Insurance Adjuster

The various factors that surround the case are often considered heavily when the damages are looked at in how much is appropriate for the situation. The actual expenses in medical costs, treatment, medication and other healthcare bills for both the current timeframe and the future assist in determining how much should be offered. Another factor when considering the damages is actual losses through income and wages when the victim cannot work or is disabled and no longer has the capacity for gainful employment. Other forms of loss or distress are also considered in equal amounts usually which include pain and suffering as well as emotional damage that is incurred during the incident.

When damages are determined so that a settlement may be offered, the case considers both the limits of the policy and the plaintiffs case strength. This means the insurance policy cannot allocate more funds to the victim than the absolute limit that it has available. If only $25,000 is possible in a liability insurance case, than no more than those monies may be provided to the victim. When the person that was injured has a stronger case based on documentation and evidence, it is possible that the insurance carrier may payout a larger amount due to these factors. However, conversely if the case is weak then the amount allocated to the settlement is significantly lower. In certain circumstances, there is a possibility of no monies provided.

Dealing with an Insurance Company Efficiently

With the assistance of research and working with an insurance adjuster, the experience and understanding of how an insurance agency works may become clear. In order to negotiate the best settlement, it is important to seek a lawyer versed in insurance policies and stipulations specified within them. With the assistance of legal representation, the victim may have another view of what may occur during the investigation. To ensure the most drama free situation, the insurance adjuster should know a lawyer has been retained to ensure the rights of the victim have been protected. This may also reinforce to the adjuster that a fair and sufficient settlement should be provided.

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Disclaimer: While every effort has been made to ensure the accuracy of this publication, it is not intended to provide legal advice as individual situations will differ and should be discussed with an expert and/or lawyer.

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