What Is an Insurance Company Adjuster and What Role Do They Play in My PI Case?

An insurance adjuster is a professional employed by an insurance company to evaluate and manage claims, including personal injury claims. Their primary role is to assess the validity and value of a claim, determine the extent of the insurance company’s liability, and negotiate settlements. In the context of your personal injury case, an adjuster plays a central role in determining how much compensation you may receive.

Role of an Insurance Adjuster in Your Personal Injury Case

Here’s a breakdown of the specific tasks and responsibilities an adjuster typically handles during a personal injury claim:

1. Investigating the Claim

• Gathering Information: After you file a claim, the adjuster’s first task is to investigate the details of the accident. They will review the accident report, interview witnesses, and collect any available evidence, such as photos, videos, and medical records. The goal is to determine who is at fault and the extent of the damages.
• Verifying the Facts: The adjuster will verify the facts surrounding the accident, which includes reviewing police reports, speaking with involved parties, and possibly hiring accident reconstruction experts. This helps them establish whether the injury is legitimate and if the claim falls under the insurance policy’s coverage.

2. Evaluating the Severity of the Injury

• Reviewing Medical Records: The adjuster will request and examine your medical records and bills to assess the severity of your injuries and the treatment you’ve received. They may also consult with medical professionals to understand the long-term effects of your injuries.
• Determining Compensation for Damages: Based on the medical records, the adjuster will estimate the economic damages, such as medical expenses and lost wages. For non-economic damages (e.g., pain and suffering), the adjuster will assess how the injury impacts your quality of life.

3. Determining Liability

• Assigning Fault: The adjuster will assess who is liable for the accident. If you were involved in a car accident, for example, the adjuster will determine if the other driver was at fault or if you share some of the blame. They will review evidence such as traffic laws, witness statements, and accident details.
• Comparative Negligence: In some cases, liability is shared between the parties. For example, if both you and the other driver were partially at fault, the adjuster will use comparative negligence to determine how much each party is responsible for the accident. Your compensation will be reduced based on your percentage of fault.

4. Calculating the Value of Your Claim

• Economic Damages: The adjuster will calculate direct, quantifiable damages like medical bills  and lost wages.
• Non-Economic Damages: These are harder to quantify and include compensation for pain and suffering, emotional distress, and loss of enjoyment of life. The adjuster may use various methods, such as multiplying your medical bills or using a per diem calculation for pain and suffering.
• Total Damage Estimate: Once they have reviewed all factors (liability, injury severity, medical history, etc.), the adjuster will determine an amount they believe is appropriate for your claim. This figure often takes into account both current and future damages.

5. Negotiating a Settlement

• Initial Offer: The adjuster typically starts with an initial settlement offer, which is often lower than what you might be entitled to. This is part of the adjuster’s strategy to save the insurance company money, knowing that you may negotiate.
• Settlement Negotiation: If you or your personal injury attorney believes the offer is too low, you may make a counteroffer or present additional evidence. The adjuster will likely negotiate with you or your attorney to settle the case for a fair amount.
• Settlement Agreement: Once a reasonable settlement is agreed upon, the adjuster will draft the settlement agreement, which you will sign. This releases the insurance company from further liability in exchange for the agreed-upon payment.

6. Dealing with Disputes or Denials

• Claim Denials: If the adjuster believes there’s insufficient evidence to support your claim, or if they dispute the severity of your injuries, they may deny your claim outright or offer a significantly reduced settlement.
• Handling Disagreements: If you don’t agree with the outcome (such as a low settlement or claim denial), you may have the option to appeal the decision, escalate the matter to higher levels within the insurance company, or file a lawsuit to pursue your claim in court.

7. Managing the Claim Timeline

• Tracking Progress: The adjuster monitors the progress of your claim throughout the process, from initial reporting to final settlement. This includes ensuring deadlines are met for submitting documents, responding to your inquiries, and ensuring that necessary steps (like medical evaluations) are completed.
• Providing Updates: You’ll likely communicate with the adjuster for updates on your claim’s status, what documents are needed, and what further steps you should take.

Important Points to Know About Insurance Adjusters:

• They Work for the Insurance Company: Keep in mind that the adjuster’s primary responsibility is to protect the interests of the insurance company. Their goal is to settle claims for as little money as possible while ensuring they meet their obligations under the policy.
• They Can Be Skilled Negotiators: Adjusters are often experienced in handling claims and may use various tactics to minimize the settlement amount. Having a personal injury lawyer can help level the playing field during negotiations.
• It’s Important to Be Cautious in Communication: Anything you say to an adjuster can be used in the evaluation of your claim. Be careful not to admit fault, downplay your injuries, or provide statements that could undermine your case.

How a Personal Injury Attorney Can Help

While an insurance adjuster works to minimize the payout, a personal injury lawyer can protect your rights by:

• Helping you understand the value of your claim.
• Dealing with the insurance adjuster on your behalf.
• Ensuring you receive fair compensation for both economic and non-economic damages.
• Advising you when the offer is too low or when further legal action is necessary.

In summary, an insurance adjuster evaluates your personal injury claim, investigates liability, determines the appropriate compensation, and negotiates a settlement. They represent the insurance company, so having a personal injury attorney can ensure that your rights are protected and you receive a fair settlement for your injuries.