This article is going to address 5 things you must understand in order to getting compensation from your injury claims. If you have already filed an injury claim with the insurance company and have received an offer from the insurance company, there are several tips that will get you in a better position. If you have not filed a claim or have filed a claim already, you are in the best position to lay a foundation of your compensation. With that said, you would be a fool to not consult with an attoreny to understand all your potential claims. How you handle filing the claim and the information you present to the insurance company before they make an offer will affect the offer you receive from the insurance company. Therefore it is best practice to consult an attorney before even filing a claim.

As a disclaimer, this is not legal advice for any specific situation and as always consult and attorney first before handling any aspect of insurance claims or any matter. With that said lets’ get started with the good stuff.

1. Percent of Liability
The percent that you and the other party is liable for your injury is the first factor. California, as a pure-comparative negligent state, liability is very important. In the event that the insurance company is deeming there insured person is not fully liable for you injuries, the offer they make to you will be reduced according to the percent of liability they believe their insured person is liable for your injuries.

Example: If they think their insured person is only 10% responsible for you injuries, then they may in fact be reducing every offer by 90% of what they think your claim is worth.
So, if your claim is worth $10,000 and the insurance company is only accepting 10% liability for your injuries, they are only going to pay $1,000 for your claim.

2. Standard or Non-Standard
Next, you must understand what type of insurance company handling your claim. In my experience, both working as a claims adjuster and as an attorney, the type of insurance company will dictate the practice of the adjuster. There tends to be two types of insurance companies: Standard or Non-Standard.

Standard companies tend to be many of the larger insurance companies like State Farm, Farmers, Allstate, or Liberty Mutual. These companies issue policies in large numbers where drivers have a good driving record, fewer accidents, more assets, and issue policies with higher policy limits.

Nonstandard auto insurance companies issue  a higher number of policies to drivers with a higher risk factors including new or young drivers, driver with recent tickets, drivers with multiple accidents or claims, and they also tend to issue more state minimum policy limits. As you can imagine, lower policy limits is likely not good for the person making a claim. But that is for another article and time.

Standard companies are more likely to fight you on paying for certain bills or amounts. This stems from many factors, but a driving reason is the simple fact that the number of claims an adjuster has in their caseload. Therefore the adjuster can focus on more time on examining records and the amount paid on a claim. These companies likely put more requirements and limits on what a reasonable settlement amount if for a claim. Therefore in order increase or justify an increased settlement amount the adjuster is going to need more documentation.

On the other hand, Non-Standard companies have their adjusters handling more claims. In order to handle claims more timely and be more effective in handling the claims the justification for paying a higher amount and pressure on an adjuster to get a reasonable settlement is less. In addition, lower policy limits can mean they want to get the claim to settle in fear of a claim reaching a value well above the policy limits. Failure of an insurance company to attempt to settle a claim within the policy limits when the value of a claim that is supported can expose the insurance company to a bad-faith lawsuit. I do not expect you to know what that is, but know the potential bad-faith exposure will push an insurance company to settle a claim.

But, the rule of thumb to take away is you may need more documentation or support to get more money from an insurance company that is a Standard verses a Non-Standard company.

3. Early Settlement May Be Your Best Settlement
A common industry practice is grading an insurance adjuster by the time it takes them to settle a claim. For example an adjuster needs to settle 55% of their claims within 60 days. This time-frame will lead adjusters to being more liberal in their offers to settle a claim and even at time the company will allow an adjuster to make offers up to $500, $1,500, or even $2,000 with little or no hard documentation. If you are looking to get a small amount of compensation without putting months into getting compensated, this may be your best time to get an efficient and best settlement.

4. How Adjusters Evaluate Claims
There is a standard way of viewing your claim and is used my most insurance companies. It is a good tool to evaluating your own claim and to understand where the insurance company is reducing your claim. This may take a bit of time to understand how this works.
Special Damages are economic damages that include medical bill, lost wages, out of pocket expenses, etc. General Damages are non-economic damages or sometimes referred to as “pain and suffering.” General damages has the greatest room for what is deemed to be reasonable.

 Here is a Sample template:  (these are hypothetical numbers)
              Special Damages:                          Submitted          Allowed
                             Ambulance                          $1200               $1200
                             Emergency Visit                  $1500               $800
                             Doctor Visit                           $180               $70
                             Therapy Bill                         $1800              $1,100
                             Missed Work                         $650               $0
                       Total Specials Allowed: . . . . . . . . .. $3170
                       General Damages Range:              #$1000-$2000
                                           Total Settlement Range: $4170-5170
In this example above, the total amount of Special Damages submitted by the injured person is $5,330 but $3170 is what the adjuster is allowing for special damages. In addition the total amount of general damages is 1000. Therefore the low end of a settlement range or even the initial offer of the adjuster is going to be $4170.

When you get this offer the adjuster may not tell you what they are not paying for your missed work and cutting the value of your medical bills. But one thing you do know is they are not giving you all of your special damages, this is because the total amount you have submitted is $5,330 and their offer does not even cover this. This is where you can attempt to pin them down on what specials they are cutting and why. This is where you can find out if you need additional support or they just do not think what you are requesting is reasonable. Getting additional support is going to be you best path to getting things paid.

Next you can see the general damages has a range. It is uncommon for an adjuster to just offer the top of their range on general damages right from the start. This is because they often like to use this as a buffer to increase an offer to cover loss of earnings or a reduced medical bill. Therefore the first offer is not going to be the best offer in most cases. For this reason, it is best to get the maximum amount of your special damages allowed by the insurance company before attempting to increase the general damages.

5. A New Set of Eyes
Finally, if you are stuck in you negotiations and you are just not getting anywhere, you may just be at an impasse with the adjuster. Just as in any profession, there are those that are good and bad, reasonable and unreasonable. I cannot tell you how many times a claim will be moved to a new adjuster because the old one no longer worked there and the new adjuster gave me the amount a client was seeking. Therefore, try to get a supervisor or manager to review the claim. They may have a different opinion on the value of a claim and increase an offer.

Feel free to contact our office with any questions by email or phone to discuss your situation. We are here to provide you with effective representation and tell you if you have a case.  Our Office number (951) 289-0202 or you can set an appointment on our website.

DISCLAIMER:  As always the above is informational only, and is not, and should not be construed as legal advice. Please consult an attorney prior to making any legal decisions. This is not intended to, nor does it provide legal advice. If you have a legal question you should make an appointment to meet with an attorney. This does not establish an attorney/client relationship between you and our firm.

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Riverside, CA 92501
Tel: (951) 289-0202