How Do Insurers Value an Injury Claim?

One of the most challenging aspects of any injury claim is putting a monetary value on the losses incurred. Different companies have their own methods, and while they all try to ensure that the plaintiff is compensated in some form or another, it is never an easy task. Your insurer will take many different factors into consideration that range from simple details like your age to complex facts surrounding future medical treatments due to the injury. At the end of the day, it is important that the potential award amount can truly cover your losses.

Main Contributors

During any injury, the patient or victim may experience a list of emotions that include pain and suffering, and mental anguish. These are also taken into consideration when a calculation is being made. The amount that is offered in a proposal depends on total expenses associated with medical costs that are linked to the injury. The insurer adds these up and multiplies the amount by a special factor that ranges from 1 to 5. This factor measures the severity of the injury. In some cases this factor can go to 10, leaving the defendant with a considerable amount to pay if they lose the case.

All the losses associated with the injury will be included in the final calculation. If you were unable to work due to the injury, your salary for the months will be factored into the total amount. These are known as “non-medical special damages” and can cover lost vacation time, sick leave, travel expenses incurred, and any other type of expense/loss that you have to bear due to the injury.

Your Background Counts

You background is another important aspect that is taken into consideration. If you have been unemployed for some time, have basic education or are categorized as an  “average” person, then these factors will also affect how much you receive. Criminal records and convictions are also analyzed.

You age is another factor as well. Young children and senior citizens generally receive higher payouts due to the frailty of their situation. However, this will depend on the injury. Someone that is in their teens or is approaching 50 can also receive higher payout values depending on how much their lives will change due to the incident.

Your earning power and worth will the taken into consideration. If you received a small salary then this will affect how much you are entitled to. Most insurance companies have a basic idea of what they are expected to pay for particular types of injuries. The portion that changes are associated with the additional charges they have to take into consideration to reflect the person’s earning power and losses due to the injury.

Your Percentage of Fault

Are you slightly responsible for the injury?  Investigation will be done to determine whether you contributed to the incident in some way. If it can be proven that the other party was totally negligent, then you will receive a large compensation package. However, if you are responsible in some way for the injuries, then the insurer will calculate the percentage of your comparative fault.

This percentage will differ greatly depending on the actions that led up to the injury. The higher the value, the larger the amounts that will be reduced from what your injuries are worth to arrive at a final figure. If for example the insurer calculates that your comparative fault is 30% then you will get 30% less of the full amount calculated for your injuries.

Your Medical Records

It is important that you get a copy of your medical form to know what the doctors wrote about you. The adjuster will look at the forms and evaluate your medical condition and see how well you are performing. However, the information on these forms can also hurt your settlement, so it is important to ensure that you know exactly what they are likely to twist to avoid paying you more. You must ensure that you follow the doctor’s guidelines very carefully and that there are no gaps in your treatment.

You must also take great care not to reveal information that can damage your reputation and undermine the injury claim. Honesty is always the best policy, but care must be taken when you expose information about past surgeries and injuries. You must remember that all you say is written on your medical history, and the adjuster will use the information. Unfortunately, adjusters are not in the business of “empathizing” with the injured, they want to ensure that expenses are kept at bay and they can do this by using the information you supplied on your medical history and anything leading up to and after the injury that can be seen as useful in their favor.

The nature of the injury will determine how often you require treatment. The more treatment you undergo the worse the injury. However, this also depends on the type of injury. It is important that you are not over treated, since again this can undermine your case and cast doubt on your condition.

You must be able to show that your injury was severe enough to require medical attention. Avoid home remedy approaches since you cannot use before a court, and—since you are not a medical expert—it can be argued that you worsened your own health.

Your Attorney’s Input Counts

Your insurer knows that it is against the law to try to settle a personal injury claim with a figure that falls well below the accepted amount. However, while they may have an established amount for specific types of injuries, your attorney can make your case more persuasive to secure you a better and higher offer. You cannot know what the “real bottom range” is for a certain injury, but your attorney knows and can argue in your favor to get a higher amount.


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