How Insurance Companies Value Personal Injury Cases

How insurance companies value personal injury cases

Although no two insurance companies have the same approach, there are some common elements on how insurance companies value personal injury cases.  Here are some, but not all of them:

1) Is liability on the part of the insured person(s) or company clear, and if not, is there any liability at all? An example would be a a slip and fall accident claim.  The insurance adjuster will closely analyze and evaluate whether or not the insured could be considered negligent in causing, or contributing to the accident.

2) The extent of injuries, disability, amount of lost wages, length of medical treatment, lost wages, lost of earning capacity by the person making the claim.  Generally the higher the losses, or damages suffered by the claimant, the more value the insurance adjuster will place on the claim.

3) Are there any liens against a potential recovery (Mass Health, Medicare, private health insurance company, medical providers, etc.?).  Sometimes cases such as a car accident claim can involve significant liens for medical bills paid for the benefit of the injured party.

4) Has the claimant made prior claims in the past?  If the claimant has many prior claims, the adjuster will likely reduce the value of the case.

5) What type of witness will the claimant make at trial? Juries are more likely to award money to people that are credible.  The deposition is an arena where the adjuster can gauge the type of witness the claimant will make at trial.

6) What type of witness will the defendant (the person who caused the accident and is being sued) make at trial?  The credibility of not just the claimant, but the party that has been sued by the claimant are also evaluated by the insurance company.

7) What are juries in Massachusetts (or the county/state the accident occurred in) awarding for similar cases/injuries?  Past jury verdicts with similar cases are very influential on insurance adjusters and how they value personal injury cases

8) What is the reputation of the claimant’s attorney, i.e. does he/she have a track record of trying cases in court?  Insurance companies keep close watch on which attorneys take cases to trial, and which don’t.  Depending on which category your attorney falls into will heavily influence the value of your personal injury case.

For all types of personal injury cases this list has many, but not all of, the factors analyzed by insurance companies when evaluating, and placing a value on, personal injury claims.  Keep in mind that with workers’ compensation cases, insurance companies generally use different factors than those on this list.


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