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What Do Insurance Adjusters Look for When Evaluating Your Claim?

Posted On 09/23/20 by Begam Marks & Traulson, PA

After you file an insurance claim for a personal injury or property damage in Arizona, the company will assign an insurance claims adjuster to your case. This will be the professional you speak to about your claim and losses. The adjuster will also be the person in charge of accepting or denying your case, as well as making a recommendation to the insurance carrier as to how much your damages are worth. Knowing what an insurance adjuster looks for during an evaluation can put you one step ahead during negotiations.

Prompt Claims Filing

Many insurance companies have a strict or loose deadline for filing new claims. This could be as short as 24 hours after the accident, although many insurance companies simply require that claimants file as soon as is reasonably possible. It is important to contact an insurance company right away after an injury to make sure you have a valid claim. Waiting too long could give the insurance adjuster a reason to doubt or deny your claim.

Police Report Number

One of the first things the insurance adjuster will ask you for is the police report number associated with your accident. It is important to call the police from the scene of a serious accident. Calling the police can prove to the insurance company that your accident did indeed happen, and that it happened the way you say it did. A police report can contain important information for the insurance adjuster to use as well, such as the date, time, location and people involved in the accident.

Professional Medical Care

An insurance adjuster will perform a comprehensive analysis of your medical records. Do not sign a blanket agreement giving the insurance company full authorization to access your medical records. This is a common tactic to allow the adjuster to search for pre-existing injuries. Instead, make sure the document you sign only grants the adjuster permission to access the medical records relevant to the case at hand.

The adjuster will evaluate your medical history for signs of negligence or reasons to deny your claim. If you waited days or weeks after your accident to see a doctor, for example, the adjuster may try to allege that your injuries are unrelated to the accident, pre-existing or that the delay made your injuries worse than they would have been. An adjuster will also check to see if you adhered to your doctor’s treatment plan.

Fault for the Accident

During the investigation phase, an adjuster will search for evidence that you caused or contributed to the accident yourself. The adjuster will be on the lookout for signs of your comparative negligence to try to diminish your payout. Do not make his or her job easier by admitting fault. Deny fault for the accident, but do not lie. Simply state the facts of how the accident happened, as requested, and wait for an official investigation to determine fault. If the claims adjuster tries to refute fault or diminish your payout based on comparative negligence, hire an attorney to help you protect your rights.

The Value of Your Damages

It is the claims adjuster’s job to calculate a settlement it believes is fair based on the value of your injuries, losses and damages. The adjuster will analyze the documents and evidence you submitted as proof of loss to come up with an amount. This could include photographs, medical bills, pay stubs and estimates from your mechanic. The adjuster may also inspect property damage in person. It is common for the first settlement offer to be far below the honest value of the client’s claim (a lowball offer). You have the right to submit a counteroffer if the insurance adjuster offers an amount you believe is too low.

Reasons to Deny Your Claim

Overall, an insurance claims adjuster will be looking for reasons to deny your claim or diminish your payout when evaluating your case. The essential function a claims adjuster serves at an insurance company is to save the investors money. The best way to combat insurance adjuster tactics during a case evaluation and recover full compensation for your injuries is by hiring a lawyer. A Phoenix personal injury lawyer can help you deal with the insurance process from start to finish.