How Does Insurance Company Go About Investigating Submitted Claim?

Following submission of a personal injury claim, the insurer opens a new file. That new file gets assigned to one of the company’s adjusters. The adjuster must investigate the submitted claim.

Actions taken by adjusters, as part of an investigation

Obtain the story provided by the policyholder, the person that has purchased the company’s insurance policy. The story should be found in the accident report.

Go after the necessary records

—The police report
—The medical record for the victim

Ways that investigation could create a challenge for the victim

Victims are usually asked to sign a form that ensures release of their medical records. No victim should sign such a release, until a lawyer has seen the release form. Lawyers have the right to make modifications in a form, before their client signs it.

Adjusters often ask the victim to offer a taped statement, regarding what took place on the day of the accident. Personal injury lawyers in Newmarket ask their clients to refuse such a request, until the taping can take place at a time when the victim’s lawyer is present. An attorney can guide a victim that must answer any questions posed to him or her, during the taping session.

What is the adjuster’s role, after the investigation has been completed?

First, the adjuster must calculate the value of the submitted claim. Traditionally, adjusters used a formula, when performing those calculations. That formula relied on the presence of a figure known as a multiplier.

Adjusters always add up the totals from each of the victim’s medical bills. Then they multiply that total by the amount equal to the multiplier. That is usually a figure between 1.5 and 5. It represents the severity of the victim’s injury.

After obtaining that product, the adjuster adds the amount of the victim’s lost income. The final figure is one that an adjuster might use, as the start of negotiations. Adjusters usually take part in the negotiating process.

Sometimes adjusters act as though they have great legal or medical knowledge. A victim that has become familiar with his/her injury might question the veracity of an adjuster’s comment, if it was made in reference to that victim’s injury.

Adjusters try to limit the size of the company’s payoff. Still, every smart victim should have in mind the minimum figure for an acceptable settlement. The victim and the adjuster must try to agree on the figure that represents a fair settlement.

The victim’s chances for obtaining a fair settlement increase, if he or she has chosen to retain a personal injury attorney. Insurance agencies normally offer a larger payoff to any victims that have taken the time to consult with and hire a personal injury lawyer.

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