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Evaluating Accident Claims: Why Some Are Better Than Others

Oct. 7, 2022

Accidents can happen anywhere at any time, and generally someone’s insurance – starting with your own if it’s an auto accident – is going to be called upon to compensate for your losses, such as medical expenses, time, and wages lost from work for recovery. 

The most likely and perhaps most frequent source of injuries is a vehicular accident. According to the Alabama Department of Transportation, in 2020, an auto accident occurred every three minutes and 55 seconds. 

When you file an injury and property damage claim with your insurance company, you will be assigned a claims adjuster, who will question you about what happened, request documents, including receipts and medical evaluations. They will also contact and question the at-fault driver and their insurance company for a subrogation claim.   

At some point, you’ll be offered a settlement – an amount of money for your injuries and other damages suffered. The figure will not be enough to cover the emotional trauma and medical exasperation you’ve had to undergo, to say nothing of the effect the accident has had on your daily and personal life.   

The insurance adjuster is unlikely to reveal the “formula” they use to arrive at your settlement offer, but practices in valuing claims are fairly standard throughout the insurance industry, though the practices can vary from insurer to insurer.  

If you or a loved one has been injured in an accident near Birmingham, Alabama, don’t deal with the insurance adjuster on your own. Adjusters can provoke responses from you to lowball your settlement or even deny your claim.   

Instead, rely on our personal injury attorney at Kies Law LLC to handle negotiations and the back-and-forth with the claim adjuster for you. Our attorney will fight to maximize your settlement. Kies Law LLC serves accident and injury victims in Birmingham, Hoover, Montgomery, Bessemer, and Tuscaloosa, Alabama. 

How Claims Are Evaluated 

At the bottom of every settlement offered by an insurance company lies the specter of a personal injury lawsuit. A settlement will always factor in what a jury might award the person if the matter goes to court. The goal, of course, is to prevent any lawsuits and the expense of going to court by settling beforehand with a lower level of compensation.  

As a practical matter, insurers break down their liabilities into two categories for calculating a settlement. One category is “special damages,” which includes medical expenses, property damage expenses, and lost wages. The other category is “general damages,” which is pain and suffering, emotional distress, and a lowered quality of life.  

Since general damages can’t be calculated using receipts, insurers rely on a multiplier to arrive at general damages. For instance, say you’re injured in an accident, and your special damages total roughly $10,000. To arrive at general damages, the insurance company will then multiply the special damages total by a factor of one to five, depending on the severity of your injuries and other considerations.  

Bottom line, they will offer you something much less. If you accept the lesser figure, they’ll be happy, but you’ll be stuck. If you accept a settlement, you cannot go back and argue for more.  

In addition, you may be wondering how the insurance company arrives at the multiplier? There is no universal formula, but in coming up with the multiplier, adjusters will factor in: 

  • The seriousness of your injuries (roughly speaking, the higher the medical bills, the greater the multiplier). 

  • The length of recovery time. 

  • Clear evidence of pain and suffering offered through medical proof or testimony. 

  • The amount of proof that the other driver was at fault. 

How Pre-existing Conditions Factor In 

In determining the severity of your injuries, insurance companies will often probe your medical history for pre-existing conditions. If they find, for instance, that you were already suffering from back pain from a previous injury and you then make a claim for a back injury in your most recent accident, they can argue that you weren’t really injured in present time and thus they can legally limit – or deny – your compensation.  

According to a legal principle known as the eggshell skull rule, however, insurers are obligated to compensate for any new injuries suffered by a person with a pre-existing condition, but they can try to avoid or limit compensation if they can show the injuries are not “new” but just a continuation of something already existing. At the very least, a pre-existing condition can be used as a reason to minimize the multiplier. 

The Use of Software to Calculate Settlements 

Some companies rely on computer software to do the calculations, but claim adjusters still have choices to make when they input the factors and variables in the calculation. One such popular piece of software goes by the name Colossus. It is used by companies such as Farmers, Allstate, Travelers, MetLife, and USAA.   

Even when software like Colossus is being used to generate settlement offers, a lot depends on the weight assigned to the data entered into the program. This determination can vary from company to company and even from adjuster to adjuster. A more experienced adjuster may make more reasonable – and favorable – calculations on the severity of the injuries being entered. 

How to Help Maximize Your Settlement 

The most crucial first step when injured in an accident is to seek the guidance and representation of an experienced personal injury attorney. 

Remember, Alabama is one of few states that rely on the contributory negligence rule. This means that if the insurer can show you contributed even a bit to the accident, you cannot recover damages and compensation from the other driver or party involved, even if they were 99 percent at fault.  

You must also be diligent in seeking and following medical treatment. Get examined immediately after the accident and follow through on any treatments or daily regimens prescribed by your medical team. If you skip medical appointments or ignore your prescribed treatment plan, the insurer can use that to argue that you’re not as injured as you claim.  

Also, never accept the first offer made by the insurance company, or sign anything they send to you without first running it past your attorney. Better yet, just let your attorney handle all the back-and-forth with the insurer. 

Experienced Guidance Every Step of the Way 

If you or a loved one has been injured in an accident and you’re making a claim against an insurance company, don’t go it alone. The insurance company adjusters are more than willing to find a way to pin at least part of the fault on you or to minimize the extent of your injuries and other losses to limit or avoid paying compensation.  

Instead, schedule a consultation and evaluation with our legal team at Kies Law LLC. Let us fight for the justice – and compensation – you deserve. We proudly serve clients in Birmingham, Hoover, Montgomery, Bessemer, and Tuscaloosa, Alabama.