How do insurance companies evaluate claims?
Updated: Mar 21
Speaking of a case prior to litigation, an adjuster will be assigned by the insurance company to evaluate your injury claim for settlement purposes.
Every insurance company is different, but a majority of all companies do have certain preset criteria for evaluating claims. Most use software programs where adjusters will input demographics, the location of the accident, the venue, the amount of property damages, diagnosis codes and medical bills to determine a settlement amount. The computer spits out a number. Usually the amount is unfair. Remember the insurance company is in the business of making money and in order to make money they must take in as many premiums as possible and pay out as little as they can on claims. That's why you may find that if you negotiate with an insurance company without an injury attorney's help, the adjuster may low ball the offer, believing you won't know the true value of your injuries.
Some insurance companies will even try to reduce the medical bills you incurred by either claiming they were unnecessary or not reasonable or not customary. Guess what? In Louisiana, unlike some states, they are not allowed to do this. Don't let them take advantage of you. Remember they are not on your side. They care more about their stockholders than they do your situation. Hire a tough injury attorney to go to bat for you.