How Insurance Companies Evaluate the Value of a Claim

Let’s face it: Accidents can happen at any time, to any person, in any place. Often, the accident victim has done absolutely nothing wrong. In other words, someone else’s negligence or carelessness can result in life-changing injuries. 

The at-fault party will no doubt have some form of liability insurance against which you can make a claim to recover compensation for your injuries and losses. The question then arises: When you make a claim against the at-fault party’s insurer, how do they evaluate your losses and calculate what’s owed you for medical expenses, lost wages, emotional anguish, and more?

The insurance companies won’t admit it if you ask them, but they use a formula to calculate how much they’re going to pay you. They will also do everything in their power to try to pin as much of the fault on you as possible so they can lower or even deny you a payout altogether. Insurers are, after all, for-profit entities. 

If you or a loved one has been injured because of someone else’s negligence or carelessness in or around Wichita, Kansas—or anywhere in Sedgwick County—contact me at Hess Law LLC. I have more than 36 years of experience in dealing with personal injury claims, and I can negotiate with the insurance company to pursue the best possible outcome. Set up a consultation today. 

Not All Claims Are Equal 

Insurance companies will use every means to reduce or eliminate their obligation in a personal injury claim. They, of course, will point the finger at the claimant to find a measure of fault that can be used as a factor in determining any settlement offered. They can also point to a pre-existing condition that may have contributed to your injury, asserting you were already injured. 

If you’ve been struck by a tractor-trailer or 18-wheeler, the driver’s parent company’s standards and reputation can play a factor in any settlement. A reputable nationwide trucking company will no doubt have more protective and aggressive insurance coverage than a driver who is an independent contractor or who works for a local firm. 

What this points out to you as the claimant is that you have to be extra vigilant in dealing with an insurance company and its claims adjusters. Allow an experienced personal injury attorney to deal with the whole claims process on your behalf. 

How a Settlement Is Calculated

Insurance companies evaluate claims on two basic fronts: economic and non-economic. Economic damages are also called special damages, and these involve medical evaluation and treatment expenses, current and future, along with lost wages and property damages.  

Non-economic damages are known as general damages, and these involve pain and suffering, emotional distress, loss of consortium (companionship and sexual relationships), and the loss of enjoyment in life. 

Here's the formula insurance companies won’t tell you: They use a “multiplier” on the special damages claim you submit, which can range from 1.5 to 5 times the total of expenses and losses in your situation. The higher the multiplier, the higher or more serious the injuries are. Then general damages are added on. 

Factors That May Be Considered

When it comes to your personal fault in a claim, Kansas law relies on a standard known as modified comparative negligence (or fault). What this means is that each party in an accident will be assigned a percentage of fault, which will then be used to determine any settlement or court award that ensues. 

Suppose you're rear-ended in a car accident, but your brake lights fail to function. You might be assigned 30 percent (or more or less) of the fault. If your claim or lawsuit is for $50,000 to cover special and general damages, you would receive only 70 percent of that ($35,000) to account for your 30 percent fault factor. However, keep this in mind: if your percentage rises above 50%, you are ineligible to receive anything. 

Other factors can certainly play into any settlement or court award. If, for instance, you failed to seek immediate medical evaluation and treatment, this can raise suspicion that you’re “gaming” the system and your injuries aren’t what you claim they are. Insurance companies also expect prompt reporting of claims. If you wait months to finally make a claim, your claim will no doubt look suspicious to the insurer unless you can show that your injuries somehow took that long to surface. 

Steps You Should Take After an Accident

Your first concern after being injured in an accident is to seek proper medical evaluation and treatment. Even if you feel no immediate pain or symptoms, get evaluated anyway. An adrenaline rush can mask any immediate symptoms, but the effects can appear hours, days, or even weeks later. Don’t shrug things off, but seek medical advice and treatment. This is also a major step in providing a basis for an insurance claim.  

Also, you’ll need to get the at-fault party’s contact and insurance information. If there are witnesses, try to get their statements and contact information, too. If you can, use your phone to take pictures or videos of the scene, including any visible injuries and property damage. When you have a chance, write down or record what happened to the best of your members. 

Finally, and most importantly, secure the services of an experienced personal injury attorney to handle everything going forward. You don’t want to deal with the insurance adjuster on your own. 

Legal Guidance You Can Trust

It may seem simple and harmless to just contact the at-fault party’s insurance company and file a claim, but for all the reasons cited above, this can put you at a distinct disadvantage. If you or a loved one has been injured in or around Wichita or anywhere else in the state, contact me at Hess Law LLC and let me handle the insurer and its claim adjusters. I know their tactics, and I can aggressively pursue the compensation you need.