How Do Insurance Companies Evaluate Personal Injury Claims?

How Do Insurance Companies Evaluate Personal Injury Claims

When you suffer a personal injury due to someone else’s negligence, you may be entitled to compensation for your medical bills, lost wages, pain, and suffering. However, the at-fault party’s insurance company will evaluate your claim before you receive compensation. You should contact a lawyer and learn more about assessing personal injury claims. 

Insurance companies use a complex process to determine the value of a personal injury claim. It involves examining various factors, such as the severity of the injury, the cost of medical treatment, and the extent of liability. Understanding how insurance companies evaluate personal injury claims can help you prepare for negotiations and maximize your chances of receiving fair compensation.

Understanding how insurance companies evaluate personal injury claims: 

  1. Liability

Insurance companies will investigate the accident’s circumstances to determine who is at fault. They may review police reports, witness statements, and other relevant evidence to assess liability. If the claimant is partially at fault for the accident, the compensation amount may be reduced based on the percentage of fault assigned. 

  1. Severity of injuries

The severity of the claimant’s injuries is a critical factor in evaluating a personal injury claim. Insurance companies will review medical records, hospital bills, and other related documents to assess the extent of the claimant’s injuries. The severity of the injuries can impact the amount of compensation the claimant receives. 

  1. Pre-existing conditions

Insurance companies will review the claimant’s medical history to determine if any pre-existing conditions may have contributed to the injury or impacted the claimant’s recovery. The insurance adjuster may ask for prior medical records to compare with the current injury. It is important to note that pre-existing conditions do not necessarily disqualify a claim, but insurance companies may consider them when evaluating the claim. 

  1. Medical treatment

Insurance companies will review medical records, hospital bills, and other related documents to assess the extent of the claimant’s injuries and the type and frequency of medical treatment received. They may consider whether the claimant followed the doctor’s orders and attended all recommended appointments. 

  1. Comparative negligence

Comparative negligence is a legal doctrine that insurance companies use to evaluate personal injury claims. It means that if the claimant shares some responsibility for the accident, their compensation may be reduced proportionally to their percentage of fault. Insurance companies will investigate the circumstances surrounding the accident and review any evidence to determine the level of the claimant’s fault. 

  1. Lost wages and earning capacity

If the claimant missed work or has reduced earning capacity due to the injury, insurance companies will consider these factors when evaluating the claim. They may review pay stubs and employment records to determine the amount of lost wages. Additionally, they may consider the claimant’s future earning potential and whether the injury impacts their ability to work. 

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