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How Insurance Companies Evaluate Personal Injury Claims

Insurance companies must act in good faith, adhere to policy terms, and process claims quickly and efficiently. However, they are profitable businesses that rarely offer total and fair compensation to injured victims without a fight.

To evaluate injury claims, insurers will consider many factors, including medical treatment, pain and suffering, and financial damages. This information is then run through computer software programs to tally the amount they will offer in settlement.


Determining a fair settlement is one step in the insurance company’s evaluation of your injury claim. It will involve a negotiation process. A personal injury claim in Florida may take nine to eighteen months to resolve. The amount of evidence, the insurance companies involved, and the severity of the injuries all affect how long the process takes. Receiving the compensation you are entitled to is guaranteed by a Vero Beach attorney.

Your settlement amount may vary greatly depending on the extent of your injuries, the cost of your medical care, and how long it takes you to heal. It would help if you communicated clearly with your doctors and therapists so they can document these aspects of your case in your charts. Insurance companies evaluate claims using software programs that calculate your general damages.

They also look at the probability of you winning at trial and how much a jury could award damages. They will review all documentation with a fine-toothed comb and check for red flags like prior injuries, malingering, or inaccurate damages claims.


Injuries from car accidents, workplace incidents, or other events can have costly consequences. Therefore, to get paid for their losses, people might have to make a personal injury claim. Understanding how insurance companies evaluate these claims can help victims strengthen their position and increase their chances of receiving fair compensation.

The first step in submitting a successful personal injury claim is to keep detailed records of the incident and injuries. It includes medical records, scans, and witness testimonies. Well-documented injuries can help demonstrate a direct link between the accident and incurred damages, such as medical expenses and future care needs.

The liable party’s insurance company will also evaluate how much to pay for your physical, mental, and emotional damages, including intangible damages such as pain and suffering. However, these values are more subjective and difficult to calculate.

Medical Treatment

Medical records are crucial to a personal injury claim because they provide an accurate picture of the severity of injuries. They can also help determine damages, such as future treatment costs and lost income.

Detailed medical records can help refute claims that victims are exaggerating their injuries. For example, an insurance adjuster might contend that your injuries were not as severe as you claim and could be related to a pre-existing medical condition if you wait weeks to see a doctor after an accident.

The length of treatment is also used to determine pain and suffering damages. This type of damage is more complex to evaluate than other tangible expenses and is typically based on multiples of the medical special damages you have incurred.


The most crucial factor in a personal injury case is the extent of the injuries. Severe skeletal or nerve injuries will qualify for more excellent compensation than a mild whiplash or back strain. Insurance companies also evaluate how much an injury has impacted your quality of life. It includes the impact on your work and hobbies. Monetary losses are relatively easy to calculate, but the adjuster will also consider non-monetary damages.

They include, for instance, punitive damages, loss of consortium, and pain and suffering. The adjuster will review all documentation thoroughly. They may even hire an investigator to look at social media activity and any offhand remarks you have made about feeling fine (which could be used against you if you are trying to claim debilitating injuries falsely). They will also check your past claims history.


The insurance provider assesses the degree and nature of the injuries sustained in injury claims. This evaluation will consider various factors, including medical records, scans, and other information from a qualified physician. Legal requirements for insurance companies include processing claims promptly, acting in good faith, and adhering to policy terms.

However, they may delay a settlement with lengthy investigations and repetitive document requests. In addition to evaluating your injuries, the insurance company will also determine fault. It can be a complicated process and is often subjective. The insurance adjuster will look for any red flags, such as an underlying health issue or a previous injury. They will then use software to tally up a dollar amount they’ll offer you.

Thomas Leishman

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