Knowing how insurance companies operate and handle personal injury claims is time well spent.  Knowing your enemy so to speak will prepare you for what can be a frustrating process.  For you, your case is a part of your life and it can bring with it a whole range of emotions.  For the insurance companies, it is a financial transaction, nothing more.

How Insurance Companies Come Into Play

Insurance companies work with, and to some extent control, the defendant and the defendant's defense attorney.  Here's how it works...

Every insurance policy in Georgia, be it a car, homeowner's, or commercial policy, has a provision that says the insurance company will pay for a defense attorney on its insured's (i.e. the defendant) behalf.  So once someone is sued and notifies their insurance company, that insurance company will assign an Atlanta defense attorney to the case.  Defense firms, and they are well known in Atlanta because these firms do nothing but defense, are called "insurance defense" attorneys.  The defense attorney will bill the insurance company by the hour for their work or sometimes take a flat fee.  There can also be a pretty big conflict of interest because sometimes what is in a defendant's best interests is not in the insurance company's best interests, or vice versa.  Needless to say, this financial arrangement makes for some interesting strategies in terms of how a plaintiff attorney can play litigation strategy. 

The insurance company will also pay, or indemnify" any settlement or verdict up to its policy limit for its insured so long as the "occurrance" is an insurable event under the Georgia policy.  So 9 times out of 10, making a personal injury claim against the person that hurt you will not result in any great financial harm to the defendant because the insurance money will step in and cover it.  And even in those times where a verdict goes over the policy limits, if we gave the insurance company the opportunity to settle for or under those policy limits, then we can go after the insurance company for the excess verdict instead of the defendant using Georgia case law.  This is because the insurance company acted in "bad faith" by not protecting its insured by settling the case when it had the chance.

Personal Injury Claim Adjusting Software

It used to be that adjusters for insurance companies relied on their knowledge and experience to figure out what a case was worth to settle.  Those days are long gone.  Now most of the major insurers use software to adjust claims and to tie the adjuster into a range of settlement values.  The major software systems currently in use are: Colossus, Claims Outcome Advisor, Injury Claims Evaluations, and InjuryIQ.

These software systems use checklists and questionnaires to prompt the adjuster to enter data about a claim.  There are approximately 600 injury codes and over 10,000 factors the software take into account.  That is why you will notice that when I do a pre-suit settlement package on your behalf, I spend a lot of time breaking out the "data" of your claim.  I want to make the adjuster's job easy and at the same time make sure they don't miss any data points by giving them these value drivers in an easily comprehensible way.

Insurance Adjusters

Once an insurance company opens a claim, it will assign an adjuster to the file.  Adjusters are not attorneys.  They are overworked case handlers that take in and review data and try to settle cases.  Their sole job is to close claims and pay as little money as possible.  Bonuses and promotions are all driven around these 2 themes.  Adjusters are also overworked.  Many handle hundreds of claims and can only remember the facts of your case after they pull up the diary notes on their computer screen.

Adjuster Tactics In Personal Injury Claims

Adjusters are trained a variety of  techniques to meet their goal of closing claims for the least amount of money.  Here is a brief list of some of the things we are up against:

  1. Rapport Building - Adjusters are trained to call you before you can hire a lawyer and build rapport with you such that you think they have your best interests in mind.  Insurance studies show people without a personal injury attorney receive less for their claim.

  2. Questioning Necessity of Medical Treatment - even though adjusters are not physicians, they will routinely take the position that medical treatment you received was not reasonable or warranted.  This can result in them cutting the amount of money they are putting to medical expenses.  Of course, my job is to call them out on this and show in court that all medical treatment was reasonable and necessary.

  3. Delaying -Adjusters have a good feel for those claimants that are desperate for money.  If you appear desperate or too eager to settle quickly, the adjuster will low ball the claim and never come to his/her senses. You must be prepared to go the distance.  That is the only way to move your case towards its maximum value.

  4. Requesting Independent Medical Exams - these are anything but independent.  Some times adjusters will demand you go see a doctor to get examined.  The doctor is going to look at your medical records and maybe do a physical exam and then state that your injuries were not caused by the accident.  These doctors make $1,000's from the insurance company.  They are bought and paid for and will always testify in the insurance company's favor.

See also:

Talking to Adjusters