Claims and Claim Payments

How do claims and claim payment work?
How much you receive for a claim will depend on how the insurance adjuster evaluates the accident. This will depend largely on the insurance company's procedures. Nevertheless, there are a few basic criteria that will determine how much a claimant receives.

The accident itself
The adjuster will need to consider exactly what happened, the speed, those involved, if the police were notified and if so, if any laws were broken and/or tickets were handed out; plus other mitigating factors.Top of Form

Who is at-fault?
Before any checks can be cut, the adjuster must determine who is liable. Typically, if liability is an open-and-shut case then the adjuster may possibly write out a check right then and there.

If it isn't clear who is at fault, then the accident will likely need to be reconstructed. In this case, the scene will be carefully scrutinized, as will the damage to the vehicles, and so on, in order to determine what happened.

If both parties are found negligent, then fault will likely be split.

Injuries
Any injuries you sustain will need to be verified. Adjusters will typically ask for information such as how long you waited until you sought treatment, how it was treated, what kind of medications were prescribed, how the treatment is going, and other things. Injuries can often be fraudulently claimed so the adjuster will do a fair amount of due diligence. Be patient and provide the requested information and it should be no problem.

Expenses and losses
Expenses can include anything such as how much you spent on medical bills or how much time off from work resulted from an automobile accident. If you are self-employed or work from home, it may likely be more difficult to prove lost wages and could require a financial expert.

Be prepared to submit documentation to supplement your claims. You will need copies of your medical bills, pay stubs, pharmacy receipts, and any other expense that result as a direct result of the accident.

When it comes to property damage, if the at-fault insurer is paying, you will need at least one estimate. The insurance adjuster will likely have a look at the vehicle themselves to assess the extent of the damage.

Varying factors
There may be some other factors you might not immediately think of but will want to point out to the adjuster.

For example, if you have children to care for and/or keep a home, you may need to hire someone to help. Also, if you have a job that requires physical exertion and you are now temporarily or permanently disabled, this would be a wise time to address the subject.

Once the adjuster has all the required information, they will evaluate your claim and make an offer. The insurance company will likely lowball you and expect you to make a counteroffer. This is a good time to have an attorney to do the finagling for you. In any event, through careful negotiation, you should be able to arrive at a sensible agreement. If not, you may need to consider taking them to court.