How Adjusters Evaluate Claims
There is a standard way of viewing your claim and is used my most insurance companies. It is a good tool to evaluating your own claim and to understand where the insurance company is reducing your claim. This may take a bit of time to understand how this works.
Special Damages are economic damages that include medical bill, lost wages, out of pocket expenses, etc. General Damages are non-economic damages or sometimes referred to as “pain and suffering.” General damages has the greatest room for what is deemed to be reasonable.

 Here is a Sample template:  (these are hypothetical numbers)
              Special Damages:                          Submitted          Allowed
                             Ambulance                          $1200               $1200
                             Emergency Visit                  $1500               $800
                             Doctor Visit                           $180               $70
                             Therapy Bill                         $1800              $1,100
                             Missed Work                         $650               $0
                       Total Specials Allowed: . . . . . . . . .. $3170
                       General Damages Rang:              #$1000-$2000
                                           Total Settlement Range: $4170-5170
 
In this example above, the total amount of Special Damages submitted by the injured person is $5,330 but $3170 is what the adjuster is allowing for special damages. In addition the total amount of general damages is 1000. Therefore the low end of a settlement range or even the initial offer of the adjuster is going to be $4170.

When you get this offer the adjuster may not tell you what they are not paying for your missed work and cutting the value of your medical bills. But one thing you do know is they are not giving you all of your special damages, this is because the total amount you have submitted is $5,330 and their offer does not even cover this. This is where you can attempt to pin them down on what specials they are cutting and why. This is where you can find out if you need additional support or they just do not think what you are requesting is reasonable. Getting additional support is going to be you best path to getting things paid.

Next you can see the general damages has a range. It is uncommon for an adjuster to just offer the top of their range on general damages right from the start. This is because they often like to use this as a buffer to increase an offer to cover loss of earnings or a reduced medical bill. Therefore the first offer is not going to be the best offer in most cases. For this reason, it is best to get the maximum amount of your special damages allowed by the insurance company before attempting to increase the general damages.

5. A New Set of Eyes
Finally, if you are stuck in you negotiations and you are just not getting anywhere, you may just be at an impasse with the adjuster. Just as in any profession, there are those that are good and bad, reasonable and unreasonable. I cannot tell you how many times a claim will be moved to a new adjuster because the old one no longer worked there and the new adjuster gave me the amount a client was seeking. Therefore, try to get a supervisor or manager to review the claim. They may have a different opinion on the value of a claim and increase an offer.

Feel free to contact our office with any questions by email or phone to discuss your situation. We are here to provide you with effective representation and tell you if you have a case.  Our Office number (951) 289-0202 or you can set an appointment on our website.