The insurance companies often try to provide you with a lower payout, and hence understanding how they handle personal injuries is necessary. After the claim is reported, they ask you about the injuries and treatments, investigate who is at fault, review the medical bills, and valuate the claim.
Columbia, South Carolina, is the state capital and a major center for healthcare, education, government, and business in the Midlands region. With busy roads, workplaces, commercial properties, and public spaces throughout the city, accidents such as vehicle collisions, slip-and-fall incidents, and workplace injuries can result in significant physical and financial losses.
In such cases, compensation may be available through an insurance claim. Going through the claims process can add stress while you are recovering, so hiring a personal injury lawyer in Columbia can help you understand your options and handle the legal aspects of your claim.
This article covers how insurance companies handle personal injury claims and what injured individuals can expect throughout the claims process.
Investigation Process
After filing for a claim, the insurance company opens the claim and allocates a claim number. You will be assigned a claim adjuster, who is responsible for investigating your case. The adjuster will investigate how the incident happened, the seriousness of your injuries, and who is at fault.
In case your insurance covers Personal Injury Protection (PIP), under D.C. Code § 31-2404, personal injury protection (PIP) coverage, provides benefits for medical and rehabilitation expenses, work loss, and funeral expenses, subject to the applicable policy terms and statutory limits.
Gather Information
You will receive a call from the adjuster, and you will be inquired about the incident, injuries, and treatment. They may request a recorded statement and ask you to sign medical authorizations through which they can access your entire history.
Assessing Who Is at Fault
The insurance company reviews evidence such as police reports, witness statements, photographs, and videos to determine who may be responsible for the accident. This assessment helps establish liability and influences how the insurer evaluates the personal injury claim.
Reviewing Medical Documents and Valuation
The next process involves the collection of medical records, bills, diagnostic tests, and treatment plans. They will also check if there is any pre-existing disease, missed appointments, and wage losses due to injuries.
The valuation will be based on:
- Medical bills
- Historical data
- Company guidelines
- Lost wages
- Adjuster judgement
- Pain and suffering
Settlement and Negotiation
The insurance company then makes a settlement offer, the worth of which would be lower than the actual loss. This is to test if you accept the settlement amount, and this is one of their tactics. Once it is signed, you cannot make any changes in the settlement offer even if you realize the injuries or loss are much more.
If this offer is denied, the adjuster may slightly increase the amount, but it will still not be worth your damages. If you make an argument, they may threaten to reduce the claim amount. Sometimes they may deny the claim, reasoning that:
- The injuries are not due to the accident.
- The treatment was done late.
- There was no fault of the insured.
- There is no statute of limitations.
Litigation and Final Settlement
If you are not satisfied with the result after negotiations, you can file a lawsuit against the at-fault party. But in most of the cases the insurance company settles the amount to further avoid charges and legal fees after the lawsuit is filed.
The insurance company finally settles the compensation, whether it be litigation or negotiation, based on the medical expenses, pain and suffering, and loss of wages.
Key Takeaways
- The insurance companies use tactics to offer a low payout, and therefore it is essential to understand how they handle personal injury claims.
- You will be assigned a claim number, and an adjuster will investigate the case.
- The adjuster gathers the information involving the incident and the recorded statement.
- They next evaluate and decide who is at fault through the photos and videos.
- They review the medical documents and evaluate the estimation based on the medical bills, lost wages, adjuster judgement, and pain and suffering.
- The settlement offer will be provided after valuation, and if not satisfied, you can negotiate.
- If the settlement amount is not worth your injuries even after negotiation, you can file a lawsuit and get better compensation.