How Do Insurance Companies Investigate Personal Injury Claims?

Filing a personal injury claim could be the beginning of a process that will ultimately bring you peace of mind, justice and financial compensation. The decision, however, is largely up to the insurance company investigating your claim. Once you file a claim, you will trigger an investigative process led by an insurance claims adjuster. The adjuster will closely analyze every aspect of your case, starting with your story.

Who Is the Claims Adjuster?

An insurance claims adjuster is someone the insurance company may employ or hire from an outside company. The claims adjuster will be the lead investigator on your case. It is someone assigned to review the facts and investigate the cause of your accident. An adjuster may see multiple cases on his or her desk each month. In general, you will know more about your case than the adjuster. Upon concluding the investigation, the claims adjuster will give a recommendation to the insurance company whether or not to approve your claim. While the insurance company can choose not to follow the adjuster’s recommendation, the two decisions usually align.

The Call to the Claimant

The first step in the claims adjuster’s investigation is to contact the claimant – the insured party – for a conversation about the accident. It is your prerogative as an injured accident victim whether or not to talk to the claims adjuster. If you wish to protect your rights and avoid any potential missteps, you have the right to hire a personal injury lawyer to take over conversations with the claims adjuster on your behalf. At the very least, you can work with an attorney to learn what to say and what not to say to help your case during phone calls with the adjuster.

The call from the adjuster can come as soon as the day you report the accident. The adjuster will ask simple questions about what happened. Stick to the facts – do not speculate – and do not admit any fault for the accident. Keep your answers simple and to the point. Do not offer to provide information the adjuster does not request. When the adjuster asks your permission to record a statement, do not give it. The recorded statement is a common tactic an insurance adjuster could use for information against you later.

Requests for Records

Next, the adjuster will ask for records, documents and evidence related to your case. The adjuster will want any official records, including the police report and accident reports, as well as documents such as pay stubs and proof of property damage. Part of this process will be asking your permission to access medical records. Do not give it or sign a medical authorization form. The adjuster may try to access your full medical history rather than only the documents relevant to your current case. This is a tactic for the adjuster to look for pre-existing conditions and reasons to deny your claim.

Physical Evaluation

In many cases, especially motor vehicle accident claims, the insurance adjuster will make a trip to see the property damage in person. The adjuster will inspect the damaged vehicle, take official photographs and match the damage with what you listed in your original claim. The physical examination, as well as information gathered from the auto shop, can help the adjuster estimate the value of your claim.

Determination of Case Value

Once the adjuster has acquired all information about your case, he or she will send a full analysis – along with a recommendation to accept or deny the claim – to the insurance company. If the adjuster suggests approval, he or she will also include an estimate of the case’s value. The insurance company will then make its own decision and notify you. With case approval, you or your personal injury lawyer can engage in settlement negotiations. The first settlement offered is often not enough to adequately cover a client’s damages. The insurance company expects you to negotiate for a higher number. Hire a lawyer to help you with negotiations, as well as take your claim to trial, if necessary. A lawyer can assist you with the entire insurance investigation process in California.