How Do Insurance Adjusters Approach A Third-Party Claim?

Someone that has been injured in an accident has the right to file an injury claim with the insurance company of the person that was responsible for the accident. That is called a third-party claim. The insurer assigns each new claim to one of the company’s adjusters.

What actions would the adjuster take?

Adjusters always go after the policyholder’s story. The policyholder is the other party in the dispute that has been created by the claim’s filing.
Adjusters check the police report, or the incident report.

A typical adjuster would request specific documents:

• The claimant’s medical bills
• The claimant’s proof of a source of income
• The claimant’s proof of property damage

What adjusters consider, before proceeding with an assignment/claim.

• If this case were to be decided in a courtroom, what are the chances that the plaintiff could win?
• If a jury had to reach a decision on this case, what amount of money might it award the plaintiff?

Before starting negotiations with the claimant, or claimant’s legal representative, how would adjuster determine the amount to quote during the initial offer?

The adjuster’s first task would involve learning the value of the reported injuries and treatments. That task would entail looking at all of the acquired medical bills. The totals from all the bills would need to be added up.

Next, the adjuster’s time would be spent using the company’s computer. In that way, some new figures could be obtained, and used in the determination of the amount to quote. Those figures from the computer would give the value for the pain and injury, which had been reported to the insurance company.

A summation of the above figures should give the final value of the assigned case. Still, the adjuster’s initial offer would not be that final value. Instead, it would be some percentage of that same value.

Sometimes adjusters’ adjustments, prior to making the initial offer follow the instructions from the insurer. At other times, adjusters decide, without an insurer’s advice, how much to lower the calculated value, before making the initial offer.

Adjusters’ offers also reflect their consideration of a different factor. Their investigations have shown them whether or not a claimant has retained personal injury lawyer in Mississauga. If their investigations have revealed the claimant’s failure to retain a lawyer, then their initial offer could be quite low.

Not many claimants know how to deal with such a low-ball offer. The correct response calls for composition of a letter. That letter should seek an explanation for the fact that the offer was so much lower than the case’s actual value. Later, a call might be used, in order to get the adjuster’s reaction to the recently delivered letter.

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