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How Insurance Companies Evaluate the Value of a Claim

Kyle H. Jarzmik Law
Injured man filling out the insurance form

When you're involved in an accident and it comes time to file a personal injury claim, understanding how insurance companies evaluate claims is important when seeking compensation. The process is unique, involving several factors that contribute to the final settlement offer you receive. Key aspects analyzed include: 

  • The policyholder's coverage details: Verifying the specifics of what the policy covers and any applicable deductibles or exclusions. 

  • The cause of the claim: Determining whether the cause of the claim is covered under the policy. 

  • The extent of the damage or loss: Assessing the severity and scope of the damage or loss to determine the cost of repairs or replacement. 

  • Previous claims history: Reviewing the policyholder's history of claims, which can influence the perceived risk and subsequent valuation. 

  • Fact verification: Confirming the accuracy of the information presented in the claim, including the circumstances of the incident and the value of the claimed items. 

  • Applicable laws and regulations: Ensuring that the evaluation and potential payout comply with relevant legal standards. 

Fortunately, at Kyle H. Jarzmik Law, I have the resources and knowledge to assess your specific personal injury claim and advise you going forward. Located in Atlanta, I serve clients throughout the state of Georgia, including Fulton County, Cobb County, Dekalb County, Gwinnett County, Forsyth County, Douglas County, Coweta County, Carroll County, Lawrenceville, and Cumming. 

The Role of Adjusters in the Evaluation Process

Adjusters are crucial in the insurance claims process. Their primary responsibilities involve investigating the accident, assessing the damage, and determining the insurance company's liability. This includes a thorough review of medical reports, accident scene photos, and any relevant evidence that sheds light on the event and its responsible parties. 

However, dealing with adjusters can be tough for personal injury victims. Before engaging in detailed discussions with an adjuster, victims should consider consulting with an attorney specializing in personal injury. This precaution is vital because adjusters, skilled in negotiation tactics, aim to minimize the insurance company's payout.  

An experienced attorney can offer strategic advice, helping victims communicate with adjusters in a manner that protects their rights and interests. 

Speaking to an attorney before an adjuster provides legal insight and also equips victims with knowledge regarding the value of their claim, negotiation strategies, and the potential outcomes of their case. This guidance is invaluable in navigating the complex dynamics of the claims process and in safeguarding the victim's entitlement to a fair and just settlement. 

Understanding Comparative Negligence

In jurisdictions such as Georgia, where a modified comparative negligence system is in place, the concept of fault is pivotal in the determination of compensation after an accident. Under this rule, the compensation an individual receives can be significantly affected by their degree of fault.  

If you are found partially responsible for an accident, insurance companies will meticulously analyze your involvement to adjust their payout accordingly, often reducing the compensation based on your fault percentage. This is a key element of understanding how fault is determined and its impact on the compensation you might expect to receive. 

Calculating Damages

Determining the value of a claim involves a comprehensive analysis that extends well beyond the simple addition of medical bills. Insurers take into account a variety of factors to assess the full impact of an injury. These include: 

Economic Damages: These are quantifiable costs directly resulting from the injury, including: 

  • Medical expenses: Costs for hospital stays, medications, rehabilitation, and any future medical care. 

  • Lost wages: Income lost due to inability to work, both current and projected future earnings. 

Non-Economic Damages: These cover the more subjective, non-monetary consequences of an injury, such as: 

  • Pain and suffering: Compensation for physical pain and emotional distress experienced as a result of the injury. 

  • Loss of enjoyment of life: Compensation for the inability to enjoy hobbies and other life pleasures as before. 

Each of these elements plays a critical role in the final valuation of a claim, aiming to provide a comprehensive compensation package to the affected individual. 

The Negotiation Process

After completing the initial assessment, the negotiation process kicks off, marking a critical juncture. This phase's importance can't be overstated, as it's here that the expertise of a seasoned personal injury attorney becomes invaluable.

An attorney with extensive experience not only navigates this phase with strategic finesse but also brings a deep understanding of how to effectively counteract low-ball offers from the opposing side. 

A skilled lawyer leverages a comprehensive analysis of the case, utilizing evidence gathered and legal precedents to build a compelling argument for a fair settlement. This includes a detailed evaluation of the damages, pain and suffering, and any long-term impacts on the client's life. The attorney's ability to articulate these points, backed by solid evidence, often plays a decisive role in securing a settlement that truly reflects the gravity of the situation. 

Moreover, an experienced lawyer understands the tactics employed by insurance companies and can anticipate moves, preparing counterarguments that protect the client's interests. This strategic foresight ensures that the negotiation process moves in a direction favorable to achieving a just outcome, reflecting the true value of the claim. 

The Importance of Legal Representation

Understanding how insurance companies evaluate the value of a claim underscores the importance of skilled legal representation. At Kyle H. Jarzmik Law, I have the experience and the determination to help clients receive the compensation they deserve for their injuries. Contact me today if you find yourself needing to negotiate a personal injury claim in Georgia.