How Insurance Companies Evaluate Car Accident Claims

1. Immediate Notification and Claim Initiation

Once you’ve notified your insurance company of the accident, they will open a claim. This notification should be prompt, as some insurance policies have specific time limits for reporting accidents.

2. Assignment to a Claims Adjuster

Your claim will be assigned to a claims adjuster, a specialist who will be your primary point of contact. This person investigates the claim, evaluates damages, and determines how much the insurance company should pay.

3. Initial Statement and Investigation

The adjuster will typically begin by collecting statements from everyone involved. This includes:

• The policyholder’s version of events.

• The other driver’s perspective.

• Statements from witnesses, if any.

They will also review the police report, if available, and any photographs or videos of the accident scene or damages.

4. Damage Assessment

The claims adjuster will evaluate the damage to the vehicles involved. This often involves:

• Getting an estimate for repairs from a body shop.

• Determining the total loss if the vehicle is irreparable.

5. Medical Expenses Evaluation

If there were injuries, the adjuster would examine medical reports and bills related to the accident. They will look at:

• Treatment costs.

• Rehabilitation expenses.

• Potential future medical expenses, especially in severe injury cases.

6. Evaluation of Other Costs

Apart from vehicle damage and medical bills, the adjuster will also consider:

• Rental car expenses (if you needed one while your car was being repaired).

• Lost wages if you were unable to work due to the accident.

• Other out-of-pocket expenses related to the accident.

7. Determination of Fault

Based on the evidence and statements, the adjuster will determine fault. Some states have a comparative fault rule, meaning both parties can share responsibility, which can affect the claim’s value.

8. Policy Review

The adjuster reviews the policyholder’s coverage to determine:

• The maximum payout amounts.

• Deductibles that might apply.

• Specific exclusions or conditions in the policy.

9. Settlement Offer

Once the evaluation is complete, the adjuster will make a settlement offer. This is their estimate of what they believe the claim is worth based on the above factors.

10. Negotiation

Often, the initial offer might not align with what the claimant believes they deserve. There may be negotiations between the claimant (or their attorney) and the insurance company. If an agreement isn’t reached, the claimant might choose to pursue legal action.

Conclusion

Understanding how insurance companies evaluate car accident claims can empower you to be proactive, organized, and well-prepared during the claims process. Regardless, speaking with an attorney who works with these claims on a daily basis is the best way to protect interests.