How Are Personal Injury Cases Evaluated by Insurance Companies?

Mar 1, 2023 | Personal Injury

Were you in an accident and wondering how the insurance company will determine settlement? Keep reading to get useful tips in our guide to injury case insurance evaluations.

Liability

One of the most important factors in a personal injury case is determining who was at fault for the accident or incident that caused the injury. If it can be proven that another party was responsible for the injury, then that party may be liable for damages.

If you engage with an insurance company before speaking with an attorney and give a recorded statement or other information, it may be used against you as an admission and the insurance company may rely on that statement to offer you a lowball settlement offer. An experienced attorney has resources to perform a customized valuation of your case so that you do not end up taking lowball offers – or worse, giving the other driver’s insurance carrier information that could be used against you.

Damages

Another important factor is the extent of the damages suffered by the injured party. Damages can include medical expenses, lost wages, pain and suffering, and other expenses related to the injury. You may have medical bills that you have already paid (past medical expenses) and you may have additional, future medical expenses that may be required to treat your injury. It is important to consider whether any additional medical care may be required and how much that care will cost.

Also, you may need to take time off work to recover from future medical procedures, meaning that you may also have additional lost wages and pain and suffering. Another way to calculate pain and suffering is to take your medical expenses and lost wages and use a multiplier based on the severity of injury and pain typically experienced by the patient (1.5x-5x, for example) and use that number to approximate your pain and suffering damages.

Causation

It must be shown that the injury was caused by the accident or incident in question. This requires establishing a direct link between the injury and the actions of the party believed to be liable. In other words, your injury must have arisen or worsened after the date of injury and the medical records or expert medical opinion must show (more likely than not) that your condition was caused by the accident or incident in question.

Insurance coverage

The availability and amount of insurance coverage for the liable party can also play a role in the evaluation of a personal injury case. If the liable party has adequate insurance coverage, it may be easier to recover damages. If the liable party has inadequate coverage, you may be able to obtain recovery from your own insurance if you have uninsured or underinsured motorist coverage or make an additional claim against a party with significant assets that failed to adequately insure itself.

Comparative negligence

In some cases, the injured party may have contributed to their own injuries by acting negligently or recklessly. This may reduce the amount of damages that can be recovered in proportion to the amount of negligence by the injured party.

Jurisdiction

Personal injury cases are evaluated based on the laws of the jurisdiction in which they are filed. Different jurisdictions may have different laws regarding liability, damages, and other factors. In California, a case may be brought where the incident occurred or where the defendant resides (if in the State of California.)

Statute of limitations

Finally, it is important to consider the statute of limitations for personal injury cases in the jurisdiction where the case is being evaluated. If the case is filed after the statute of limitations has expired, it may be dismissed.

In California, the statute of limitations for filing a personal injury claim related to a car accident is typically two (2) years from the date of the accident. This means that if you were injured in a car accident in California, you have two years from the date of the accident to file a lawsuit against the at-fault driver or their insurance company for damages.

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