How Do Insurance Companies Value Personal Injury Cases?

When it comes to personal injury cases, insurance companies use a variety of strategies to determine how much they are willing to pay. The first person who evaluates your case is usually a claims adjuster. Adjusters are trained to assess injury claims, but it’s important to remember—they are not doctors or attorneys. Their primary goal is often to minimize the insurance company’s payout.

One of the most common ways adjusters value a case is by looking at property damage. For car accident cases, for example, if the damage to your vehicle is minor, adjusters may argue that your injuries are minor as well. While property damage can be one factor, it doesn’t always reflect the severity of your injuries. Insurance companies may also consider when and how quickly you sought medical treatment. If you wait several days or weeks before seeing a doctor, an adjuster might claim your injuries aren’t serious or weren’t caused by the accident.

Another strategy is to look at preexisting conditions. Adjusters may argue that your current injuries existed before the accident or that your symptoms are unrelated. In some cases, they may even attempt to assign partial fault to you. In Texas, personal injury compensation can be reduced by the percentage of fault you are assigned. For instance, if you are found 20% at fault for a car accident, any compensation you receive may be reduced by 20%. If you are more than 50% at fault, you may not be entitled to any recovery at all.

Insurance companies also evaluate the type of treatment you received. They might compare conservative treatment, like physical therapy or chiropractic care, with more invasive procedures such as surgery or hospital care, to determine the value of your claim. Some companies use diagnostic codes and treatment codes to calculate how similar cases have been settled in the past. They may even argue that your medical bills are excessive or inflated compared to what is typical, regardless of whether those costs are reasonable or necessary.

Because of these tactics, having an experienced personal injury attorney is critical. A skilled lawyer can document your injuries thoroughly, gather expert medical opinions, and counter insurance company strategies designed to undervalue your claim. Attorneys also know how to calculate damages that go beyond just medical bills, including lost wages, pain and suffering, mental anguish, and long-term disability, ensuring that your personal injury case is fully and accurately valued.