How Does Insurance Adjuster Arrive At Number Presented In First Offer?

The pre-settlement negotiations begin after the insurance adjuster has made the first offer. The claimant could accept or reject that offer. A rejection would call for introduction of a counteroffer.

Reasonable offers have been based on known facts

Those should be the facts that the adjuster has uncovered during an investigation.

Adjusters obtain a statement from each of the involved parties, and also read the police report. The adjuster also studies the company’s database, in order to learn whether or not the claimant has submitted claims in the past. Adjusters ask to be provided with the significant documents:

-The claimant’s medical bills
-Proof of the report on the claimant’s earnings
-The claimant’s tax returns
-Proof of any reported damage to property

What might happen, following delivery of the requested documents?

If the claimant had suffered a previous injury, or had allowed the injury to malinger, before seeing a doctor, then the adjuster might refuse to make an offer, until after receiving more documents.

The same action could be expected, if the adjuster’s examination of the documents had shown a discrepancy between the claimant’s reported earnings and the number given by the employer. Again, the adjuster would seek additional information.

What adjusters do, once the quantity and quality of the received documents has allowed them to come up with an offer?

• Add up all of the claimant’s medical costs (might reduce size of bills from any chiropractors)
• Use software to obtain a value for the claimant’s pain and suffering
• Add up all the costs, and share that calculated figure with the supervisor
• Learn from the supervisor what percentage of the calculated value should be used during presentation of the initial bid/offer.
• The adjuster might simply calculate the indicated percent of the value that was shared with the supervisor. In that case, the adjuster would use that newly-calculated figure when making the initial bid.
• Adjusters do not have to make a bid that matched exactly with what the supervisor’s suggestion. Adjusters have the ability to learn whether or not a given claimant has chosen to hire a lawyer. That knowledge could shape their decisions, with respect to the approach that must be taken.

Suppose that an adjuster’s investigations had shown that the claimant had hired a Personal Injury Lawyer in Kitchener. What would happen then?

In that case, the adjuster would probably decrease further the amount of money that had been suggested by the supervisor. Adjusters like to test how strongly a claimant’s demand represents a desire for quick cash. Adjusters’ experience has taught them that a claimant without an attorney is more apt to accept a lower offer. Also, if lacking an attorney, a claimant might not wait for the moment of maximum medical improvement.