Insurance agent examine damage after car accident

How Insurance Companies Evaluate the Value of a Claim

Jose Orihuela, Attorney at Law June 22, 2023

As drivers, we know we have to carry auto insurance in order to stay in compliance with state laws. In 2019, drivers spent an average of $1,070.47 per year on their car insurance, according to the Insurance Information Institute. With an expense this high, it’s only natural that you’d want to know how to maximize compensation after filing an accident claim.  

Everyone should be able to answer basic questions about their insurance company, such as, “What are the factors that determine how much I’ll get for my accident?”; “How much is my personal injury case worth?”; and “How much can I recover after my accident?” If you’re in the Webster or Houston, Texas area and would like to learn more, call me today at Jose Orihuela, Attorney at Law. I care about your situation and strive to give you the answers you need, clearly and efficiently.  

Each Claim Will Be Evaluated Individually

Insurance companies (and all companies, really) are in the business of making money. To do this, they evaluate each claim based on what they think your chances are of winning at trial if you file a personal injury lawsuit and how much a jury could potentially award you in damages. If your chances seem high, they’ll likely offer a higher settlement; if your chances are low, then you’re likely to see a lower settlement.  

For example, imagine you were involved in a car accident that was originally thought to be solely the fault of another driver, but then it was later discovered you were using your cell phone at the time the crash happened. An insurance company will probably offer you less because they think there’s a high likelihood that a judge or jury would find you at least partially to blame.  

Factors That May Be Considered

Once you file an insurance claim, an adjuster will be assigned to your case, and they’ll begin a comprehensive analysis. They’ll then use this information to come up with a dollar amount for the total damages you should be awarded. Some factors they’ll consider include the following: 

  • how severe your injuries are

  • what your long-term medical diagnosis is 

  • whether your injuries resulted in a permanent disability 

  • how much medical care you’ve received so far and the costs associated with it 

  • the amount of medical treatment you’re expected to need in the future 

  • whether your injury will prevent you from being able to earn an income 

  • the policy limits on your specific plan 

Another key component the insurance adjuster will look at is your actions both during the accident and after it. Specifically, they’ll examine comparative fault and any failure to mitigate damages: 

  • Comparative Fault: Texas follows a comparative fault model when deciding compensation for personal injury cases. Using our above example of one driver being on their phone at the same time another driver ran into them is a good way to understand this concept. If a judge decided that the driver who was on their phone was 40% responsible for the accident happening, their total compensation will also be reduced by 40%. Adjusters will use this information when deciding on a settlement amount.  

  • Failure to Mitigate Damages: This concept applies mostly when someone is injured in an accident. For instance, if you don’t immediately seek medical care or if you don’t follow through with the treatment plan recommended by your doctor, an insurance company will use this information to try and prove that your injuries weren’t that serious, and therefore, they’ll offer you less in damages. 

Steps You Can Take to Maximize Compensation 

  1. Hire a personal injury attorney. Working with an experienced attorney is the best way to set yourself up for a successful claim.   

  1. Seek medical attention right away. It’s crucially important to always seek a professional opinion and get it documented

  1. Don’t take the first offer from the insurance company. They will almost always try to lowball you. Always consult with your lawyer before accepting or signing anything. 

  1. Document everything and gather important information. This includes police reports, witness testimony, photos or video, medical bills, and diagnosis.    

Reach Out to Skilled Advocacy

If you’d like to learn more about the process for obtaining a favorable settlement from an insurance company, call me, Jose Orihuela, Attorney at Law serving South Houston, Texas, including Katy, Webster, Pasadena, and more. I diligently offer my services to individuals and workers everywhere, including blue-collar industrial workers. When you need support, reach out to me.