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What factors will the insurance company consider when evaluating my claim and formulating an offer?

Key Factors in Evaluating Your Personal Injury Claim

When you file a personal injury claim, it’s essential to understand the factors that insurance companies take into account when assessing your case and determining a settlement offer. The outcome of your claim hinges on various elements, and these can either bolster or weaken the offer you receive. Here, we delve into the eight critical factors that shape the evaluation process.

1. Fault (Liability): The Foundation of the Case

Clear Liability: One pivotal factor is fault, often referred to as liability in legal terms. Is the defendant, the individual you hold responsible for your injuries, clearly 100% at fault? If not, the settlement value of your case may decrease as the percentage of fault, or perceived fault, increases.

2. Your Medical Expenses and Treatment Records: Documenting Your Injury

Well-Documented Treatment: The extent of your medical expenses and the thorough documentation of your treatment play a significant role. If your treatment is well-documented, indicates a serious injury, aligns with the nature of your injury, and correlates with your treatment records, it generally increases the settlement value of your claim.

3. Quality of Medical Information: Supporting Your Claim

Detailed Medical Information: The quality of medical information supporting your claim is crucial. Detailed narrative reports from your treating doctor and comprehensive office records or nurses’ notes positively impact your settlement offer. Conversely, if your medical documentation consists mainly of fill-in-the-blank medical reports/forms, this may negatively affect your settlement offer.

4. Nature of Your Injuries: Objectivity Matters

Verifiable vs. Subjective Injuries: Insurance companies tend to place higher value on objectively verifiable injuries, such as broken bones visible on an X-ray or visible deep cuts, compared to injuries supported primarily by subjective complaints of pain, like whiplash and other soft-tissue injuries.

A woman distressed by her lost wages.
Demonstrating documented and verifiable proof of your lost income, wages, and/or profits to insurance companies is critical.

5. Lost Income and Economic Losses: Documenting Financial Impact

Economic Losses: Demonstrating documented and verifiable proof of your lost income, wages, and/or profits is critical. Without such evidence, the value of your claim may decrease, negatively affecting your settlement offer.

6. The “Likeability” Factor: Perception Matters

Perceived Likeability: The insurance company considers whether prospective judges or jurors are likely to favor you over the defendant. This can significantly impact the settlement value of your claim.

7. Quality of Your Witnesses: Strength in Testimony

Strong Witness Testimony: The quality of your witnesses matters. Well-spoken and objective witnesses can strengthen your case. Conversely, if your key witnesses are biased, such as close family members or friends, this may be viewed less favorably.

Factors that Shape Your Claim

Navigating a personal injury claim involves a nuanced understanding of these critical factors. The outcome of your claim is a delicate interplay of fault, medical documentation, the nature of your injuries, economic losses, perception, and witness quality. To ensure your rights are protected and your claim is evaluated fairly, it’s advisable to seek legal counsel who can guide you through this intricate process. Understanding these factors empowers you to make informed decisions and work toward a fair and just settlement.

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