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How Insurance Companies Evaluate the Value of a Claim

David Lee Sellers, PA May 21, 2024

Business man in the office fills out insurance policyEver wondered how insurance companies decide how much money your claim is worth? It seems like a mystery filled with professional speak and complicated formulas, all designed to examine everything from how bad the damage is to what your policy actually covers.

Getting help with this process can make it easier for you to put together your claim and know what kind of payout you might be looking at. 

Insurance companies have a methodical approach to evaluating claims, which can often seem opaque to those not well-versed in the various details of the industry.

Understanding how insurers assess the value of a claim can empower policyholders and victims, providing them with the knowledge required to ensure they receive fair compensation for their losses. 

Not All Claims Are Created Equal 

It's important to understand that when it comes to insurance claims, no two are exactly alike. Insurance companies take a close, careful look at each claim that lands on their desks, considering a variety of factors before deciding how much to offer in compensation.

A key part of their evaluation is figuring out how things might play out in court if a personal injury lawsuit comes into the picture. They’re thinking about how likely the claimant is to win, and what a jury might decide to award in terms of damages. This can involve digging into the details of the injury, including how severe it is and what exactly happened to cause it. 

For example, if you have a history of back problems and you’re claiming for a back injury after an accident, the insurance company might be wary. They might see a chance to argue that your current injuries were not entirely caused by the accident but were partly due to your pre-existing condition.  

Here's another example: If the accident involved a commercial truck from a company known for its high standards and spotless record, your claim might be seen in a different light than if it involved a company with a dubious record of hiring drivers with problematic histories. 

Factors That May Be Considered 

When evaluating a claim, insurance companies also closely scrutinize the claimant's actions following the incident. This includes whether the injured party sought immediate medical attention and adhered to the treatment recommended by medical professionals. Failure to do so may lead to what is known as "failure to mitigate damages," which can significantly impact the valuation of a claim. 

Comparative Fault 

Another crucial concept that comes into play is comparative fault. This legal doctrine reduces the amount of damages a claimant can recover based on the percentage of fault attributed to them. In essence, if you are found to be partially responsible for the incident that led to your injuries, your compensation could be reduced proportionally. 

Steps You Can Take to Maximize Compensation 

Understanding how to maximize your compensation can significantly impact the final outcome of your insurance claim. Here is what you can do: 

  1. Hire an attorney. Engaging a seasoned attorney can significantly impact the outcome of your claim. An attorney with experience in personal injury claims, such as David Lee Sellers from Pensacola, Florida, can provide invaluable guidance and representation. With a deep understanding of legal strategies and the ability to negotiate with insurance companies, an attorney can help ensure you receive fair compensation. 

  1. Seek medical attention. It's crucial to seek professional medical advice and get your injuries documented immediately following an accident. This not only aids in your recovery but also serves as vital evidence for your claim. 

  1. Don’t take the first offer. Insurance companies often present lowball offers initially. Resist the urge to settle quickly and consult with your attorney to ensure the offer reflects the true value of your claim. 

  1. Document everything: Keep a detailed record of all medical treatments, communications with insurance companies, and any other documents related to your claim. This documentation can be pivotal during the negotiation process.  

Don't be afraid to seek help and advocate for yourself to receive a fair assessment of your losses. So, if you are ever involved in an accident or suffer an injury due to someone else's negligence, use this knowledge to confidently go through the claims process and get the compensation you rightfully deserve. 

Take Proactive Steps Today 

Understanding how insurance companies evaluate claims is the first step toward securing fair compensation. By recognizing the factors that influence these evaluations and taking proactive steps to strengthen your claim, you can position yourself for a more favorable outcome.

Remember, when dealing with insurance companies, having a knowledgeable attorney like David Lee Sellers by your side can make all the difference.  

If you're in Pensacola, Florida, or the surrounding areas, reaching out for legal guidance can help protect your rights and interests every step of the way. David Lee Sellers serves clients throughout Crestview, Fort Walton Beach, and Milton, Florida.