When anyone is injured and files a claim with an insurance provider, an adjuster is assigned to the case. The ultimate goal is to determine if the claim is legitimate and if some type of benefit should be tendered to the injured party. During the course of evaluating the claim, an insurance adjuster will seek to identify and confirm specific information related to the case. Here are some examples of what the adjuster will look for and confirm before recommending the claim be honored.
Documentation Related to the Injury
The insurance adjuster will want to go over any documentation related to the events leading up to the injury. That includes statements provided to the law enforcement professionals who responded at the time of the call for help as well as the testimonies of those who were present and saw the event take place. Doing so makes it easier to get an idea of the sequence of events that led up to the actual injury. Depending on the outcome of talking with those who witnessed the event, the adjuster may conclude there is no need to investigate further and recommend that the claim be honored.
Visiting the Location Where the Injury Took Place
The adjuster may take the time to visit the place where the event occurred and compare the layout of the area with the documents obtained from witnesses and the local police. This can have the effect of settling questions that are in the mind of the adjuster or bringing other ideas to mind. For example, the adjuster may find it difficult to see how a witness could have had a clear view of the event because of some type of obstruction. When that’s the case, the adjuster is likely to check into the details a little further.
Documentation About Medical Treatment
Going over documents about medical treatment provided at the site and subsequently in a hospital, emergency room, or other medical facility will also come under scrutiny. What did the paramedics find when they arrived at the scene? What took place in the emergency room and what measures were taken to treat the client before scheduling surgery or moving the patient to a room. What type of ongoing therapy or treatment will the patient need to make a full recovery or adjust to life with a permanent injury? Answers to those questions will further help the adjuster determine if the claim is a legitimate one.
Interviews With the Injured Party
The adjuster will want to meet with the person who sustained the injury. While the primary goal is to confirm the details recorded in various documents, there is often a desire on the part of the adjuster to determine if the injured party contributed to the series of events that led to the unfortunate event. If anything is said that could be construed to mean the person was partially at fault, the adjuster would have grounds for recommending a lesser settlement.
The interviews do not have to take place in person. It is possible to conduct such an interview over the phone, or even seek answers to questions using email. Adjusters usually seek to communicate with injured parties using whatever means are appropriate given the condition of the party.
Many injured individuals take the prudent move of engaging the services of personal injury attorneys when they plan to seek damages. An injured party would do well to only speak with the adjuster when the attorney is present. This makes it possible for the attorney to protect the interests of the client by ensuring that all questions asked are straightforward and that the answers provided are an accurate rendition of what took place.
Even if there is no immediate reason to think that an injury claim will be rejected or attempts will be made to get the injured party to settle for less than a reasonable sum, it makes sense to hire a personal injury attorney. Once the attorney is involved, all communications should be directed through the legal counsel. If an interview is requested, it should only take place when the attorney is present. In the long run, the presence of an attorney provides the injured party with someone who will make full use of current laws and precedents to protect the interests of the client.