How an Insurance Adjuster Determines an Injury Settlement Offer

If you've been involved in an accident due to someone else's negligence, you may be entitled to some compensation for injuries or damages sustained. After you report your personal injury, an insurance company will likely assign someone to process your claim. This person is called an insurance adjuster or claims adjuster. They can evaluate and […]
February 7, 2023

If you've been involved in an accident due to someone else's negligence, you may be entitled to some compensation for injuries or damages sustained.

After you report your personal injury, an insurance company will likely assign someone to process your claim. This person is called an insurance adjuster or claims adjuster. They can evaluate and recommend treatment options, determine the next steps, and decide what amount of money you are entitled to. Understanding how car accident settlements work and how the insurance adjuster handles personal injury cases can go a long way to easing your mind during a stressful time. 

Insurance Adjuster

An adjuster typically conducts a forensic examination of the accident to understand the surrounding events, assess damages, and determine liability. The next step in an settlement negotiations is typically negotiating the value of the settlement offer and making changes to it. 

This involves understanding what goes into valuation and what comes next in the negotiation process.

A Houston personal injury lawyer will have the expertise to help you negotiate your best possible claim outcome.

This article will examine how the adjuster determines the amount of compensation for your damages.

Understanding Insurance Settlement Outcomes

When you have suffered an accident that is no fault of your own, some steps immediately follow the accident that will help determine how much you are entitled to and how the insurance adjuster from your insurance company decides your settlement offer.

What Happens After You File a Claim with Your Insurance Company?

You will be contacted by the claims adjuster assigned to your file.

The adjuster may ask you to meet with them in person, or they may handle the entire claim over the telephone. Your claim needs to be supported by a written document. A sworn statement in support of your claim is called Proof of Loss, which is mandatory within fifteen days in the state of Texas.

Your insurance policy will cover the various damages and expenses you are aware of. The claims adjuster will help assess how much of the damages will be covered by your policy, as certain items of personal property are not insured. Additionally, they'll ask you questions as they progress through the claim process.

Insurance Adjuster On the phone

How is the Settlement Amount Determined?

Personal injury settlements are calculated by looking at specific factors involved in an accident, but there is no general formula. The adjuster determines the number through a series of long and careful calculations for each case.

It can be challenging to know your potential compensation if you suffered an injury due to somebody else's negligence. It is essential to realize that insurance adjusters are being paid by the company and will try to minimize how much compensation you may be entitled to. A lawyer specializing in this area of practice can help you know your rights and guide you through the process of maximizing your payout.

How Do Insurance Companies Determine Payout?

Insurance Company

As a result of their extensive knowledge of personal injury laws and the insurance claims industry, Rose Sanders has been able to expedite the process of filing an insurance claim. 

Below is a list of factors that go into a personal injury claim and how insurance claims adjusters determine compensation:


In a personal injury case, the physical injury involved varies in severity, with the most severe outcome of amputation or lifetime disfigurement. If that's the case, then you may be able to claim a substantially higher amount because of it.

There are two types of injury claims that you can make after being hurt. The first type is permanent injuries; these injuries affect the body's ability to work as it should. The second type is temporary injuries, which refer to the period during which your condition worsened and impeded your ability to work but improved over time.

Permanent Injuries

Sometimes, accidents occur in such a way that the injured party can sustain short-term or even long-term disabilities. These include paralysis, brain injuries, vision loss, and spinal cord damage. 

If you were injured because of someone's negligence, and you have a successful claim, the court might not give you an automatic calculation of your claim. Instead, they will base your compensation on the medical bills related to your injury.

This is one of the most challenging parts of the process for the plaintiff's attorneys and the insurance adjuster.

Insurance adjusters use formulas and software that make it easier to value a pain and suffering claim. These tools provide a calculation estimate that the insurance adjuster will use to determine the settlement number that you are offered. 

However, with Rose Sanders, you have an experienced attorney on your side. We look at the impact that permanent injuries may have on your life and the financial wellness of the party at fault to devise a fair, practical payout you may use as a counteroffer, if necessary.

Temporary Injuries

Headaches, neck injuries, and other common claims last for weeks or months. For instance, in car accident cases, one of the most common injuries people experience is whiplash.

The insurance claims adjuster will determine a claims amount or a temporary injury claim based on several factors, including:

  • Duration of the symptoms
  • Occupation and employment status
  • Age

Lost Wages

Lost wages are how much you would lose if you couldn't work. If you were out of work for a week, your lost wages would equal the equivalent of one week's pay. Lost wages may also include overtime pay, tips, gratuities, and bonuses missed due to the injury.

An insurance claims adjuster will attempt to compensate you for the shortest time away from work. However, you may need time off when recuperating from an injury.

A personal injury attorney will evaluate your work history and calculate wages you can expect to miss with a temporary or permanent injury. 

For example, you were off work for two weeks and made $1,000 per week before the accident. As such, your lost wages would be $2,000. A Texas personal injury lawyer will work to ensure that you are fairly compensated to cover any ongoing symptoms and make sure you're fully recovered.

For a permanent disability that can potentially keep you off work for life, the attorney will use compensation.

Property Damages Under Personal Injury Claim

Damages are classified as either economic, non-economic, or punitive. Economic damages and non-economic damages are also called general and special damages.

Loss of Property Use

You can claim compensation if you cannot use your own property because it was damaged by the unfortunate accident. The court may order the repair of your vehicle (or damaged property) or pay you an amount that matches the value of your property at the time of the accident.

Physical Property Damage

Physical damages can include anything from broken windows to damaged doors and more. The compensation you'll receive will depend on the extent of the damage and its replacement cost.

Incurred Medical Bills

Each injury is different, and every situation is unique, making personal injury settlements challenging to predict. This is why it's crucial to find a good settlement attorney. Incurred medical bills are one of the most critical factors in determining an injury settlement amount. 

Considerations should be made for the following:

  • Initial emergency room visit
  • Any hospital stay
  • Surgery
  • Medical procedure
  • Medications
  • Post-injury rehabilitation, such as physical therapy, chiropractic treatment, massage, and other types of treatment

Note that the statute of limitations for personal injury claims differs from one place to another. For example, in Texas, the statute of limitations is two years from the date of the accident.

It is vital that you receive maximum compensation for your claim because any medical expenses incurred after two years are not recoverable as part of your claim. This is why it is always best to consult a personal injury lawyer to understand the details and to navigate the process, so you reach a fair settlement.

Insurance Policy Limits

Insurance Policy Limits

Finally, an insurance adjuster will use the insurance policy limits to determine how much your settlement offer will be. In personal injury, the policy limit is the maximum amount the insurance company will pay for losses.

The calculation of this amount is determined by:

Claimed Damages

Claimed damages are expenses you have incurred as a result of your case. These include medical treatment costs, lost wages, and property losses.

Policy Limits

The policy limits are the maximum amount the insurance company will pay.

The insurance policy limit is calculated by determining the insurance policy's coverage amount. Auto insurance policies typically include $50,000 in liability coverage per person and $100,000 per accident. These amounts will be increased if additional vehicles are insured under the policy.

The insurance company will take the total damages from the total liability coverage to determine the injury settlement amount.

Negotiating a Settlement with an Insurance Claims Adjuster

A personal injury attorney from Rose Sanders Law can help you determine the amount of compensation you are entitled to. If you're considering accepting an insurance settlement offer from the insurance company, it's essential to negotiate and confirm the sum before actually signing.

At Rose Sanders Law, our firm is dedicated to helping you find the proper amount for your claim. We understand how confusing such a calculation can be, so we offer a free consultation to get started on your case.

Call us today to schedule a free consultation, and get the personal injury lawyer you need to recover from your accident.

Rose Sanders Law Firm

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Houston, TX
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Dallas, TX
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