How Insurance Companies Place a Value on a Personal Injury Claim


To determine what a personal injury claim is worth, there are two things you must always keep in mind. First, the value of the case is only worth what the insurance company is willing to settle for. Second, the case value is only different from what the insurance company sees it as if and when it is placed in front of a jury, and placing your case in front of a jury has potential for various outcomes. These factors make it sometimes difficult to determine what your case’s value is because they may be very different from what your expectations are. Ultimately, and case by case, the totality of the circumstances that are present in the claim is what will help to determine your specific case’s value. To better understand the insurance companies and how they conclude their opinions on your claim, a breakdown of the process is provided below.

What Insurance Companies Pay Out

In order to assess your personal injury claim, you must initially be aware of the different ways that you may deserve compensation. When a person or business is found liable for another person’s injuries and that person or business is insured, their insurance company will pay the inured person’s:

  • Medical Expenses
  • Property Damage
  • Lost Wages from Work
  • Lost Educational Experiences
  • Permanent Disability
  • Damages for Emotional and Mental Distress

Formulas Used By Insurance Companies on Assessing Damages

There are certain damages in personal injury claim that can easily be calculated. The money that it costs for medical treatment, wage losses and other figures that are relatively easy to ascertain are generally not a part of any confusion. The complex issues that sometimes create problems when attempting to increase the dollar amount in a person’s case is determining the value of pain and suffering, opportunities lost, and missed experiences. It is at this point that an insurance adjuster’s formula comes into play.

At the point that a claim reaches negotiations, the total amount of medical costs related to a personal injury claim are calculated by the adjuster for the insurance company. The medical costs involved, or ‘specials’ as referred to by adjusters, is what is used to gauge the injury as a whole. Pain and suffering, and other nonmonetary losses referred to as ‘general damages’, are figured out by analyzing the injury itself. Depending on the severity of the injury, an adjuster with multiply the amount of special damages, anywhere from one (1) to (5) percent, and as high as ten (10) percent in some extreme injury cases. Any lost income as a result of the injury is then added on to the total amount. Keeping this general formula in mind, it must be emphasized that everything is on a case by case basis, and nothing is set in stone. This is also just a starting point where adjusters generally begin negotiations to settle personal injury claims.

Assigning Fault to a Personal Injury Claim

Determining who is a fault for the event that caused the injury to you is an insurance company’s number one goal. Numbers can be figured out quite easily for the most part, but it is an adjuster’s number one incentive to avoid having to use the above formula and not pay out anything. If an insurance company feels that their client was not at fault, or only partially at fault, they will use that fact in minimizing or avoiding all-together paying out on your injury. There are certain scenarios that leave no question as to fault, or liability. Adjuster’s, however, will attempt to find a reason to show that your actions were contributing factors in causing the accident, and in essence, making your partly responsible for your injury. Depending on what percentage of liability an insurance adjuster accepts for their client’s actions can affect the amount they are willing to offer for settlement.

Allow the legal team of Madalon Law to help you get the highest compensation for your injury possible. Call today for your free consultation.