Over the phone, the adjuster sounds like the most reasonable person in the world, and that’s no accident.
Their job isn’t to decide what your injuries are worth. No, their job is to close your file for as little money as the company can defensibly pay. Much of that amount gets shaped by software and a fault calculation, which happens before anyone is sure what your damages will add up to.
If you’re staring at a first offer that seems a bit rushed or a bit arbitrary, it’s best that you understand the insurance claim evaluation process. In fact, if you’re weighing a West Virginia injury claim, you should know how that rushed settlement number got built.
Here’s what goes into an adjuster’s valuation and where it gets squeezed.
What They’re Actually Weighing
Personal injury settlement factors are pretty limited and weighted toward things that are easy to document.
Severity comes first. It is measured less by how you feel than by what your chart says. Here are some of the key things an adjuster looks at:
- Diagnosis codes
- Whether you had surgery
- Whether an injury is objectively verifiable on imaging
- How long your treatment lasted
A fractured wrist with an inserted fixation plate reads as a serious injury. Persistent back pain with normal films does not, regardless of how real that injury is.
Next, the adjuster will look for clarity of fault, treatment gaps, and that same old ceiling: policy limits. A catastrophic injury against a minimum-limits policy is a math problem that can lead to a lifetime of problems for the injured person. No amount of proof can solve it.
The medical records review is where most of the work happens. Adjusters read for prior injuries to the same body part, gaps between appointments, and any note where you told a nurse you were feeling better.
Three weeks between visits because you couldn’t find childcare reads in that file as three weeks of not being hurt. That friendly-sounding adjuster from the phone isn’t likely to make any assumptions in your favor.
The Software Behind the Settlement Offer
Here’s something that surprises people who don’t work in the insurance industry. Many large insurers don’t evaluate bodily injury claims by judgment alone. They run them through valuation software, and Colossus is the best known.
Colossus insurance software takes coded inputs from your medical records and returns a suggested settlement range. The program turns injuries into values. Duration of treatment, type of provider, and documented impairment all become variables in the formula. Calculating pain and suffering damages becomes a matter of which boxes in the software got checked.
We know a fair amount about how this works because regulators have looked. In 2010, they examined market conduct from multiple states. After this investigation, Allstate was forced to pay $10 million in damages to 45 states over its handling of the program. Investigators found the company hadn’t tuned the software consistently across its many claims regions. However, the regulators did not find any systemic underpayment.
The remedies are interesting. Among other things, Allstate agreed not to require adjusters to settle claims solely on the value Colossus recommended. They also agreed not to give adjusters incentives for settling at or near the number the software recommended.
That’s right: Regulators had to extract a promise that adjusters wouldn’t be rewarded for hitting the software’s figure.
The Percentage That Costs You Real Money
West Virginia comparative negligence gives adjusters a second lever, and they tend to pull it early.
Under state law, your recovery drops by your share of fault. Your recovery disappears entirely if your fault exceeds the combined fault of all other parties. In a practical sense, this means you recover nothing if you are more than 50 percent at fault in a two-party crash. Every percentage point of fault an adjuster can pin on you is money they don’t have to pay out.
You can expect the familiar arguments: You were going a little too fast. You could have braked sooner. You didn’t have your headlights on at dusk. There was a smartphone on the passenger seat. None of these accusations need to be proven at this stage since nobody’s in front of a jury yet. They just need to make these arguments plausible enough to justify paying you less.
An adjuster assigning you 20 percent of blame has cut a $100,000 claim to $80,000 without filing a single document. That’s why fault gets contested from day one rather than at trial.
How the File Gets Built Against You
Insurance adjusters are polite, it’s true. Meanwhile, their investigation tactics can have permanent results on your recovery.
The recorded statement comes first, often before you even have a full diagnosis. “How are you doing?” is a question you’ll answer reflexively to the sympathetic voice on the phone, and you’ll see your own words from that moment quoted back to you months later. So please remember, you’re generally not required to give any recorded statement to the other driver’s insurance company.
And then there’s the medical authorization. It’s often written broadly enough to open years of unrelated records. A narrower authorization limited only to treatment for this crash is a reasonable thing to insist on. You don’t need the other insurance company going over your whole medical history.
They’ll check your social media for any clues you’re not as hurt as you claim. To that end, they’ll also check to see if you’re making all your follow-up appointments for treatment or rehabilitation. They’ll use any missed appointment against you.
Meanwhile, their first offer will arrive fast, often while your bills are still coming in. That’s the whole point. They want you to settle and “put it all behind you” before you even know how much it will all cost. West Virginia does require insurers to follow fair claims settlement practices; however, the Office of the Insurance Commissioner takes consumer complaints when they don’t.
A well-supported demand letter can change the whole conversation by forcing the file to be evaluated on records, not on assumptions.
Forbes Law Offices Knows What’s on the Other Side of the Call
An adjuster’s valuation is not an unbiased read of what happened to you. It’s an output produced by coded records, a fault percentage, a policy ceiling, and a set of practiced questions you answered while still figuring out how hurt you were.
Forbes Law Offices has handled serious injury claims in Charleston for decades. Our attorneys know how these files get built because we so regularly take them apart. We document the injuries that a software program can’t neatly code. We also push back on fault percentages assigned by someone who never saw the road.
If an offer landed in front of you and the number is suspiciously inadequate, speak with an attorney before you sign anything. Don’t leave your recovery up to some software program’s best guess.
