How are insurance bodily injury claims handled?

Answer 1

This is not a question that lends itself to a short answer, here is an outline:

1. After the incident, either the policyholder or the claimant (or his/her/its representative) must report the incident to the insurer. A timely report is usually a condition to coverage under the policy (if coverage is found to exist).

2. The insurer will commence an investigation of the occurrence. This may be done by in-house adjusters, or the insurer may hire outside adjusters to investigate.

3. Depending upon typr pg occurrence, elements of the investigation will include police reports, photographs, diagrams, witness statements, statements of the insured and as many other people as may have knowledge of the "who where, when, why, and how" factors.

4. Assuming that the claimant was injured, the adjuster will want to collect medical records of treating practitioners, therapists, and others. These will be assessed for objective and subjective complaints of injury, indicia of preexisting conditions, prescriptions, and other types of medical care and therapy.

5. The adjuster will also need to know how the injury has affected the claimant. Work records, including lost time/income, inability to perform work-related functions, etc. will be important. The adjuster will also want to know how the injury has affected other aspects of the claimant's life--participation in activities, etc. Age of the claimant will also be a factor, because (1) a serious, permanent injury will adversely affect a younger person longer; (2) a less-serious injury to a younger person is likely to heal better; (3) an injury to an older person will affect the person for a shorter time, but is less likely to readily resolve.

6. The adjuster will need to determine if there is any fault om the claimant. Depending upon the jurisdiction involved, the rule of law may be such that recovery of damages is precluded or reduced depending upon the fault factor (based on "comparative" or "contributory" negligence).

7. Most insurers have ranges within which they settle claims, based upon the above factors, and others. They also look to jury verdict research to determine what similar injuries are "bringing" when suit is filed and the cases go to trial. For the most part, the goal is to resolve a claim amicably if it is possible to do so. In fact, insurers have the obligation to settle a claim within policy limits (the maximum amount payable as liability benefits) if it is possible to do so, rather than subject the policyholder to suit and to the risk of a verdict against him/her/it that is in excess of policy limits. Insurers also consider the expenses that they incur in defending a lawsuit (defense attorney fees and court costs) in making the decision.