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Personal Injury Settlement Process

What Everyone Wants To Know:

  • Why is my insurance claim personal injury settlement process so difficult?
  • What is the reason insurance company being so unreasonable about the value of my claim?
  • Why is the claims adjuster dragging his feet?

The simple answer to these questions is: This is how insurance companies make their money. They attempt to pay as little as possible on accident claims. Or, if they can, they will deny the claim outright. These situations often happen with claimants who do not have a personal injury accident attorney.

The Home Office

This is the headquarters of the insurance company. It is the home of the chairman, president, CEO, COO and so on. They set all company-wide policies, and provide oversight of all company activities:

  • Investments
  • Underwriting
  • Actuarial
  • Marketing
  • Claims

The Regional Office

Regional managers are responsible for supervising the local claims offices in a region of the US. Regional managers handle coverage issues, claims that go over reserves and policy limits, and other complex claims issues.

The Local Claims Office

Claims Manager

  • Operates the local claims office.
  • Ensures that all claims adjusters and claims supervisors follow the company’s settlement practices.
  • Oversees all the claims handled in the local office.
  • Oversees all accident lawsuits.
  • Carefully protects the bottom line, especially the many small and medium-sized claims cases in the office. The manager must ensure that they do not overpay on claims and upset the regional or corporate office.

Claims Supervisors

  • Local office “middle management.”
  • They report directly to the Claims Manager and supervise the Claims Adjusters.
  • Assign claims to Adjusters for investigation and day-to-day handling.
  • They supervise and set “reserves.” The “reserve” is the estimated cost of the claim to the insurance company. It is the amount the company sets aside (or “reserves”) to pay the claim.

Claims Adjusters

  • Claims adjusters report their case results to claims supervisors.
  • Adjusters are responsible for the daily handling of claims. They interview the insured and injured claimant. Also, go over medical records and negotiate settlements in a range determined by supervisors.
  • Adjusters are rewarded with perks and promotions if they settle cases that cost the company as little as possible.
  • They often have caseloads of 150-200. This fact explains why you may not hear from the adjuster as much as you like.
  • Note that busy claims adjusters may ignore or take advantage of claimants who do not have an attorney. They know you are probably desperate for money and do not know the insurance claims game. They may ignore you so that you will eventually take the lowest possible settlement.