How Does The Insurance Claim Process Work?

Insurance companies are in business to make a profit.

The insurance company’s profit is the difference between what it collects in premiums and what it pays out in claims.

So the insurance adjuster’s job is to settle your claim for as little as possible – after delaying as long as possible.

Our job is to settle your claim for its maximum value with the minimum possible delay.

Insurance companies have developed a huge bureaucracy to fight claims, to sort out bad claims, and to pay as little as possible.

I remember visiting an insurance claims office in Kirkland. It was a room as large as a gymnasium, and it was organized like a first grade classroom, with rows of desks facing the front. At the front was a glassed in room for the teacher.

So when the adjuster settles a claim for $10,000 he takes the little file to the supervisor in the glassed in room. And the supervisor is likely to say “You paid too much. This file does not support a $10,000 payment.”

But, if that same adjuster settles a claim for $100,000 and brings the supervisor a thick and well-documented file that includes complete witness statements, complete medical opinion letters, and comprehensive records of all medical care, wage losses, and other expenses, the supervisor is more likely to say, “Good job, it could have been worse.”

Our job is to help the insurance adjuster build a file that supports a full and fair claim settlement.

Our goal should be to maximize your financial recovery.

We have a reputation for honest dealing; for a fair but firm settlement posture; for refusing to settle for a penny less than the claim is worth; and for being prepared to take a claim to trial if necessary to get a full and fair recovery.

There are basically five steps the insurance adjuster takes in handling a personal injury claim:

1. Collecting Information
2. Setting Reserves
3. Evaluating Damages
4. Negotiating Settlement
5. Defending in Trial if Necessary

Lets go through them one at a time.

1.Collecting Information.

Since the adjuster has to collect information in order to understand your claim, we provide all the required information to establish that it is a valid claim.

Sometimes insurance adjusters are so busy looking for damaging information about you or your claim that they miss favorable information.

We collect and highlight that favorable information: witness statements, photographs of the accident, photographs of your injury, opinion letters from experts in medicine, accident reconstruction, and economic loss.

We present the claim to the adjuster, with full evidentiary backing, so the adjuster understands the significance of your claim.

2. Setting Reserves.

When a claim comes in, the company must set reserves, an accounting entry, to assure government regulators that the company has set aside adequate money to pay the claim.

If initial reserves are set too low, when the time comes to settle the claim, the adjuster will sometimes be too limited in the amount of money he can offer in settlement.

We get the appropriate information to the adjuster as soon as possible to assist the company in setting high enough reserves that the ultimate settlement can be for the full claim value.

3. Evaluating Damages.

Since the adjusters must evaluate the claim value, we provide them with all relevant information, including comparable cases from state, regional and national publications, computerized databases, and our own evaluation of the claim’s value.

We don’t just wait for an offer; we help create it.

4. Negotiating Settlement.

There is an old saying, “A lawyer who represents himself has a fool for a client.”

Likewise, a personal injury victim who attempts to negotiate a settlement with a professional insurance adjuster is likely to recover far less than the claim’s true value.

Do not attempt to negotiate a settlement of your personal injury claim without professional advice.

5. Defending in Trial if Necessary.

If a settlement cannot be negotiated, the insurance company must defend its position in court.

Your lawyer must have a track record of exceptional verdicts, so that the insurance company realizes that trial is NOT an easy way out.

In dealing with insurance companies, our job is to take the stress off our client's shoulders
and put it back where it belongs: on the shoulders of the insurance company for the negligent party who caused the problem in the first place.

We've been doing this for 35 years. Insurance companies know us. They know our reputation for thorough claim documentation, compassionate care for our clients, and fair but firm negotiating and litigating skills.

In fact, since insurance companies know how well-prepared we are, over 90% of our claims are settled out of court.

We have won multiple million and multi-million dollar verdicts and settlements and have established record high verdicts and settlements in several Washington jurisdictions.

Anybody can tell you how the insurance claim process works. We know how it works.

We have been doing this for 36 years.