After an accident, you may find yourself dealing with an insurance adjuster before you fully understand what happened or how your injuries may affect you. Knowing how an insurance adjuster personal injury claim is evaluated can help you understand what to expect and make informed decisions about your case.
An insurance adjuster may contact you to ask about the accident, request photographs or records, discuss your medical treatment, or eventually make a settlement offer. The adjuster may also investigate the circumstances of the accident, review available insurance coverage, evaluate liability and damages, and negotiate with you or your attorney.
It is important to remember who the adjuster represents. An adjuster working for an insurance company is evaluating the claim on behalf of that insurer. The adjuster is not your attorney and does not represent your personal interests.
If you were injured in an accident in Florida, understanding how an insurance adjuster evaluates a personal injury claim can help you protect your interests throughout the claims process.
What Is an Insurance Claims Adjuster?
An insurance claims adjuster investigates and evaluates insurance claims. Depending on the circumstances, the adjuster may review the insurance policy, accident reports, photographs, medical records, witness statements, property damage, and other evidence.
There are several types of insurance professionals you may encounter, including:
- Staff adjusters: Employees of an insurance company who handle claims for that insurer.
- Independent adjusters: Professionals who are not direct employees of the insurer but may be hired by an insurance company to investigate or evaluate claims.
- Public adjusters: Professionals who represent policyholders in certain insurance matters. Florida law regulates public adjusters and the services they may provide.
The type of adjuster involved can depend on the insurance policy, the type of accident, and the insurer’s claims-handling process.
In a Florida personal injury case, you could communicate with an adjuster representing the other driver’s insurance company, your own insurer, or another potentially responsible party’s insurer.
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Who Does the Insurance Adjuster Represent?
Understanding who the insurance adjuster represents is an important part of dealing with an insurance adjuster personal injury claim.
An adjuster who works for an insurance company evaluates the claim on behalf of that insurer. The adjuster is not your personal legal representative and does not provide you with legal advice.
That does not mean every conversation with an adjuster is improper or that every insurance company is acting unfairly. Insurers have legitimate responsibilities to investigate claims and determine what benefits or damages may be owed under applicable policies and Florida law.
However, information you provide may become part of the insurer’s claim file. The insurance company may consider those statements when evaluating liability, your injuries, the amount of your damages, and whether to make a settlement offer.
Florida law also prohibits certain unfair insurance claim-settlement practices. The state’s insurance statutes address various practices involving the investigation and settlement of insurance claims.
How Does an Adjuster Investigate a Personal Injury Claim?
Once an insurance company receives notice of an accident, it may begin investigating the circumstances surrounding the claim.
The investigation can involve several different types of evidence.
Reviewing the Accident Report
An adjuster may obtain and review a crash report, incident report, or other documentation concerning the accident.
In an automobile accident, the report may contain information about the vehicles involved, the drivers and passengers, witnesses, road conditions, citations, and the investigating officer’s observations.
Examining Photographs and Other Evidence
Photographs and video can provide important information about what happened.
An insurer may review photographs showing:
- Vehicle damage
- The accident scene
- Road conditions
- Visible injuries
- Property damage
- Traffic signals or signs
- Potential hazards
Other sources of evidence may include business surveillance footage, traffic-camera recordings, residential security footage, and dash-camera video.
Because some video recordings may only be preserved for a limited period, identifying potentially important evidence early can be important in a personal injury case.
Speaking With the People Involved
An adjuster may contact you, the other driver, witnesses, or other people who may have information about the accident.
The insurer may be trying to determine what happened, how the accident occurred, and whether its insured may be legally responsible.
You should provide truthful information when communicating with an insurer. At the same time, you do not necessarily need to immediately answer every question or provide every requested document without first understanding why the information is being requested.
Reviewing Medical Records and Bills
Medical information can play an important role in an insurance adjuster personal injury claim.
An insurer may request documentation concerning the injuries you are claiming and the treatment you have received. This may include:
- Emergency-room records
- Physician records
- Diagnostic testing
- Physical therapy records
- Prescription expenses
- Medical bills
- Information about future treatment
- Documentation concerning lost income
The nature, severity, duration, and medical documentation of an injury can all affect how an insurance company evaluates a claim.
Florida Car Accident Claims and PIP
Florida automobile accident claims can involve additional insurance considerations because Florida uses a no-fault automobile insurance system.
Personal Injury Protection, commonly called PIP, generally provides benefits for certain medical expenses and lost income resulting from a covered motor vehicle accident. Those benefits are subject to Florida law and the applicable insurance policy.
Florida’s 14-Day PIP Rule
One important requirement is Florida’s 14-day rule.
To qualify for PIP medical benefits, an injured person generally must receive initial services and care within 14 days after a motor vehicle accident.
PIP coverage is separate from a potential bodily injury claim against another person whose negligence caused the accident.
Depending on the circumstances, someone injured in a Florida crash may have to deal with:
- Their own PIP coverage;
- Potential health insurance coverage;
- A bodily injury claim against an at-fault driver; and
- Other applicable insurance coverage.
Because several sources of insurance coverage may be involved, determining which insurer should pay for particular expenses can become complicated.
Should You Give an Insurance Adjuster a Recorded Statement?
An insurance adjuster may ask you to provide a recorded statement about the accident.
A recorded statement can become part of the insurer’s claim file. The insurance company may later compare what you said with medical records, accident reports, witness statements, photographs, or other evidence.
This does not mean that you should automatically refuse every request from an insurance company. Instead, understand what information the insurer is requesting and why it wants that information.
If you already have an attorney, the insurer generally should communicate with your attorney regarding the claim.
When you are not represented and an adjuster requests a recorded statement, consider speaking with a Florida personal injury attorney before providing one, particularly if liability or the extent of your injuries is disputed.
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Do Not Guess About Your Injuries or the Accident
When speaking with an insurance adjuster, focus on facts that you know.
For example, you may not remember exactly how fast another vehicle was traveling or how far away it was before the collision. In that situation, it is better to explain that you do not remember than to guess.
Your injuries may also change over time. Avoid making definitive statements about the extent of your injuries before you have completed your medical evaluation.
Someone who tells an adjuster that they are “fine” immediately after an accident could later have that statement used to argue that the accident did not cause a significant injury. Symptoms can sometimes appear or become worse after an accident.
The goal is simple: be truthful, but do not speculate.
Be Careful With Medical Authorizations
An insurer may ask you to provide medical records or sign a medical authorization as part of its investigation.
Medical documentation can be important evidence in a personal injury claim. Before signing an authorization, however, understand what records the authorization allows the insurer to obtain.
A broad authorization could potentially provide access to medical information beyond the treatment directly related to the accident.
Previous injuries or medical conditions do not automatically prevent someone from recovering compensation. An insurer may nevertheless investigate whether the accident caused the claimed injury, aggravated a preexisting condition, or resulted in a new medical problem.
An attorney can review a proposed authorization and help determine what medical information may reasonably be necessary to evaluate the claim.
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What Information Should You Give the Insurance Adjuster?
You should be truthful and cooperative with legitimate requests while remaining mindful of the information you provide.
Depending on the circumstances, an insurer may reasonably need information such as:
- Your contact information
- The date and location of the accident
- Basic information about the vehicles or parties involved
- The accident or incident report
- Information about your medical treatment
- Medical bills and records
- Documentation of lost income
- Photographs or other evidence related to the accident
Keep copies of documents and photographs you send to the insurance company.
It can also be helpful to maintain a record of your communications with the adjuster. Write down the date of each conversation, the adjuster’s name, and the general subject of the discussion.
Keeping organized records can make it easier to track the insurance claim and provide information to your attorney if you later seek legal representation.
How Can You Find Out What Insurance Coverage Is Available?
In some Florida personal injury claims, identifying available insurance coverage is an important part of evaluating the case.
Florida Statutes § 627.4137 provides a mechanism for a claimant or the claimant’s attorney to request information about known liability insurance policies.
Upon a qualifying written request, an insurer generally must provide information including:
- The name of the insurer;
- The name of each insured;
- The applicable liability limits;
- Certain coverage defenses the insurer reasonably believes may apply; and
- A copy of the policy.
The statute generally requires the insurer to provide this information within 30 days of the written request.
Knowing the available liability coverage can be particularly important when determining whether the insurance available may be sufficient to compensate an injured person for their damages.
How Does an Insurance Company Determine a Settlement Amount?
There is no single formula that determines the value of every Florida personal injury claim.
An insurance company may consider several factors when evaluating an insurance adjuster personal injury claim, including the extent of the injuries, medical expenses, lost income, future treatment, liability, and other damages.
Medical Expenses
Medical bills and treatment records can provide evidence of the financial impact of an injury.
The insurer may review the type of treatment received, the duration of treatment, the medical providers involved, and the relationship between the treatment and the accident.
Lost Income
An injury that prevents you from working may result in lost wages or other employment-related losses.
Documentation such as pay records, employer statements, tax records, or other employment information may help establish these losses.
Future Medical Treatment
Some injuries require continuing treatment or additional procedures.
Medical evidence concerning future care can therefore become important when evaluating the potential damages associated with a personal injury claim.
Pain and Suffering
Depending on the type of claim and applicable Florida law, an injured person may also seek compensation for non-economic damages.
These damages can include physical pain, emotional effects, and other consequences associated with an injury.
Liability and Comparative Fault
An insurance company will also evaluate who was responsible for causing the accident.
Liability is particularly important in Florida because the state’s comparative-fault law can affect recovery in negligence cases.
Under Florida Statutes § 768.81, a claimant’s damages in a covered negligence action generally are reduced according to the claimant’s percentage of fault. A claimant found to be more than 50 percent at fault for their own harm generally may not recover damages, subject to statutory exceptions.
As a result, an adjuster may focus not only on how seriously someone was injured but also on whether another person or entity can legally be held responsible.
Why the First Settlement Offer May Not Be the Final Offer
After reviewing the available evidence, an insurance company may make a settlement offer.
The first offer is not necessarily the final value of the claim. Before accepting a settlement, you should understand what the proposed agreement is intended to resolve and whether the amount accounts for the damages supported by the available evidence.
Consider the potential impact of future medical treatment, ongoing symptoms, lost income, and other damages before agreeing to a settlement.
Once a settlement is accepted and the appropriate release is signed, your ability to pursue additional compensation may be limited or eliminated.
For that reason, carefully review any settlement agreement before signing it.
What If the Insurance Company Offers Too Little?
An insurer may make an offer that does not adequately account for your damages.
Additional evidence may help demonstrate the value of the claim. Depending on the circumstances, this could include medical documentation, employment records, photographs, witness information, expert opinions, or other evidence concerning liability and damages.
An attorney may also negotiate with the insurance company on your behalf.
If the parties cannot reach an appropriate settlement, litigation may become necessary. Filing a lawsuit, however, involves additional legal requirements and deadlines.
Negotiating with an insurance company does not automatically eliminate the need to comply with Florida’s applicable statute of limitations or other legal deadlines.
What If the Insurance Company Is Not Handling the Claim Fairly?
Florida law addresses certain unfair claim-settlement practices.
Florida Statutes § 626.9541 identifies various practices as unfair methods of competition or unfair or deceptive acts or practices in the insurance industry, including certain unfair claim-settlement practices.
Florida Statutes § 624.155 also provides a civil remedy under specified circumstances for certain violations and insurer conduct, including failing to attempt in good faith to settle claims when the circumstances require it. The statute contains specific procedural requirements, so these issues should be evaluated based on the facts of the individual case.
An insurance dispute does not automatically mean an insurer has acted unlawfully. If you believe an insurer is improperly handling your claim, an attorney can evaluate the circumstances and explain what legal options may be available.
How a Florida Personal Injury Attorney Can Help With an Insurance Claim
Dealing with an insurance company while recovering from an injury can be difficult.
A Florida personal injury attorney may assist with many aspects of the claims process, including:
- Communicating with insurance companies;
- Investigating the accident;
- Gathering and preserving evidence;
- Identifying potentially responsible parties;
- Reviewing available insurance coverage;
- Obtaining medical records and other documentation;
- Evaluating liability and comparative fault;
- Calculating economic and non-economic damages;
- Negotiating with insurance companies;
- Reviewing settlement agreements; and
- Filing a lawsuit when appropriate.
At Bogin, Munns & Munns, our Florida personal injury attorneys represent people who have been injured in automobile accidents, truck accidents, motorcycle accidents, premises liability incidents, and other types of accidents.
Our attorneys can review the circumstances of your accident, explain the legal options available to you, and help you understand how an insurance adjuster may evaluate your personal injury claim.
Frequently Asked Questions
Does an Insurance Adjuster Work for Me?
Generally, no. An adjuster employed or retained by an insurance company evaluates claims on behalf of that insurer. The adjuster is not your personal attorney or legal representative.
Should I Talk to the Other Driver’s Insurance Company?
You may need to communicate with an insurance company after an accident, but you should be careful about providing statements or signing documents without understanding their purpose.
If you are unsure how to respond to an adjuster’s request, consider speaking with a Florida personal injury attorney first.
Can an Insurance Adjuster Deny My Personal Injury Claim?
An insurer may dispute whether its policy provides coverage, whether its insured is legally responsible, whether an injury was caused by the accident, or the amount of damages being claimed.
Whether a denial is legally justified depends on the facts, the applicable insurance policy, and Florida law.
Can I Find Out How Much Insurance Coverage the At-Fault Driver Has?
Florida Statutes § 627.4137 provides a procedure for requesting information concerning known liability insurance policies.
A qualifying written request generally requires the insurer to provide specified information within 30 days.
Should I Accept the First Settlement Offer?
You are not required to accept a settlement offer simply because an insurance company makes one.
Before accepting an offer, consider whether you understand the extent of your injuries, future treatment needs, damages, available insurance coverage, and the effect of signing a settlement agreement.
What Happens If I Cannot Reach a Settlement With the Insurance Company?
If negotiations do not result in an acceptable resolution, filing a lawsuit may be an option depending on the circumstances.
A lawsuit is subject to Florida’s statutes of limitations and other procedural requirements. You should not wait until a deadline is approaching to investigate your legal options.
Contact Bogin, Munns & Munns
An insurance adjuster can play an important role in handling a personal injury claim, but you do not have to navigate the process without legal guidance.
If you were injured in an accident in Florida, Bogin, Munns & Munns can help you understand your rights, evaluate your potential claim, communicate with insurance companies, and pursue compensation when appropriate.
Contact Bogin, Munns & Munns to discuss your Florida personal injury case.
This article is intended for general informational purposes and does not constitute legal advice. Florida insurance laws and claim requirements can change, and the rules applicable to an individual claim depend on the specific facts and circumstances of the case.
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