How Does the Insurance Company Decide How Much My Case is Worth?

Injury Assessment Software for Injury Cases

computer imageAll major insurance companies now use computer software programs to assist adjusters in placing a “value” on injury claims. These specially-designed programs purportedly allow adjusters to “standardize” claim information so that claims evaluations are efficient and consistent. The problem is, the programs were written for the insurance companies, using their input as to what was fair compensation. So the whole program is flawed in favor of the insurance company.

Some insurance companies have developed their own adjustment software programs, while others have opted for the commercially marketed software programs. The leading adjustment software programs that are commercially available are Colossus, Claims Outcome Advisor, and Claims IQ. These programs systematically assess claim information and assign a reduced value to each injury claim. The program assesses all your past medical conditions and treatments and your current and future medical treatments and then arbitrarily places a “value” on your claim.

Some programs also assess the skill and experience of the personal injury attorney, and whether he or she is capable of getting a substantial verdict against the company. Claims adjusters are instructed not to deviate from the computer assessment of the injury claim. What they personally may think about the value of the injury claim is completely taken out of the picture; it’s not important or relevant. This is why the adjuster’s “low-ball” offer of settlement doesn’t bother them; their personal opinion doesn’t matter.

Example of a Computer Assessment for a Personal Injury Claim

Let’s consider how a claims adjuster would use computer assessment software to assess the value of a serious injury claim. Suppose the serious injury being evaluated is a crush injury to the foot. Because no surgery would adequately repair the damaged ligaments in the foot, the surgeon is reluctant to try surgery unless the injury victim reports that they can’t walk at all. So, the medical bills are just a few thousand dollars for initial treatments. But the injury victim can’t work on his or her feet without pain, and can’t participate in many other activities previously enjoyed.

The claims adjuster will enter information about the claim on the computer program, and the assessment program will indicate a highest possible value on the claim. The problem is, the assessed value may be as low as only 25% of the full value of the claim. Nonetheless, the adjuster will not offer even this grossly inadequate amount as a settlement offer—they are prohibited from doing so without special company authorization.

How Does the Insurance Adjuster Use this Computer Generated Assessment of my Injury Claim?

click here for free report buttonThe adjuster is only permitted to negotiate a settlement significantly below the computer assessment. The adjuster will attempt to withhold payment of at least 50% of the full value of claim to the injury victim.  In the assessment of this injury claim, the computer assessment may be as low as $10,000. The claims adjuster then will offer only $5,000 in settlement, which is half of the computer assessment value. The computer assessment completely ignores the possibility of future surgery costs, which may be as much as $30,000, because the surgeon is hesitant to say exactly when a future surgery would be needed.

Although it is clear that there is a permanent injury—a torn ligament—and all other previous treatments have failed to correct the symptoms, there is a “minimal” value placed on the injury claim.

The claims adjuster can’t even consider any lost wages because the person can still walk, albeit, in a lot of pain—thus, no reason not to work! The claims adjuster remains convinced that her low-ball offer is fair because she has a computer program assessment to support her position.

Even if the adjuster felt compelled to offer more money in settlement, she’s not allowed to offer more without authorization from management. Because computer assessment software is written for the benefit of insurance companies, there is a built-in bias against your claim, and it should be no surprise that the claims adjuster’s assessment of the value of your injury claim is grossly inadequate to compensate you for all your injuries.

So What Can I Do to Receive Maximum Compensation for my Injuries and Losses?

free e-book buttonWhat is the value of an attorney in negotiating with an insurance company? If you go it alone, you may wind up settling for much less than your claim is actually worth. Many times, insurance companies offer settlements for cents on the dollar. But they will tell you a settlement is in your best interests. They may try to get to you say things that hurt your case. Many people who are struggling with injuries find this an intimidating and confusing process. If you enlist our firm to represent you, we will handle all negotiations on your behalf.

We have handled numerous insurance claims involving car accidents, truck accidents, premises liability and other personal injury accidents. In the past, our lawyers have represented insurance companies, and therefore we know how they value claims and what arguments they will respond to. We are adept at reaching favorable results through negotiation and settlement. If we do not achieve favorable results by those means, we are always prepared to meet the insurance companies in court.

Contact a Morgantown Insurance Dispute Attorney

Contact us to learn how we can help you recover full and fair money damages for your injuries and financial losses. From our offices in Morgantown, we represent clients in car accident and motor vehicle injury cases throughout West Virginia.  Call Today:  304-594-1800 or 304-216-6695 after business hours for a free evaluation of your insurance claim.  You don’t have to do this alone.

righting_the_wrong_3dSource:  Righting the Wrong:  West Virginia Serious Injury Guide by Jeff Robinette, Word Association Publishers, 2012.

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Injured in WV? Get the Facts.

Free Books for WV Accident Victims:

Beside Still WatersRighting the WrongsCollision Care

Click on book image for immediate download, or if you are a WV injury victim, call 1-304-594-1800 or email our office today to have a soft cover book sent to your home at no cost or obligation to you.

Collision Care: A Guide for West Virginia Accident Victims will give you the basic facts that you must know in order to make the best decisions for your present and future circumstances and to help you achieve the best result possible regarding your injury claim. (87 pages)

Righting the Wrong: West Virginia Serious Injury Guide provides serious injury victims and their families essential information about the insurance claims process to enable them to maximize their efforts to rebuild their lives. (161 pages)

Beside Still Waters: West Virginia Fatal Injury Guide provides surviving family members the information they need in order to pick up the pieces of their lives to enable them to rebuild a financial future for themselves and their children. (123 pages)

Click on a book cover image for a free immediate download, or if you are an injury victim or family member, call our office today to have a soft cover copy sent to your home. Due to limited availability, there is a limit of one book per family.

All of these books can also be purchased on Amazon.com and Barnes and Noble for $16.95 each, plus shipping, but if you act now, Jeff will send it to you at No Cost or obligation.

Some of the useful information you will find in these books:

  • What Are My Legal Rights?
  • What Is Legal Liability?
  • What Is Comparative Fault? What happens if we were both at fault?
  • How Do I Prove My Claim? What documentation must I provide?
  • For What Damages May I Receive Compensation?
  • Do I Really Need A Lawyer? How to choose the right lawyer for your case.
  • Can I Afford A Lawyer?
  • Financial Motivation Of The Insurance Company – to minimize their pay-outs and maximize their own profit.
  • What is a wrongful death?
  • Statements and Authorizations – Think twice and get advice before you sign that release!
  • Social Media Traps and insurance company surveillance of your activities.
  • Spoliation of Evidence , vehicle salvage issues.
  • And much, much more!

Bonus Information: The Anatomy of a Real-life Injury Case and 10 Ways to Ruin Your Case

Our Mission
Morgantown lawyer and principal attorney, Jeff Robinette, shares what he believes is the mission of the Robinette Legal Group, PLLC. The primary objective of a personal injury law firm is to help the average person who has been the victim of negligence against the powerful resources of the insurance industry.

About the Author:

Jeffery L RobinetteJeffery Robinette is a personal injury lawyer with decades of insurance litigation and trial experience in personal injury and wrongful death claims. Prior to representing injured individuals exclusively, Mr. Robinette was a partner in a major West Virginia law firm where he focused his legal practice on defending serious personal injury and wrongful death claims and lawsuits stemming from auto and truck collisions. He has also represented the nation’s largest and most powerful insurance companies at all levels of litigation including jury trials and appeals in state and federal courts in West Virginia.

Mr. Robinette taught insurance companies and their adjusters how to follow insurance laws and regulations, including how to adjust insurance claims in good faith. He was a frequent speaker at insurance conferences on West Virginia insurance law.

Submitted by the Robinette Legal Group, PLLC, West Virginia Injury Lawyers.  Call us today: 304-216-6695 or 304-594-1800.  We are glad to answer your questions.

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What is First Party Insurance Bad Faith?

Your insurance company has an obligation to fairly consider your interests and compensate you according to the loss you have suffered within the limits of your insurance policy.  If the insurance company considers its own best interest, and you suffer losses as a result, you have a right to sue your own insurance company for bad faith.

Personal Property Insurance Bad Faith:

If you have suffered significant damage by fire, flood, ice, or wind to your home or place of business, your insurance company may only offer a fraction of the amount of money it will take to repair the damage (learn more about home insurance affiliate program firms service in this case).  Insurance companies are motivated to pay as little as possible, so you will need a lawyer if you wish to recover the full value of your loss.

In order to prove bad faith, your attorney will have to prove that your insurance company acted unreasonably in the adjustment of your claim.  This will be a complex process of litigation, and for optimum results it is essential that you hire an attorney with many years of experience in working directly with insurance companies.

Motor Vehicle Accident Insurance Bad Faith:

Likewise, if you have been in a car, truck, or motorcycle accident and are suffering from a personal injury and your insurance company has acted unreasonably or unfairly in settling your claim, you may be a victim of insurance bad faith.

If you need help with your insurance claim, contact us at www.robinettelaw.com or 1-304-594-1800.

Why your Insurance Company doesn’t want you to hire a lawyer

With over two decades of experience as an insurance defense lawyer, the insight I have gained may be helpful to you in deciding whether or not you need your own legal representation.  The following are a few considerations about Insurance Companies:

  •  Insurance Companies are primarily concerned about their own profitability.  They do not profit from settling claims for their full value.
  • The Insurance Company’s lawyer is paid to ensure the company pays the smallest possible amount for your claim.
  • The Insurance Adjuster will encourage you to quickly settle the claim before you experience any long-term health effects resulting from the accident.
  • The adjuster from the Defendant’s Insurance Company is seeking to discredit your case and even seemingly innocent statements made by you can be used against you later.
  • Your Insurance Company may use detectives with surveillance cameras to monitor your activities, especially if you are claiming a long-term disability.
  • Once you have an attorney representing your claim to the Insurance Company, the insurer knows they must make a reasonable offer or face the costly prospect of defending themselves in court.

If you sign the Release of Claim form, even if you have future medical problems and may even need an operation, the Insurance Company has no obligation to pay for any further treatment.  Without representation, you may find that you have run out of money before your treatment is complete.  Your attorney will ensure that the full cost of all your present and future damages is part of the claim.  The proposed insurance settlement may seem reasonable, but unless you are an expert in the field of insurance law and the settlement of claims, you will never know if you guessed wrong.

For more information:  www.robinettelaw.com  — Call Today:  1-304-594-1800