Insurance companies take the following factors into consideration when they evaluate a settlement demand for a car accident:
- Nature & severity of the auto accident (low impact, big impact, rear-end, head-on, t-bone, sideswipe, etc);
- Any comparative negligence on the injured party;
- Severity of the injuries (diagnosis, etc.);
- Age, health and prior medical history of the injured party;
- Reasonableness of the treatment (in terms of frequency, duration, etc.). Did the injured party treat a reasonable amount of time for the injury they sustained? This is often measured, at least in part, by how much the treatment helped resolve or improve the symptomatic complaints;
- The cost of the medical care;
- The medical prognosis (did the injured party have a full recovery, do they have ongoing residual complaints, will they need future care, will their residuals likely worsen over time, etc.);
- The need for any future medical care (how probable, the probable future care needed, the estimated costs, etc.)
- Lost wages (time missed from work because of one’s injuries or medical appointments);
- Lost earning capacity (if can no longer perform the type of work done before their injury);
- Any other out of pocket expenses (medication, ice, heat, machines, equipment, mileage, etc);
- Pain & Suffering (all the aggravation caused by the injuries). In other words, the adverse impact the injuries had on one’s life (during treatment and/or from any residuals
Medical bills will have a dollar amount, and the insurance carrier often has software that looks for certain diagnosis and/or CPT Codes for billed medical care.
In terms of lost wages, they will want to see a doctor’s note taking the injured person off-work and conformation from the employer.
Lost earning capacity can be calculated by the appropriate expert based on past earnings, residual restrictions/limitations, and the prevailing job market.
Pain and suffering is a nebulous number that is different for every claimant.
Although there might be some generalities in terms of soft tissue injuries and the “average” amount of treatment received before such injuries typically resolve, every case is truly different as there are many factors and variables to consider.
The adjuster will base his/her evaluation of your claim based on all of the above factors, as well as their experience in dealing with your attorney, other attorneys, and in monitoring arbitration and trial results in the County where a lawsuit of your claim would have to be filed if unable to negotiate a settlement.
Many insurance carriers have a board in their conference room where they track the arbitration and trial results of their cases.