How Insurance Adjuster Handles Claim In Open File

Once someone has submitted a claim with an insurance company, the submitted claim gets put in a file. After the insurer has assigned an adjuster to that particular claim, then the claim’s file gets opened.

Adjuster’s actions after the opening of the file

• The adjuster studies the filed facts
• The adjuster talks with the plaintiff and reads the accident report. Also obtains the police report
• Adjusters respond to any demand letter.

How adjuster’s actions allow for pursuit of an investigation

Adjusters look at any previous claims that have been submitted by the current claimant. Whenever evidence indicates that the same claimants submitted several other personal injury claims in the past, adjusters’ suspicions increase. Any of the claimant’s entries on a social media account come under inspection. The reported activities should match with the message given to the doctor, regarding any movement/action that the patient/claimant cannot carry out.

Adjuster obtains the claimant’s relevant medical records. Insurers might try to obtain all of the available records. A smart claimant keeps the insurance from having any records, except those that are relevant to the case. Adjusters often try to get the injured party to cooperate with the making of a recorded statement. Smart adults refuse to provide such a statement until one can be made in the presence of their lawyer.

Eventually, adjusters calculate the value of their assigned case.

Calculations get made by using the data from the medical reports: The sum of the amounts from the different bills gets multiplied by a given number. That number represents the extent of the victim’s injuries.

Personal injury lawyer in Lower Sackville knows that after making the calculations, the adjuster starts to negotiate with the claimant, or a representative for the claimant. Claimants study the adjuster’s various offers and make different counter-offers. Smart claimants have established in their minds the size of the minimum acceptable offer. Negotiations continue until the adjuster has come close to proposing that minimal figure. If an adjuster’s low offer comes close to that minimum, then the minimum figure needs to be increased.

On the other hand, the adjuster’s offer might come close to the claimant’s minimum. In that case, it has become clear that, in order for negotiations to continue, that minimum figure needs to be increased. Smart claimants try to play with adjusters’ emotions. The addition to the demand letter of photographs helps to work on the emotions of an adjuster. By the same token, an emotion-laden message can get directed at the adjuster when a claimant details the struggles of a recovering patient.

Ideally, the negotiators (claimant and adjuster) finally agree on one figure. That then becomes the amount chosen for the settlement. The claimant asks for confirmation of the settlement, and for the date when the check should go to the claimant’s lawyer.

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