How Insurance Adjusters Determine Causation

When insurance claims adjusters evaluate your personal injury claim, the calculations and methodology they use can be complex and often, incomprehensible to the layman. A First Coast personal injury attorney can help you understand how your claim will be evaluated and how much it is likely to be worth. Causal Relationship Between Accident & Injury One important factor is the causal relationship that can be proven between your accident and subsequent injuries. This requires documentation in the form of medical records, which will be sent by your attorney along with your claim for damages. The adjusters will check to see if your claim contains medical opinions that support the length of disability you are claiming, medical opinions that support the injury or damages you are claiming, any prior injuries that might have contributed to your current condition, any sign of intoxication or drug influence on your part, and anything that might deviate from what you are claiming as the “official” account of what happened. How These Factors Can Damage Your Claim These factors can be damaging to your claim in ways you don’t expect. In one product liability case, a claimant claimed to have suffered back injuries when she fell off a physical therapy table. She claimed that the table was defective and responsible for her injuries, and asserted a product liability claim. Her attorney sent her medical records to the insurer for verification. However, her medical records made no mention of a fall off of a physical therapy table; instead, they made mention of the claimant having had a slip-and-fall incident on rocks while crossing a creek. The insurance company pounced on this account and claimed they were not liable for her injuries, and the claimant had a difficult time making her case after that. Do Your Bills Fit Your Injury? Another factor that will be looked at closely by insurance adjusters is the proportionality of your claimed injuries to your actual medical bills and how much they correlate. When the medical bills submitted don’t match up with the expected nature and severity of your injury, adjusters can tell, and will be very skeptical that your injuries are truly as severe you claim. If you have further questions about your personal injury claim, contact First Coast personal injury attorney John Fagan.