What is an Insurance Adjuster’s Role in the PI Claims Process?
You have been injured, maybe in a car crash on I-35, a slip and fall at a local store, or another incident caused by someone else’s negligence. Beyond the pain and doctor visits, you are now facing the insurance company. One of the first people you will deal with is the insurance adjuster.
But who are they really, and what is their role in your case?
In a busy city like San Antonio, where traffic congestion and injury claims are frequent, adjusters often handle heavy caseloads. That can mean quick offers, pressure to settle, and undervaluing your injuries.
Knowing how to protect your rights matters. That is why many turn to the experienced San Antonio injury lawyers at The Aguirre Law Firm for guidance through the claims process.
Who Is the Insurance Adjuster?
Think of the insurance adjuster as the gatekeeper between you and the insurance company’s money. Insurance companies hire adjusters to investigate claims, determine liability, and decide how much, if anything, the insurer should pay out. They might go by titles like claims specialist or analyst, but their mission is always the same. Protecting the insurance company’s bottom line by settling for as little as possible.
What Does an Insurance Adjuster Do?
When you file a PI claim, the adjuster springs into action. Their job includes:
- Reviewing accident details and police reports
- Inspecting property damage or accident scenes
- Interviewing you, the insured, and any witnesses
- Requesting and analyzing your medical records
- Consulting with experts if needed
They are looking for evidence that supports and discredits your claim. For example, they might dig into your medical history or driving record to find reasons to reduce your payout.
How Adjusters Evaluate Your Claim
Once the investigation wraps up, the adjuster determines if the insurance policy covers the incident and if the insured party is at fault. If so, they will calculate the value of your claim, considering:
- Medical bills and treatment costs
- Lost wages or income
- Property damage
- Pain and suffering
- Future medical needs or permanent impairment
For subjective elements like pain and suffering, adjusters use formulas, like multiplying your actual losses by a set number or assigning a daily rate for each day you are affected.
Negotiation and Settlement
After crunching the numbers, the adjuster makes a settlement offer. But here is the catch: their first offer is usually much lower than what your claim might be worth, sometimes 25% to 50% lower. They hope you will accept quickly, avoiding a lawsuit and saving the insurance company money.
You have the right to accept, reject, or counter the offer. You can present more evidence or arguments if you disagree with the adjuster’s assessment. Sometimes, you can negotiate a higher settlement, especially if you are organized and understand your claim’s true value.
Why Adjusters Are Not on Your Side
It is easy to assume the adjuster is there to help, but remember: they work for the insurance company, not for you. Their performance is measured by how little they pay out and how quickly they close cases. That is why consulting with a personal injury attorney before giving statements, signing medical releases, or accepting any settlement is important.
Tips for Dealing with Insurance Adjusters
- Be present during inspections and keep your records
- Do not rush to accept the first offer
- Stay organized and document everything
- Consult with an attorney before signing anything or providing a recorded statement
Conclusion
Insurance adjusters play an important role in the PI claims process. They investigate, evaluate, and negotiate claims, always considering the insurance company’s interests. Knowing how they operate can help you protect your rights and pursue the compensation you deserve.
If you are ever in doubt, contacting an experienced legal professional can make all the difference in your case.