Sample Car Accident Claim Negotiations with the Insurance Adjuster

Here’s where we walk you through a sample negotiation with an auto insurance adjuster and provide helpful hints for settling your own injury claim.

From fender-benders to head-on-collisions, vehicle accidents happen every day on American roadways. If you’re injured in a car accident, you expect the at-fault driver to pay for your damages.  For most of us, that means dealing with the other driver’s insurance company.

If you’ve recovered from relatively minor injuries and only missed a few days of work, you can probably settle your injury claim on your own. With a little know-how, there’s no reason you can’t negotiate a fair settlement with the insurance company.

Serious injury claims are best handled by an experienced personal injury attorney to get anywhere near a fair settlement.

Most attorneys don’t charge car accident victims for their initial consultation, so it costs nothing to get an expert opinion on your case.

Follow along with Sharon, our fictional car accident victim, as she negotiates an injury settlement with the other driver’s insurance company. We offer hints along the way as Sharon works through the personal injury claim process.

Sample Claim Summary: Whiplash Injury from Car Accident

Sharon Moore is a middle-aged divorced woman who has worked in the local elementary school’s cafeteria for nearly twenty years. She lives in a modest home with her dachshund, Fritz. Her son and his new wife live in the same town. Sharon spends most evenings knitting and watching her favorite TV shows.

One afternoon, Sharon was heading home from work when she stopped behind a car that was waiting to turn left. Suddenly, her compact car was struck from behind by a larger sedan driven by a young woman named Chelsea Lewis. Sharon’s car was pushed forward, but fortunately, she had left plenty of space between her and the car ahead of her when she stopped.

The impact threw Sharon forward, then slammed her back into her seat, violently snapping her head and neck. It all happened so fast, Sharon sat stunned in her seat. As she realized what just happened, she began to feel sick and dizzy.

A man appeared at her window and said, “Lady, just stay still. I saw what happened and called 911. They’ll be here in a minute.”

Police and EMS arrived within minutes. Sharon’s neck was immobilized with a brace, and she was transported to the hospital for further evaluation of her neck injury and a possible concussion.

The man who called the police told the investigating officer that he was waiting to pull out of the bank parking lot and witnessed the entire accident happen in front of him. He said that the larger sedan didn’t even slow down, and he saw the driver (Ms. Lewis) was turned and reaching into the back seat when she crashed into the back of the smaller car.

Chelsea admitted to the police officer that she’d been distracted by her child in the back seat and had turned to retrieve the toddler’s dropped toy. She didn’t see the car in front had stopped until it was too late to avoid the crash.

At the hospital emergency room, Sharon had x-rays of her neck and an MRI. Sharon was diagnosed with neck and shoulder strain and confirmed to have suffered a brain concussion. She was prescribed muscle relaxers for her neck, advised to use over-the-counter pain medications, and referred to a neurologist for follow-up on the concussion.

After the crash, Chelsea’s insurance company was notified of the accident.

Sharon couldn’t return to work for ten days, because of lifting restrictions for her neck, and headaches and fatigue from the concussion. Her medical bills and lost wages totaled $7,000.

When Sharon recovered from her injuries, she sent a demand letter with supporting documentation to the insurance company asking for $25,000 in compensation.

Click the   buttons to better understand insurance negotiation tactics. 

Negotiating the Hard Costs of an Injury Claim

Russel Thompson is the claims adjuster assigned to Sharon’s car accident claim. Like many car insurance adjusters, Russell is always suspicious of “whiplash” injury claims.

Russell is a tough negotiator. He’s proud of the bonuses he’s gotten over the years for minimizing payouts for soft-tissue injury claims. He’s primed and ready to handle Sharon’s injury claim.

SHARON: Hello?

ADJUSTER: Sharon Moore? My name is Russel Thompson, and I’m calling to discuss your claim with Traditional Insurance Company. How are you this morning?

SHARON: Hello, Mr. Thompson. I’m ready to talk about my injury claim. Have you looked at the packet I sent to your company last week?

Sharon avoided a common negotiation mistake by side-stepping the adjuster’s greeting. If she had said, “I’m fine” when Russell asked how she was, he could have used that as an “admission” that she had no lingering effects from her injuries.

ADJUSTER: I’ve reviewed the packet, and I’m having a hard time getting some of the medical bills approved. We can’t see any reason for such an expensive MRI on top of all those X-rays, or why you made three visits to a specialist for sore muscles.  

SHARON: Well Sir, if you would take a look at the report from the paramedics who took me to the hospital and the emergency physician’s notes, you’ll see that in addition to a neck injury, I had several positive signs of a traumatic brain injury.

You’ll see in the notes that my pupils were dilated, I was dizzy and nauseated, I threw up in the ambulance on the way to the hospital, I had a terrible headache, and a big lump where my head hit the window from the impact. The emergency room doctor was following the correct protocol when he ordered the MRI to check for a skull fracture or a brain bleed.

I didn’t randomly decide to take myself to a specialist. The doctors were certain I suffered a concussion, so I was referred to a neurologist.

Carefully study your medical records before negotiating your injury claim. Be ready to explain the reasons for your treatment, imaging tests, and medications.

ADJUSTER: All right. I don’t know what this doctor was thinking, but after looking at the entries on your chart I will go ahead and pay for the MRI and neurologist visits.

That brings us to this ridiculous wage claim. Your boss might let you get away with slacking off for two weeks, but we don’t have to pay for it.

Don’ lose your cool if the adjuster is rude or downright insulting. Every adjuster has their own negotiation style, and some are bullies. The adjuster might be trying to trick you into getting angry as a way for them to get the upper hand.

SHARON: Sir, my time off work was ordered by my primary care doctor and the neurologist based on their knowledge and experience. It was no treat for me to be suffering from daily headaches, blurry vision, and neck pain and stiffness because your insured failed to keep her eyes on the road.

Read the doctor’s notes written on the same days as the work slips. I wasn’t even allowed to drive until my vision cleared, and between the neck injury and brain injury, I was in no condition to rush around a commercial kitchen handling hot foods, sharp utensils, and dangerous kitchen equipment.

Even at home, I couldn’t stand to watch television or pick up my knitting because of light sensitivity, headaches, and neck pain. For the record, I’ve had nearly perfect attendance at work for the last 20 years. I’m sure my supervisor would be happy to testify that I’ve never “slacked off” on the job.

Insurance adjusters don’t hesitate to challenge lost wage claims. Be ready to point to evidence in your medical records to confirm the necessity for your time off.  

ADJUSTER: Okay. Against my better judgment, I’m willing to pay all your hard costs, including the wage claim, so that we can settle this. I’m willing to pay you $7,500, and we’ll call it a day.  

SHARON: Well, that offer is pretty low, but I’ll think about it over the weekend and get back to you.

Most adjusters start with a low-ball settlement offer to see if you’re desperate enough to settle, or don’t have the stomach for further negotiations.

Negotiating Pain and Suffering Compensation

Sharon had no intention of accepting such a low settlement offer. She deliberately waited until the following Tuesday to call, so the adjuster would know she was willing to negotiate with patience and persistence.

SHARON: Hello, Russell. I thought about the offer you made last week and decided it’s just too low for me to accept. However, in the spirit of compromise, I’m willing to lower my demand to $21,000.

Sharon knows a smart negotiator works down from their last demand, never up from the adjuster’s last offer.

ADJUSTER: I made you a good offer, including some consideration for your inconvenience. After all, you were stopped in the middle of the road.

Adjusters often try to reduce injury claim payouts by trying to pin some of the blame for the car accident on the victim.

SHARON: I have a copy of the police report in front of me that clearly states your insured was solely to blame for the accident. You have a copy of the same report. I was obeying all traffic laws, including stopping because the car ahead of me was waiting to turn.

Your insured, Ms. Lewis, admitted she wasn’t looking where she was going. She was ticketed for failing to keep a lookout and following too closely.

If not for the negligence of your insured, I would not have been injured. My world has been turned upside-down because of your client, through no fault of my own.

The police car accident report carries a lot of weight with insurance carriers. Police officers are unbiased experts who are trained to determine fault in vehicle crashes.

ADJUSTER: The thing is, Ms. Moore, I’ve taken a hard look at this, and I can’t come close to what you’re asking. That is not even close to my authority.

The adjuster’s “authority” is the amount they are authorized to pay without additional approval from a supervisor. The adjuster’s authority is not the same as the insurance policy’s liability limits. State laws establish the minimum liability limits for auto policies.

SHARON: Well, this case certainly merits your obtaining the authority to pay me a fair settlement.

ADJUSTER: I don’t see anything in the file supporting your demand. I have already fully repaired your car and have agreed to pay your hard costs, including the full amount of your time off from work. That’s just about the highest we usually go for soft-tissue injuries like yours.

SHARON: You have no idea how terrifying it was to hear the screech of tires followed by the sound of crumpling metal on impact. I was completely helpless and tossed around like a rag doll. I didn’t know what hit me. My mind was so foggy, and everything seemed far away. I hurt and I felt sick to my stomach. I couldn’t think straight.

Thank heavens for the good people who saw what happened and came to help me. The paramedics had to lift me out of the car. I could barely answer their questions. I was so confused, but I remember how mortified I was after throwing up in the ambulance. I cried and cried.

Using descriptive language to describe the emotional impact of your injuries is one way to persuade the adjuster to pay more for your pain and suffering.

ADJUSTER: I don’t doubt you were affected by your injuries, but you’re asking us to pay you an excessive amount for an upset stomach. I can’t agree to that.

SHARON: I don’t know why your offer continues to be so low. The police report makes it clear that your insured directly caused my injuries. Anyone looking at my medical records can see I had more than a few days of sore muscles. As you can see from the neurologist’s files, I was diagnosed with a traumatic brain injury with ongoing symptoms.

Look at the discharge summary from the emergency room. I was only released from the hospital because my son and his wife agreed to stay with me for at least 48 hours and follow the brain injury protocol for monitoring my concussion symptoms.

My daughter-in-law had to wash the vomit out of my hair and help me bathe and change my clothes. I was so embarrassed to need help with my personal care. My family and friends took turns coming over to check on me, prepare my meals, and feed and walk my little dog.

The pain and stiffness in my neck was enough to keep me out of work for two weeks, but the brain injury is a big concern.

I still have daily headaches. I can’t focus enough to knit, and I get so tired that I have to take naps. I’ve never had to live like this before. The neurologist says it can take months for brain injuries to heal, and I might be at higher risk of dementia later because of this accident.

Don’t take my word for it; look it up in the doctor’s notes. Your insured’s negligence left me with constant headaches and a significant fear for my future health.

I wanted to settle this claim on my own, but maybe I need to hand this over to an attorney.

ADJUSTER: You don’t want to hire an attorney. Why throw money away? I want to get this done for you. Let me see what I can do and call you back.

The adjuster is supposed to protect their insured. When you’ve got a strong case, they’ll increase your compensation for pain and suffering to keep you from taking the at-fault driver to court.

Agreeing on a Fair Accident Settlement

Sharon did her homework before she sent her demand for compensation to the insurance company. She calculated what her claim was worth and knew that both sides would have to compromise to reach a fair settlement.

ADJUSTER: Ms. Moore, after talking it over with my manager, we’re offering you $19,000 for your hard costs and your pain and suffering, if we can settle this claim today.

SUSAN: Thank you. I’m willing to accept that amount.

Always follow up with written confirmation of the settlement amount and terms. You can send a letter or an e-mail confirmation to the adjuster.

ADJUSTER: You should have the release and settlement agreement in a few days. We’ll send your check as soon as you return the signed agreement.  

It’s your responsibility to review the settlement agreement before signing to be sure it matches your verbal agreement. If you don’t understand some of the language in the agreement, consider hiring an attorney for an hour or two to look it over for you.  

Sharon invested the time to organize her car accident paperwork and learn everything she could about handling personal injury claims. Her diligence paid off, and she successfully settled her claim for almost twice the amount of her hard costs.

Charles R. Gueli, Esq. is a personal injury attorney with over 20 years of legal experience. He’s admitted to the NY State Bar, and been named a Super Lawyer for the NY Metro area, an exclusive honor awarded to the top five percent of attorneys. Charles has worked extensively in the areas of auto accidents,... Read More >>