The Personal Injury Claim Process: Follow These Steps to Settlement

Here’s your guide to the personal injury claim process in easy to understand language. Follow these steps to get fair compensation for your losses.

Injuries caused by someone else’s carelessness happen every day. Insurance companies pay out billions of dollars in compensation for injuries caused by car accidents, slip and fall claims, medical malpractice, and more.

Our goal is to empower injury victims. You don’t have to be at the mercy of the insurance company.

We explain the personal injury claim process from start to finish, so you have the information you need to get the injury compensation you deserve. You might also like to use our Injury Claim Status Log to help you see at a glance where you are in the process.

Learn the basic steps to personal injury claims, including calculating your claim value, negotiation tactics, and final settlement.

What You Need for a Winning Personal Injury Claim

To build a successful injury claim you’ll need to be able to show you were hurt, and that your injuries are someone else’s fault. Collecting evidence is an important part of the personal injury claim process.

Begin to gather evidence like medical bills, pictures, police reports, and more, as soon as you’re hurt and continue to collect evidence through your recovery.

Showing You Were Hurt

It’s not enough to complain of pain or stiffness. You must have medical bills and records that connect your injury to the car accident, slip and fall, or another incident.

Immediate medical care after an accidental injury is very important to your claim. You can go to the hospital emergency department, an urgent care center, or your primary healthcare provider.

Waiting to see how you feel can ruin your claim. The insurance company will jump at the chance to say your injuries aren’t from the accident or aren’t as bad as you say.

Tell every medical provider who takes care of you exactly when, where, and how you were injured. The medical records must tie your injury to the accident.

When you are ready to make an insurance claim, request copies of your medical records and bills from your doctors, physical therapist, and anyone else who treated your injuries.

Proving Fault for Your Injuries

The insurance company won’t pay you a dime unless you can show that the person they insure is at fault for your injuries.

It helps to understand some legal terms used by insurance companies when talking about fault.

  • Negligence is when a person makes a mistake, does something wrong, or does something no reasonable person would do in the same circumstances. Texting while driving is negligent.
  • Liability means legal responsibility. The at-fault driver is usually liable for the financial cost of the accident victim’s injuries.
  • Proximate Cause is an action that causes something to happen which wouldn’t have otherwise happened. You wouldn’t have been hurt if the texting driver hadn’t rear-ended your car.

Evidence like police or incident reports, eyewitness statements, and pictures and video can help prove the other person’s fault for the situation that caused your injuries.

When the insurance company “accepts liability” for their insured, it means they might have to pay for your losses.

Evidence for Complicated Injury Claims

High-dollar, complicated injury claims require the kind of evidence that you need an attorney to go after by issuing a subpoena or a seeking a court order.

For example:

Communicating with the Insurance Company

As soon as possible after your injury, you or your attorney will send a notice letter to the at-fault person’s insurance company to let them know you intend to file a claim.

Your attorney will handle all communications from the insurance company. If you decide to handle your claim without an attorney, letters and calls from the insurance company will come to you.

Don’t be surprised to get a standard Reservation of Rights letter from the insurance company. The letter will say that the company will investigate your claim with the understanding that they might deny the claim if they decide there is no coverage for your injury.

The insurance adjuster might call to ask for a recorded statement and ask you to sign a medical release form. Watch what you say when giving a recorded statement. The insurance adjuster is trained to look for reasons to deny or reduce your injury claim.

You have the right to consult a personal injury attorney before giving a recorded statement or at any other time during the claims process.

Be very careful. Anything you say in a recorded statement can be used against you. Also, giving the adjuster access to old medical records might give them a reason to argue that your injuries happened long before the accident.

Don’t let the insurance adjuster rush you into an early settlement. If you’re still in treatment for your injuries, it’s too soon to tell what your injury claim is worth.

Calculating Injury Claim Value

The losses you suffer because of an injury are called “damages” by insurance companies and injury lawyers. The insurance company won’t tell you what you can claim for damages, so be sure you include everything.

For personal injury claims, damages are separated into two categories: “special damages” and “general damages.”

Special damages, or “specials” are expenses you can measure, such as:

  • Medical or chiropractic bills
  • Therapy or treatment bills
  • Out-of-pocket medical expenses for things like medications or bandages
  • Replacement service expenses, like lawn care
  • Lost wages

Adding up your special damages is not hard because you’ll have bills and receipts, and proof of your lost wages.

“General damages” are harder to calculate, and include:

  • Pain and suffering
  • Emotional distress
  • Loss of consortium

General damages don’t have a price tag, so they are harder to measure. Still, there are ways to justify your general damages as part of your demand for compensation.

For example, if your medical records show you were not allowed to lift more than ten pounds, your emotional distress because you couldn’t care for your 20-pound baby is justified.

The better you can justify your general damages, the more the adjuster will accept.

For most injury claims, it’s reasonable to add one or two times the total of your special damages to account for your general damages. The total is a fair estimate of your claim’s value.

Sending a Settlement Demand Packet

Now that you know the value of your injury claim, the next step in the process is putting together a Settlement Demand Packet to tell the insurance company how much money you think they should pay for your claim.

Your packet will contain a demand letter that lists the details of your damages. You’ll also attach copies of your medical bills, receipts, and other paperwork that backs up your claim.

We make it easy with our sample Personal Injury Demand Letter.

Make two packets, send one to the insurance company by certified mail, and keep one for your records. When the green confirmation card comes back from the certified mail, staple it to your copy of the packet. You’ll know exactly what you sent to the insurance company, and have proof they got your demand.

Injury Claim Settlement Negotiations

For most people, negotiating a settlement is the hardest part of the personal injury claim process. If you’ve decided to handle your claim without an attorney, be prepared to move slowly and keep your cool.

The adjuster wants to settle your claim quickly, for as little as possible. You can end up with better compensation by negotiating with patience and persistence. Having some time pass between offers and counteroffers can work to your advantage.

Don’t be so afraid of messing up that you’re afraid to negotiate for more money. If you do mess up, it can most likely be fixed without killing your claim, just be prepared for some pushback from the adjuster.

If you simply say, “I misspoke,” it should be enough to put settlement negotiations back on the right course. Don’t waste time worrying about something you said or didn’t say.

The Adjuster Isn’t Your Friend

Don’t be fooled by a polite or sympathetic claims adjuster. They are all about saving money for the company, not what’s best for you. If the adjuster can tell you’re anxious, in need of fast money, or embarrassed by flattery, they will take advantage of your “weakness.”

The adjuster will then base their counteroffers on your weakness, rather than the facts of the claim. Staying calm and businesslike keeps the focus of the negotiation where it belongs – on the facts.

There are no laws that require a claims adjuster to offer you a fair settlement, although many states will punish insurance companies for bad faith practices, like repeatedly asking for the same paperwork, or failing to make a coverage decision when their insured was clearly at fault.

Negotiation Styles and Tactics

The adjuster will eventually respond to your demand. This is when the real negotiations begin.

Depending on their personality and style, the adjuster will, in some way communicate that your claim has little or no value. They might throw out statistics and fancy words to try and convince you that they know more than you about claim values.

In other words, the adjuster won’t agree with your demand amount.

The first counteroffer from the adjuster is usually very low. They might act like the counteroffer is doing you a favor or try to justify it by saying your demand exceeds their “authority.”

Some adjusters might say your medical bills and lost wages are too high for the type of injuries you had. The adjuster might even go so far as to say that if you don’t accept the offer right away, they may not be able to offer it again.

Don’t fall for the adjuster’s tactics. They’re testing you to see if:

  • You really understand how the settlement process works
  • You’re impatient enough to jump at a ridiculously low offer
  • You believe their authority is limited
  • You’re intimidated enough to give in to their arguments
  • You’re serious, and just how far you’ll go – including filing a lawsuit

The best way to stop the adjuster in their tracks, and let them know you’re not intimidated, is to thank them for the counteroffer and say you don’t agree with the amount. Calmly explain that your injuries were real; your doctor ordered your treatment because it was absolutely necessary.

You can tell the adjuster you might consider reducing your demand, but not by much. Thank them, and say you’ll be back in touch after reviewing the offer.

Your Drop-Dead Settlement Amount

Your drop-dead figure is the lowest amount you’ll accept to settle your claim. If you can’t settle the claim for at least that amount, your next step is to file a lawsuit. Never tell the adjuster how low you’re willing to go. Hopefully, you’ll do a good job negotiating and settle for an amount well above your drop-dead figure.

Always work down from your original demand, bit by bit. Never work up from the adjuster’s counteroffer.

Negotiations resume when you reduce your demand amount slightly. Don’t get frustrated if the adjuster doesn’t respond right away. Here’s where your patience can pay off. Wait for the adjuster to respond to your latest demand. Calling before you have a firm counteroffer can put you in a position where you’re negotiating against yourself.

The process will continue with offers and counteroffers between you and the adjuster. You’ll continue to defend your position, and the adjuster will do the same. Eventually, you’ll both come to a figure you are willing to accept.

Final Settlement Agreement and Release

As soon as you and the adjuster have come to an agreement, write down the details. Send a written follow-up to the adjuster confirming the amount you’ve agreed to accept and the terms of your agreement.

When you get the formal settlement agreement and release, carefully review the document to make sure it matches your verbal agreement. The settlement agreement is a legal contract. It’s up to you to know what you’re signing.

When Settlement Negotiations Fail

Although it’s in the best interest of both sides to settle the claim, sometimes negotiations fall apart. Remember, the adjuster does not have to look out for your best interests.

If the settlement process for your personal injury claim has dragged on, watch out for the statute of limitations, which is the deadline in your state for filing a personal injury lawsuit. The adjuster knows that if you haven’t settled your claim or filed a lawsuit before the statutory deadline, you lose the right to seek compensation for your injuries.

Don’t wait until the last minute to protect your claim. Most injury attorneys don’t charge for their initial consultation. When settlement negotiations stall, it costs nothing to find out what an experienced attorney can do for you.

Video: Basic Steps to Negotiate an Injury Settlement

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 >>