insurance adjuster reviewing claim

The Role of Insurance Companies in Personal Injury Cases

By Greg Kohn

People buy insurance to protect themselves when things go wrong. Sometimes, though when you file a claim, the insurance company treats you as if you are trying to steal their money from them. It could help if you knew the role of insurance companies in personal injury cases.

A New Jersey personal injury lawyer could handle your injury claim and negotiate directly with the claims adjuster on your behalf. Working with a lawyer could give you the time to take care of yourself and focus on your health and well-being.

Why Insurance Companies Get Involved in Personal Injury Claims

Insurance companies get involved in personal injury cases because their policyholders pay them money (premiums) to protect them financially by paying legitimate claims from people the policyholders harm through negligence.

Let’s say that you were in a car accident with another driver. The police found the other driver at fault for causing the collision. You got the driver’s insurance information at the scene of the crash. You went to the emergency room for your injuries, then contacted your automobile liability insurance company.

You also contacted the at-fault driver’s insurance company and notified them that you will be filing a claim for your injuries and other losses against the at-fault party, who is their insured policyholder. So, what happens between that point and you getting a settlement check from the insurance company? Plenty.

How the At-Fault Party’s Insurer Processes Personal Injury Claims

The insurance company will investigate the claim to make sure of these things initially:

  • Their insured’s policy has not lapsed.
  • The policy covers the situation in which the loss occurred. For example, and homeowner’s insurance policy would not be the first line of coverage for a motor vehicle accident, an automobile liability policy would.
  • Their insured was at fault for causing the accident. If you were 100% at fault, you would have to look to your own resources to pay your losses.

After opening a claim file and verifying these initial issues, the second stage of claim processing begins.

The Claims Adjuster Digs Deep

The claims adjuster collects the standard evidence, like the police report of the accident, the medical records of all injured parties, and employer records of lost wages. Depending on the amount of money at stake, the adjuster might get a copy of your medical records to check on pre-existing medical issues and previous injuries.

The adjuster will talk to their policyholder and then reach out to you for information about the accident and your claim. They will likely ask if you will allow them to record the conversation. We do not recommend that our clients agree to recorded statements. In fact, before you talk to the at-fault party’s insurer at all, you will want to talk to a personal injury lawyer about your claim and let the attorney handle the claims adjuster.


After the adjuster has the information they want, they submit the claim file to their supervisor or another department within the insurance company, requesting authority to settle the claim or getting a denial of the claim. If the insurer grants authority to settle, the adjuster will get told an acceptable range for settling the case, like between $25,000 and $75,000.

The adjuster or a defense lawyer will negotiate with your personal injury attorney. If they reach a settlement, the insurance company pays the settlement proceeds. If the claim does not settle and your lawyer files a personal injury lawsuit, the insurance company hires and pays defense lawyers to represent the at-fault party. If the plaintiff wins at trial, the insurer pays the jury verdict to the plaintiff. This summary barely scratches the surface of the many tasks involved in processing personal injury claims with insurance companies. A New Jersey personal injury attorney could help you navigate every step of the claims process and litigation. Reach out to our office today for help with your case.

About the Author
Greg Kohn is a partner at Nagel Rice and specializes in complex civil litigation cases, including professional malpractice, personal injury, class actions, wrongful death, products liability, and commercial litigation.  He has extensive experience representing clients in both state and federal court. Greg has tried many jury trials to verdict and has recovered over $50 million in settlements and verdicts in all types of personal injury matters including automobile accidents, wrongful death cases, slip and falls, and other catastrophic injury cases. Greg also handles medical malpractice cases, involving misdiagnoses, wrongful birth, and delayed cancer diagnosis. If you have questions regarding this article, you can contact Greg here.