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Accepted Claim

Definition - What does Accepted Claim mean?

Individuals injured from the negligence of another person or injured in the course of employment may have the right to file a personal injury claim. Claims which are covered under the injured party’s insurance policy and accepted by the insurance company are considered accepted claims. An accepted claim also can include workers’ compensation claims which the workers’ compensation insurance provider has agreed to accept.

Accepted claims and the insurance company

If the insurance company agrees that an injured party’s injury or loss is covered under the insurance policy the first step is for the insurance adjuster is to investigate the facts of the case and determine how much they are obligated to pay out to the claimant. Although the goal of the insurance company is to limit their liability, the insurance company does not want to have to take the case to court. A settlement offer is generally their goal.

With this is mind, the insurance adjuster will make an offer which is less than the maximum they are willing to pay and expect that the final settlement amount may be a bit higher after negotiations are completed.

How does the adjuster determine the value of the accepted claim?

Before making a settlement offer for the accepted claim, the adjuster will review the injured party’s actual expenses, including future and past medical bills and lost wages. The adjuster will also consider emotional distress and pain and suffering, two calculations which can be much more subjective and difficult to calculate.

To make the process easier, however, the adjuster may use a standard formula to calculate pain and suffering. For example, they may determine the amount of days the claimant suffered or use some type of multiplier, calculating the actual loss and multiplying it against a “pain multiplier.”

Regardless of the injuries or pain and suffering, the insurance company will never pay out more for the accepted claim than what is allowed for under the policy limits.

For example, if the policy states that $100,000 is offered for liability insurance, this is the maximum that they will offer. The settlement offer will be less than the maximum offered under the policy limit, but will be higher depending on the strength of the plaintiff’s case and whether or not the insurance company believes the claimant can take their case to court and win.

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