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Definition - What does Adjudicate mean?

Adjudicate is the action of making a decision on a legal case, dispute, or conflict through a judicial procedure. This term is commonly used in personal injury claims to refer to the insurance company’s process of paying or denying claims after the insurance company has determined if the loss or injury is covered under the purchased policy.

Insurance claim settlement and the adjudication process

If a person has been injured by the negligence of another person or entity they may first seek compensation for their losses by filing a claim with the defendant’s insurance provider. An injured party may also seek compensation for their injuries from their own insurance company. In either case, the adjudication process is initiated when a claim is filed with the insurance company and the insurance company begins reviewing the claim.

Most insurance claims are initially processed electronically with different software applications reviewing the eligibility of the claim, whether the claimant has provided accurate information, and whether the policy is up to date. Other submitted claims are reviewed manually by an insurance examiner.

How will I know the decision to my claim?

After the adjudication process is completed and the insurance adjuster has made their decision, they will send a letter to the requester. Requests may be denied, approved, or partially approved. All denials should include information about why the request was denied. Partial approvals must also provide information for the decision. After the adjudication process is completed there may be some type of appeal allowed.

Hiring a personal injury lawyer

If you have been injured from the negligence of another person or entity you may be dealing with their insurance company. In some cases insurance companies will attempt to offer settlements which do not fully compensate you for your injuries. If the insurance adjudication process fails to provide adequate compensation you may have the opportunity to file a claim in court to fight for additional compensation for your losses.

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