What Insurance Companies Look For in a Personal Injury Claim

Published on April 4, 2018

Personal injury claims almost always involve insurance companies.  When it comes to personal injury claims, a common question is, what insurance companies will look for when it comes to evaluating such a claim.  As such, this blog post will take a look at several of the factors that are typically involved.

In general, insurance adjusters will look at the following factors in order to determine appropriate damages:

Expenses (Medical Bills, Etc.)

An insurance adjuster will be looking at the actual expenses involved in your personal injury claim; this includes medical bills, ambulance costs, or other expenses that have been incurred.  These are also known as “special damages”. 

Actual Losses

The insurance adjuster will also examine “pecuniary” general damages (the actual losses that have or will occur as a result of your personal injury), particularly in the form of lost income or lost wages.

General Damages For Pain and Suffering

An insurance adjuster will also be examining pain and suffering damages.  These damages are awarded based on awards from prior cases.  In the trilogy of cases decided in 1978: Andrews v. Grand & Toy Alberta Ltd., Arnold v. Teno and Thornton v. School Dist. No. 57 (Prince George), the Supreme Court of Canada imposed a cap of $100,000 (as of 1978) on non-pecuniary damages (pain and suffering).  This decision was made on the basis that as a matter of public policy, there should be a limit to the amount of compensation awarded for pain and suffering.  With inflation, the current cap on pain and suffering is approximately $375,000, for the most catastrophic injuries.

Other Considerations: Policy Limits and Strength of Case

Lastly, insurance companies will also examine the policy limits and the strength of the case in general. As for policy limits, insurance companies will never pay more than the maximum amount of the insurance policy.  If your claim is worth more than the policy limits, you may or may not be able to recover these damages.  If the defendant in your claim is a corporation with assets, then this should not be a problem.  If the defendant is a person who is unemployed, with no assets, then recovery will prove significantly more difficult.

As for the strength of the case, this will also be taken into consideration when it comes to your personal injury claim.  The insurance company will often pay based on what it considers the exposure or risk of a finding of negligence.  In a car accident case, for example, if the insurance company believes there is a 50% chance a judge or jury will conclude the defendant was at fault, and the case is worth $100,000, then the insurer will probably offer an amount of approximately $50,000, to settle the case.

Our Ottawa injury lawyers have significant experience handling personal injuries claims and assessing damages.  They will get you the compensation that you are rightfully owed. Contact our office to schedule a free no-obligation consultation.