How Does An Insurer Put Value On An Injury Claim In Ontario?

In a personal injury case, the insurance company for the defendant must pay the compensation requested by the claimant. The claimant does not dictate the value of his or her claim. The insurance company must calculate the value.

How are such values calculated?

Although the claimant has suffered several losses, the insurance company focuses on the victim’s/claimant’s medical expenses. What did the victim have to pay for any tests and then for treatment? Did the victim have to undergo a period of rehabilitation? The costs for each of those expenses must get added up.

The total for all the expenses represents what the insurer calls the specials. The figure for the specials gets multiplied by a number that equates with the victim’s pain and suffering. The insurer picks a number between 1 and 5, unless the claimant/victim was in a catastrophic accident. In that case, the specials might be multiplied by a figure between 6 and 10.

The resulting product gets added to the amount of income lost by the claimant. The final figure gets used by the adjuster. It is the number quoted by the adjuster at the start of negotiations.

Consider the losses that were not used by the insurance company to calculate the value of a given injury claim.

For instance, the insurer’s calculation did not factor-in the existence of damaged property, of any lost education or lost recreation, or of any emotional effects that were linked to the injury-causing accident. Personal injury lawyer in Huntsville knows that each of those issues can be mentioned during the negotiations. The claimant can seek to increase the size of the offer from the insurance company. Mention of those added losses can be used to strengthen the claim made by the victim/claimant.

The insurance company can contest the allegations made, regarding any claimed loss. By contesting the allegations, the insurance company tries to lower the figure that will be used at the time of settlement. Ideally, the 2 sides finally agree on a final figure, and that is what the victim will receive.

If the 2 sides do not agree, the case becomes the subject of a mediation. Unlike the insurer, the mediator does not use any formula. At that point, that calculated value has no meaning. Instead, the mediator focuses on getting each side to appreciate the argument made by the other party. Hopefully, the 2 sides will reach an agreement.