What Really Happens Behind the Scenes of a Personal Injury Claim?

From insurance negotiations to medical bill reductions, here's what Georgia injury victims should know.

By Derek Hays, Derek Hays Injury Law

When someone is injured in a car accident, slip and fall, or another preventable incident, one of the first questions they ask is, "How does the personal injury claim process actually work?"  Most people assume an attorney simply sends paperwork to an insurance company, negotiates a settlement, and hands over a check. In reality, there's quite a bit happening behind the scenes.  Understanding the process can help injured Georgians make better decisions and avoid costly mistakes.

Step One: Investigating the Claim

Every successful personal injury claim starts with building a case. This means gathering accident reports, photographs, witness statements, medical records, and other evidence that establishes who was responsible and how the injury occurred.  Insurance companies conduct their own investigations, too. Their goal is to evaluate liability and determine how much they believe the claim is worth. The stronger the evidence, the harder it becomes for an insurer to dispute responsibility.

Step Two: Understanding the True Value of the Injury

One of the biggest mistakes injured people make is settling too early.  Before negotiations begin, an attorney needs to understand the full impact of the injury. That includes medical expenses, lost wages, potential future medical treatment, diminished earning capacity, and pain and suffering.  A claim isn't necessarily ready to settle just because someone has received their initial medical bills. Some injuries take months to diagnose, treat, and fully understand.

Step Three: Negotiating With the Insurance Company

Once the medical picture and supporting evidence are sufficiently developed, the attorney typically prepares a demand package outlining the facts, injuries, treatment, financial losses, and requested compensation.  The insurance adjuster reviews the demand and usually responds with an offer. Rarely is that first offer the final number.  Negotiations may involve several rounds of offers, counteroffers, additional documentation, and discussions about disputed medical treatment or responsibility. If the parties cannot agree on a fair amount, filing a lawsuit may become necessary.

Step Four: The Part Many People Don't Expect — Medical Bill Reductions

Here's something many injury victims don't realize: The eventual settlement amount or verdict isn't the amount they take home.  The insurance company doesn’t pay a settlement amount or verdict and then, pay the medical expenses, lost wages, attorney fees, and costs separately.  The settlement amount or verdict includes money for all of those costs.  Medical providers, health insurance companies, Medicare, Medicaid, or other benefit programs may potentially have liens against the recovery that must be addressed from the proceeds of the settlement or verdict.  Depending on the circumstances, an attorney may negotiate with medical providers or lienholders to reduce or even waive the amounts owed.  The leverage that an attorney has in negotiating these reductions can make a substantial difference in increasing the client's final recovery amount in pocket. 

In other words, just because an injured person’s medical expenses following a car wreck total $30,000.00, it does not mean that $30,000.00 of the recovery will be paid to satisfy those bills.  It can be substantially lower than that amount.  This is why it is essential to have an experienced personal injury attorney handle your claim. 

Step Five: Getting the Settlement Check

Once everyone agrees on the settlement, the necessary release documents are signed, settlement funds are received, and outstanding liens, medical obligations, attorney fees, and case expenses are addressed.  The remaining balance goes to the client.  The important thing to understand is that a settlement is not simply about getting the biggest initial offer. It's about maximizing the client's overall recovery while properly resolving the financial obligations connected to the claim.

At Derek Hays Injury Law, we believe clients deserve to understand every step of the process. Since 1997, Mr. Hays has helped injured Georgians navigate complicated claims, insurance negotiations, and settlement issues.