The ability to accurately evaluate a claim is the most essential professional skill for liability claim adjusters. No checklist, computer program, or actuarial data can replace the human skills necessary to analyze information and generate a reliable value for a personal injury or a wrongful death claim. Evaluating a claim is as much art as it is science. It requires a well-trained, experienced professional to be done properly. The evaluation of every claim starts with obtaining as much information as possible about the claim. That information is then examined under the harsh light of two primary factors: fault and damages. The adjuster's evaluation skills become critical when it is time to examine the facts in minute detail, including an infinite number of subcategories that affect the two primary factors. Those subcategories are too numerous to list. They tend to vary widely with each claim because no two claims are identical. However, one critical factor is necessarily present in every claim and may be more important than any other: Where will the claim be brought?

Often, location is viewed as a static background fact that determines nothing more than the geographical assignment of the claim, the applicable legal principles — pure comparative, modified comparative, or contributory — and the choice of legal counsel. However, just as in the real estate business, "location, location, location" is a critical factor in evaluating a liability claim. Certain geographical areas, such as Chicago, Appalachia and south Texas, are well-known as notoriously plaintiff-friendly venues. Because the value of a claim is driven by the prospective result of future litigation, the evaluation process must include an investigation and careful consideration of the characteristics of the jurisdiction where that litigation would take place.

As an example, let's take a routine personal injury claim arising from a disputed lane-change motor vehicle accident. Assume that both involved vehicles had non-intrusive sheet metal damage and were driven from the scene. Our hypothetical claimant immediately complained of neck pain and an MRI revealed a herniated cervical disc. Conservative therapy was ineffective, so the claimant underwent cervical fusion surgery six months after the accident. Her attorney claims that she has incurred $55,000 in medical expenses. Of course, much more information is needed to accurately evaluate the claim. What are the most important additional facts would you need in order to evaluate this claim? Perhaps her medical history, medical prognosis, and her employment status will be necessary? You might also need a credibility comparison between the claimant and your insured driver. All of that information is essential, but none is as vital to the evaluation as the characteristics of the venue where the claim would eventually be litigated.

Want to continue reading?
Become a Free PropertyCasualty360 Digital Reader

  • All PropertyCasualty360.com news coverage, best practices, and in-depth analysis.
  • Educational webcasts, resources from industry leaders, and informative newsletters.
  • Other award-winning websites including BenefitsPRO.com and ThinkAdvisor.com.
NOT FOR REPRINT

© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.