10 Steps to Accurate Low-Impact Injury Assessments

By following a simple ten-step plan, insurance carriers will be able to sort through the facts, conduct more consistent investigations, and achieve more accurate outcomes. Select the "Next" button at the bottom right to review the steps.

1. Triage claims at the outset of the loss. Focus on key elements of the property damage such as damage to any sheet metal and drivability. Gather information from all involved parties to understand early on if there was meaningful property damage. 

2. Get the right claim to the right person. Let's face it; not all claims are the same. At times, it is beneficial to have a specific workgroup with niche expertise and local claims knowledge, as well as a proficiency in both material damage and medical claims adjusting. 

3. Obtain a recorded statement of all involved parties, including claimants, occupants and witnesses. Ask critical questions about the events leading up to, during and after the accident. Establishing a mechanism for injury is crucial. If at all possible, meet the parties involved face-to-face in order to assess credibility. Key aspects of the claimant statement should include:

1. The facts of the loss.
2. A description of the scene.
3. Other party description.
4. Medical provider description, directions and procedures.

4. Physically inspect all vehicles involved in the accident. Identify the principle direction of force.  Observe force lines, abrasions, and metal folds. Be sure to check for multiple impacts and pre-existing damage. Also consider the vehicle movement at impact and compare that to what was reported in the claimant statements. Was the vehicle stopped or moving? Did the front end dip from braking? Is the damage consistent with the specified speed? Does the damage match the striking object? Are there appropriate pain transfers? 

5. Obtain quality photographs. A cornerstone of a good low-impact investigation must include photos of both vehicles, as it is possible to have significant damage to one car and virtually none to the other. For example, a Ford Focus that rear-ended a full-size Chevy pickup would ride under the truck, resulting in extensive front-end damage to the Ford and virtually no rear-end damage to the Chevy.  Each vehicle should be photographed from multiple angles at a distance in order to capture the entire vehicle. Both involved vehicles should be photographed from the same distance. 

6. Measurements of the damage are critical as well, as these can not only validate the two cars indeed struck one another, but also can provide a biomechanical engineer with critical data when determining the velocity and resultant G-Forces exerted on the occupants who are claiming injury. When possible, have the measuring device in the photographs.  

7. Complete index/background checks on all parties to the accident. This step is critical to ruling out known associates or links to other parties with a questionable claims history. During this stage of the investigation, identify possible parties who can be contacted to corroborate the presented medical history, such as neighbors, co-workers or ex-spouses. In addition, look for professional licensure so as to validate any inability to work that may be presented.  

8. Have an early settlement or cash out strategy. While many low-impact claimants seek early attorney representation, not all do. It is imperative to have a strategy to resolve the claims early, and for a reasonable cost. Of course, reasonable is somewhat subjective and is very venue-specific. This is why leveraging local counsel and adjusters with local claims knowledge is crucial to achieving a quality outcome. Try to get a handle on what the claimant is seeking to resolve the claim. Sometimes it is as simple as having a doctor visit paid for, other times it may be significantly more. 

9. Effective negotiation is the key to resolving these claims. Whether represented or unrepresented, it is imperative that solid negotiations take place. Recognize that the client is telling people they are hurt and this will be reflected in the medical records and in a dialogue with the attorney. This is why assessing credibility early on is very important. Make an early offer and advise that it is final absent objective evidence to the contrary that can be attributed to the claim at hand. 

Attorneys should know the limitations of a case if the facts are presented properly. Chances are the attorney never saw the claimant vehicle, so providing 8 x 10 color photographs early in the claims cycle can be very beneficial. Juries rarely are sympathetic to low-impact cases, recognizing that these types of opportunistic claims are what drive up their premiums. Attorneys are well aware of this phenomenon.  

If the case persists, then request an independent medical exam and request a medical history. For these types of claims, asking for a twenty year history is not unreasonable. There can also be significant benefit to enlisting the help of a biomechanical engineer to affirm or refute the mechanism of injury. Surveillance can be beneficial if someone involved in the accident claims he or she is unable to work or perform other activities because of injury sustained in the accident. 

10. Reviewing the claimant's demand. While some of these negotiation strategies may succeed in resolving claims early, there will be other times when the claimant or their legal counsel insists on pushing forward. In such instances, the adjuster will ultimately be presented with a demand. It is critical to effectively review the demand with a three-pronged approach for resolution: 

The first consideration is liability. It is crucial that liability be established and argued. Short or a rear end accident, there is likely comparative negligence involved as many low impact losses occur in parking lots, intersections or during lane changes in heavy traffic. This is an area where carriers often struggle, assessing comparative on only 3 to 5 percent of all claims presented, while juries consider it one more than half of all cases adjudicated. 

Then there are special damages. Just because the medical specials are presented doesn't mean that they are reasonable. It is critical to dig into the medical specials to see if bills are reasonable for the zip code where treatment occurred. Moreover, were bills upcoded or unbundled? Was there modifier abuse? Where global surgical edits properly used? This is a daunting challenge for adjusters who are already busy, but there are proven solutions to assisting the adjuster with this task. This can provide a tremendous lift, as presented specials can range between 30 and 50 percent more than what is reasonable for consideration.

The adjuster must also look at general damages. Like liability and specials, generals need to be factored in. Is pain and suffering owed for the particular case being evaluated? Is the venue liberal or conservative? In some states, the tort threshold must be pierced.  

By developing a solid third-party strategy for low-impact claims, carriers can derive a significant benefit while gaining a competitive edge in the marketplace. 

Christopher Tidball is a claims consultant, author and speaker. He is a veteran of the insurance industry, having held multiple adjusting, management and leadership roles for various Top 10 P&C organizations. To learn more, visit www.christidball.com.