Offers of compensation are determined by a variety of factors. Some of these factors include the adjuster or the company. First, when a claim for personal injury is made, the insurance adjuster assigned will estimate the claim's initial value based on the type of injury sustained and place that money on reserve. The insurance adjuster then makes check-ups every thirty (30) days to determine if the claimant has completed treatment, so the adjuster can modify the amount in reserve if need be.
Generally speaking, once a demand is made through an attorney, the insurance adjuster has a thirty (30) day period to respond or make a counter-offer, per Florida Statute. Now, just because the adjuster has thirty (30) days does not necessarily mean the offer will be made in that time frame. It could take more time, it could take less. Compensation offers are based on the adjuster's review of the medical records and respective itemized charges. Additionally, insurance adjusters review the claimant's recommended and completed course of treatment, pain and suffering, wage loss, prior injuries or claims for injuries, pre-existing injuries, and severity of impact versus treatment. Depending on the claimant, this type of review could take more than the thirty (30) days an insurance adjuster has, not to mention an insurance adjuster's level of authority. If an insurance adjuster requires approval from upper management before extending an offer, this can take additional time for an offer of compensation.
If an insurance adjuster does have complete authority to make a settlement offer, then that insurance adjuster may look at the total amount of medical expenses incurred and the available policy limits to determine whether or not the value of the claim is per the amount demanded. Because the insurance adjuster has full authority to extend an offer, this makes the time frame for the offer of compensation much shorter than the allotted thirty (30) period.
For instance, if someone is involved in a motor vehicle collision with another motorist that carries the minimal amount of state-required policy limits, $10,000.00/$20,000.00, and the injuries sustained require immediate surgical intervention. As a result, the expenses incurred for the initial medical treatment far exceed what the at-fault driver has available. Policy limit demands can take a bit of time, perhaps more than the allotted thirty (30) day time frame, because policy limit demands must go through an entire chain of command before an insurance adjuster can make an offer. Policy limit demands, common in motor vehicle collisions, generally consist of injuries such as fractures, broken bones, or surgical intervention.
Another substantial and incredibly crucial component determining how long it takes to receive an offer of compensation is the total amount of available policy limits. If a motorist is involved in a motor vehicle collision with more than one other motorist, and several parties sustain injuries, an offer for compensation may take additional time because all injured parties must have completed treatment before the insurance adjuster extending any offers for compensation. This is commonly called a “global settlement” and this type of claim is generally done on a pro-rata basis that is determined on the severity of the injury and medical expenses incurred by each injured party and the total available policy limits.
Furthermore, if the claimant has various or extensive personal injury claims, an insurance adjuster must research the types of prior injuries or pre-existing injuries and request additional or prior medical records before making an initial offer of settlement. Other determining factors that may exceed the thirty (30) day time frame may involve the medical provider administering treatment to the claimant. For instance, if a medical provider has been under close watch for suspicion of insurance fraud, an insurance adjuster may put a complete hold on any offer of compensation until the investigation on that medical provider is complete. These types of investigations can take up to more than a year to complete, making the time frame for compensation offers even longer.
Alternatively, if the insurance adjuster assigned to the personal injury claim has the authority to offer or immediately extend an offer, the insurance adjuster may propose compensation upon review of the medical records and itemized bills. As previously stated, offers for compensation can truly vary on the insurance adjuster assigned or the company that issued the insurance policy. Smaller or lesser-known insurance companies have insurance adjusters that may not necessarily be as responsive as the bigger and better-known insurance carriers, and as such, they do not respond to the allotted time frame. This requires the attorneys and their assistants to constantly reach out to them, making that time frame longer.
Offers of compensation for serious injuries may also take more than the thirty (30) day time frame because, perhaps due to the type of injury sustained or severity of impact, requires the assigned insurance adjusters to communicate with various departments of the insurance company, resulting in additional adjusters reviewing the medical records and bills submitted, which extend the time for an offer of compensation.
Aside from the allotted time frame provided by the Florida Statutes, insurance adjusters can take longer because it depends not only on the adjuster assigned or the insurance carrier that issued the policy but also on the claimant. Claimants that have extensive prior injuries, or even patterns that may indicate insurance fraud or treatment with providers that may be under investigation for suspicion of insurance fraud, can determine when that offer of compensation is made. Some insurance adjusters respond to demand with an offer of compensation well within the allotted thirty (30) day time frame, while others, taking the previously mentioned factors, can understandably exceed the given period.
