InjuryCompass Editorial Team · Last reviewed October 29, 2026 · How we research
Every step of that line is a judgment call made from your claim file. The rest of this guide shows what goes into each one, and what you can control.
When an insurer values a car accident injury claim, there is no secret price list, but there is a fairly predictable process. An adjuster decides how much of the crash was their driver’s fault, confirms how much coverage exists, sets aside a reserve, reviews your medical records, often runs them through claims evaluation software, and then negotiates within the authority their manager gives them. Knowing that process will not guarantee a number, but it explains why two people with the same medical bills can receive very different offers.
Inside the claim file: seven steps from crash to offer
- 01
Liability decision
The adjuster reads the police report, photos, statements and vehicle damage, and decides what percentage of the crash was their policyholder’s fault. In most states your share of fault reduces what you can recover, and in a few it can bar the claim entirely.
You control: photos, witness names and the police report number, gathered early. - 02
Coverage check
They confirm the at-fault driver’s policy was active and note the per-person bodily injury limit. As of July 2024, 35 states plus D.C. set the minimum at $25,000 per person (Insurance Information Institute), and many drivers carry only the minimum.
You control: checking your own underinsured motorist (UIM) coverage. - 03
Reserve
Insurers set aside a case reserve, an internal estimate of what the claim will cost, as soon as the claim is opened, and adjust it as information arrives. Industry guidance describes it as gross value multiplied by the insurer’s share of liability: a $10,000 claim at 75% liability becomes a $7,500 reserve.
You control: sending complete records early, so the reserve reflects the real injury. - 04
Medical records review
The adjuster checks that each treatment is related to the crash, reasonable and continuous. Delays before the first visit and gaps between visits draw the most scrutiny.
You control: following your doctor’s plan and explaining any gap in writing. - 05
Evaluation software
Many large insurers use programs such as Colossus. The adjuster enters diagnosis codes, treatments, duration and any permanent impairment, and the software suggests a range for general damages.
You control: making sure every diagnosis and symptom is in your records. - 06
Authority and negotiation
The adjuster can usually settle only up to the authority set by a supervisor, often tied to the evaluation range. A first offer near the low end is common; new evidence is what moves the range, not repetition.
You control: a demand letter that answers the weak points before they raise them. - 07
Release and payment
When you accept, you sign a release that ends the claim for good. Health insurers, Medicare or Medicaid and medical providers may have liens to be paid from the settlement first.
You control: not signing until treatment ends or your future care is estimated.
What adjusters count, and what they discount
Claims software and the adjusters who use it reward objective, documented injuries and steady medical care. These are the factors most often described by former adjusters and in litigation over these programs.
| Factor in your file | Usually | Why it matters to the adjuster |
|---|---|---|
| Fracture, herniated disc on imaging, organ injury | Raises value | “Demonstrable” injuries are scored higher than sprains and strains because they show up on tests. |
| Ambulance transport or hospital admission | Raises value | Shows the injury was serious from the start. |
| Care from a medical doctor or specialist | Raises value | Weighted above chiropractic care alone; therapy usually counts most when a physician referred it. |
| Formal permanent impairment rating | Raises value | One of the heaviest factors after injury severity itself. |
| Late first visit | Lowers value | Opens the argument that something else caused the injury. |
| Gaps in treatment | Lowers value | Read as the injury having healed, even if you could not get an appointment. |
| Very long passive care, such as months of chiropractic only | Lowers value | Care beyond what the program treats as typical is often rejected as excessive. |
| Prior injury to the same body part | Lowers value | Lets the insurer argue that only a worsening, not the whole injury, came from the crash. |
Based on Nolo’s summary of how Colossus-type programs weigh claims (updated March 2024). Each insurer configures its own system, and internal rules are not public.
Read your claim like an adjuster
Enter your numbers and the facts of your file. The worksheet shows how an adjuster would likely frame the claim, which flags they would raise, and which documents to gather before you send a demand.
General damages use illustrative bands of the common 1.5 to 5 multiplier rule of thumb (1.5 to 2 for soft tissue, 2 to 3 for injuries seen on imaging, 3 to 5 for surgery or permanent impairment); red flags pull the range toward its low end. Insurers’ own software and rules differ.
For a full estimate with future medical costs and underinsured coverage, use our car accident settlement calculator, and see the pain and suffering calculator for the multiplier and per diem methods side by side.
Myths about how insurers calculate settlements
Your rights when you think the offer is too low
Many states base their claims rules on the NAIC Unfair Claims Settlement Practices Act. Among the practices it lists as unfair are not attempting in good faith to settle promptly and fairly once liability is reasonably clear, and failing to give “a reasonable and accurate explanation of the basis” for a denial or a compromise offer.
In practice: ask the adjuster in writing to explain how they reached the number, which treatments they excluded and why. If the insurer does not respond, you can file a complaint with your state’s department of insurance. Strictly, these rules protect the insurer’s own policyholders, and how they apply to a third-party claimant varies by state.
Questions people ask
Can I ask if they used Colossus?
Yes, you can ask, and you can ask for the valuation range. Insurers often decline to share it, but asking for a written explanation of the offer is always reasonable.
Do they use billed or paid medical amounts?
Adjusters often look at what was actually paid. Whether a jury could hear the full billed amount depends on your state’s collateral source rules.
How long until I get an offer?
Usually not until your treatment ends or your doctor says you have reached maximum improvement. Our claim timeline guide breaks down each phase.
What if I was partly at fault?
Your recovery is reduced by your share in most states, and barred above a threshold in modified-fault states. In a few contributory negligence jurisdictions, any fault can bar the claim.
Does a recorded statement hurt my claim?
You generally do not have to give the other driver’s insurer a recorded statement. Anything you say about fault or how you feel can be used in the evaluation.
When should I talk to a lawyer?
When injuries are serious, fault is disputed, the policy limit is lower than your losses, or the insurer denies the claim. Most offer a free consultation; see what a lawyer costs.
The bottom line
Insurers calculate car accident settlements from your file, not from your story: accepted medical costs and lost income, a general damages range scored from your records, a cut for any fault they assign to you, and a ceiling set by the policy limit. The parts you can influence are the records and the evidence, so the most valuable work happens before you send a demand.
Request your complete medical records and itemized bills, and get the police report.
Ask the at-fault driver’s insurer for the policy limit in writing and check your own UIM coverage.
Wait until treatment ends, check for liens, and get any reduction explained in writing.
Related guides
- Car Accident Settlement Calculator
- Average Car Accident Settlement by Injury
- Comparative Negligence by State
- How to File a Car Accident Claim
- Pain and Suffering Calculator
This guide is general information, not legal advice. InjuryCompass is not a law firm and does not evaluate individual claims. Insurance rules and fault laws vary by state; for advice on your situation, speak to a licensed attorney in your state.
Sources
- Insurance Research Council, “Auto Injury Insurance Claims: A Study of Increasing Claim Severity”, press release, July 30, 2026: insurance-research.org
- Highway Loss Data Institute, “Bodily injury liability: 2022 to 24 models”, loss facts, December 2025: iihs.org
- Michael Murdock, “Setting It Aside” (case reserves), CLM Magazine, November 28, 2012: theclm.org
- Nolo, “How the Colossus Computer Program Estimates Accident Settlement Values”, updated March 21, 2024: nolo.com
- NAIC, Unfair Claims Settlement Practices Act (Model Law 900), Section 4: content.naic.org
- Insurance Information Institute, “Automobile financial responsibility laws by state”, July 2024: riskeducation.org