How Insurance Companies Evaluate Your Injury Claim — And What You Can Do About It

Before I became an attorney, I spent over 20 years working inside major insurance companies — DaimlerChrysler, Winterthur Swiss, and a KKR-owned national insurer. I reviewed claims. I evaluated reserves. I watched adjusters make decisions about what cases were worth and how aggressively to defend them.

That experience is now the most valuable thing I bring to every injury case I handle. I know exactly how the other side thinks — because I used to be the other side.

Here is what happens when you file a claim after an accident in Michigan.

The Adjuster Opens a File the Same Day

The moment your claim is reported, an adjuster is assigned and a reserve is set. That reserve is the insurance company’s internal estimate of what your claim is worth. It is set early — often within 48 hours — based on limited information: the police report, your initial statement, and whatever the insured told their agent.

That early reserve matters more than most people realize, because adjusters are evaluated in part on how closely their reserves match their final payouts. There is institutional pressure to keep reserves conservative. The initial offer you receive is almost always anchored to that early reserve.

Three Things That Drive Their Valuation

Insurance companies do not evaluate claims the way most people think. They are not simply looking at your medical bills and multiplying by some factor. The factors that actually move the needle internally are:

Liability clarity. How clean is the negligence story? If there is any argument that you were partially at fault, the reserve goes down. Michigan is a comparative fault state, which means your recovery can be reduced by your percentage of fault. Adjusters know this and they will look hard for anything that shifts blame toward you.

Medical documentation quality. Gap in treatment? That is a problem. Inconsistent complaints across different providers? That is a problem. Adjusters are trained to look for documentation that does not support the injury story. Consistent, well-documented medical records are worth more than the same injuries with spotty documentation.

The attorney factor. Claims represented by attorneys settle for more. This is not an opinion — it is documented across the industry. Adjusters know that an unrepresented claimant is less likely to understand the full value of their claim, less likely to know the litigation risks the company faces, and more likely to accept a quick settlement to be done with it.

What You Should Do Immediately After an Accident

Get medical attention the same day, even if you feel you can manage. Do not give a recorded statement to the other party’s insurance company without counsel — they will use anything you say to minimize the claim. Document everything: photos, names of witnesses, the specific road conditions. And call an attorney before you accept any offer.

The insurance company will be pleasant. They will tell you they want to resolve things quickly. They may send a check within days. That check is almost never full value. Once you cash it and sign the release, the claim is closed. There is no reopening it.

The Insider Advantage

When I take an injury case, I am not guessing about how the other side thinks. I know how their reserve system works. I know how claims escalate internally when litigation becomes likely. I know which arguments move adjusters and which ones do not. That knowledge changes the negotiation.

If you or someone in your family has been injured in an accident in West Michigan, I am happy to talk through the situation at no cost. Understanding what your claim is actually worth — and how the insurance company is thinking about it — is the starting point for everything that follows.

This article is for informational purposes only and does not constitute legal advice. Contact Sheridan Haddock PLLC to discuss your specific situation.