The three questions every adjuster is answering
Does the policy respond? Was coverage in force, is the driver covered, does an exclusion apply. If the answer is no, nothing else matters.
Who is responsible, and how much? California applies pure comparative fault, so the output is frequently a percentage rather than a yes or no.
What is it worth? Medical expenses, wage loss, the nature and permanence of the injury, and the credibility of the documentation, measured against policy limits.
Every question an adjuster asks maps to one of these three. Recognizing which one a question belongs to tells you what the answer is being used for.
How injury claims actually get valued
Most carriers use claims evaluation software that reads coded entries from medical records — diagnosis codes, treatment types, visit counts, duration — and produces a suggested range.
This has a specific consequence: what is written in your medical record drives the number more than what you tell the adjuster. A symptom you reported that never made it into the chart does not exist for valuation purposes.
It also explains why treatment gaps hurt so much. The software reads a gap as an interruption in the injury, and no amount of explaining afterward changes what the record shows.
Software output is a starting range, not a final answer. Adjusters adjust it for factors the software cannot read, and those adjustments are where documentation and advocacy actually operate.
Reserves, authority, and why offers plateau
Early in a claim the adjuster sets a reserve — the amount the insurer books as its likely exposure. It is internal and you will never see it, but it anchors everything that follows.
Adjusters also have settlement authority up to a defined figure. Below it they decide. Above it, a supervisor or committee does.
This is why negotiations sometimes move fluidly and then stop dead at a particular number. The plateau usually means the adjuster has reached the edge of their authority, and moving past it requires someone else to re-evaluate the file. Documentation that justifies a higher reserve is what prompts that.
How to deal with an adjuster effectively
Be polite and brief. Hostility gives an adjuster a reason to slow-walk a file and never improves an evaluation.
Put everything in writing. Phone calls leave no record on your side and a complete record on theirs.
Answer what is asked and nothing more. Never guess at speed, distance or timing, and never describe a medical condition a physician has not yet diagnosed.
Decline what you are not required to give: a recorded statement to an opposing carrier, and a blanket medical authorization opening your entire history.
And keep the record clean, because the record is what gets evaluated. Consistent treatment, complete symptom reporting to your providers, and documented wage loss do more for a claim than any conversation with an adjuster ever will.
When the relationship is not the problem
Some claims are simply disputed. Liability is genuinely contested, the medical causation is genuinely arguable, or the policy limits are genuinely insufficient. No amount of rapport with an adjuster resolves those.
The signals that a file has reached that point: an evaluation that ignores documented treatment, a liability position unchanged by new evidence, an offer that does not move across multiple submissions, or a claim that goes silent for months.
At that stage the question stops being how to work with the adjuster and becomes what the claim is actually worth and how to establish it. That is a different exercise, and the two-year deadline under Cal. CCP § 335.1 keeps running throughout.
