How Insurance Companies Really Evaluate Car Accident Claims

If you’ve been injured in a car accident, you might assume the insurance company will look at your medical bills, listen to your story, and come up with a fair settlement. Unfortunately, that’s not how it works.

Here’s the truth: insurance companies use software, not just people, to evaluate your claim. Programs like Colossus take your diagnosis codes, treatment history, and injury type, and calculate a number. That number usually has very little to do with how the injury has actually affected your life.  The software instead is designed to save the insurance company money by focusing on a few key pieces of information. 

The software looks at things like:

• What kind of doctors you saw

• How quickly you got treatment

• How long you treated

• Whether you had X-rays or MRIs

• Whether your injury shows up in objective findings

• Whether you were transported by ambulance

And if the software doesn’t like what it sees — or there are gaps or delays in care — it spits out a lower value.

The Insurance Company Will Also Try to Blame You

Another tactic they use is to argue that you were partially at fault for the crash. Under New Mexico’s comparative fault system, they can reduce your compensation by whatever percentage they say was your fault — even if it’s small.

Some common arguments we see:

• You were speeding

• You didn’t use a turn signal

• You “slammed on the brakes”

• You weren’t paying attention

• You made a bad lane change

• You could have avoided the accident

Even without solid evidence, they’ll try arguing comparative fault on you — because it saves them money.

Check out my article here for a more detailed explanation of comparative fault.

What Actually Makes a Difference In Your Claim

To get full value for your claim, we primarily focus on:

• Consistent medical care and documentation

• Objective findings like imaging or specialist evaluations

• Permanent impairment or long-term limitations

• Clear evidence that the other driver caused the crash

And if their software undervalues your case? That’s when we negotiate, apply pressure, and use the most beneficial combination of facts and New Mexico law to your advantage.  Our understanding of how insurance companies (and their software) value cases allows us to craft our arguments and positions to those items which add the most value to your claim. 

This is a key reason why it is important to have an attorney helping you.  If an insurance company uses these tactics against you and you do not have an attorney, then you’ll be forced to take their low ball offers.  

A Few Tips To Protect Your Claim

If you’re in treatment now, or helping someone who is, here’s what helps:

• Get medical treatment as soon as possible after the crash — delays can hurt your health and your claim

• Keep every appointment and follow your doctor’s advice

• Don’t minimize your symptoms — speak up so it’s properly documented

• Let us know how the injury is affecting your work, family, or routine

• Avoid talking to the other driver’s insurance — they’re not calling to help you

We know their system — and we’ve built one of our own to make sure you’re not undervalued or overlooked.

Need help? Have questions?

If you’ve been hurt in a car accident and aren’t sure what your next step should be, feel free to contact us.

Our dedicated personal injury team at The Injury and Disability Law Center is here to help. Call our office at 575-300-4000, start a chat, or fill out our online form to schedule your free initial consultation today. 

If you want even more information, feel free to check out my free book, Car Accident Cases Made Simple(r), where I discuss this topic and more.