You open the envelope, read the settlement number, and feel the shock immediately. The figure the adjuster put on your car accident claim looks nothing like the reality of your injuries, your medical bills, or the weeks you lost.
That number is not a guess or an insult. It is the output of a specific process the adjuster follows every day, one built from measurable inputs and internal rules that most claimants never see. The offer reflects what the adjuster has been authorized to pay at that moment. That figure is rarely the same as what the claim is worth.
Understanding how that evaluation works puts you in a far stronger position. When you know which inputs move the number and which behaviors quietly lower it, you can present your claim in a way the adjuster’s system is forced to take seriously.
A car accident attorney has built thousands of claims against that exact framework. The right attorney acts as a translator between what you lived through and what the adjuster’s system measures, and their involvement changes the calculation itself.
The adjuster evaluates your claim using a system. An attorney who understands that system builds your claim to beat it.
The Step-by-Step Process Adjusters Follow
Every car accident claim moves through the same sequence as the adjuster works to evaluate it. The final number is built one stage at a time. Knowing where you are in that sequence tells you what the adjuster is doing and what comes next.
The process runs from the moment the claim is reported through to the day the file is closed. The adjuster investigates fault, reviews your medical treatment, calculates damages, and then asks a supervisor for permission to offer a specific amount.
That request for permission is the stage almost no claimant sees, and it is where the ceiling on your offer is set. The steps below trace the full pipeline so that the offer you receive, seen in full context, stops being a mystery.
From First Notice of Loss to Investigation
The process begins with first notice of loss, the moment the accident is reported and the claim is logged in the insurer’s system. From that first contact, the adjuster starts building a file that will follow the claim to the end.
Next comes the investigation. The adjuster gathers the police report, scene photographs, and any witness statements, and often calls to request a recorded statement from you. Everything collected here becomes raw material for the valuation that follows. The earliest days of a claim carry more weight than most people expect.
Liability, Medical Review, and Damages
With the investigation assembled, the adjuster turns to fault. Liability determination fixes who caused the crash and by what percentage, and under Texas comparative fault that percentage directly scales the payout.
The adjuster then reviews your medical records for treatment type, duration, consistency, and total cost. Those records feed the damages calculation, which separates economic damages such as bills and lost wages from non-economic damages such as pain and suffering.
The medical total anchors the entire number. How your treatment reads on paper, more than how you actually felt, shapes everything the adjuster calculates downstream.
Authority Requests and Settlement
Here the process turns internal. Before making an offer, the adjuster submits an authority request, asking a supervisor to approve a settlement figure within an assigned range. The number you first hear is the bottom of that authorized band, not the adjuster’s honest read of your claim.
Settlement negotiation follows, the back-and-forth between that opening offer and a final resolution. If agreement is reached, the claim moves to closure with a payment and a signed release that ends the file for good.
The pressures on the adjuster shape all of this. A single adjuster may carry well over a hundred open files at once, with internal targets that reward fast, low-cost closures. Knowing an authority range and a heavy caseload sit behind the number tells you the first offer is rarely the last, and rarely the adjuster’s real read of your claim.
What Factors Drive the Adjuster’s Valuation
Once the pipeline is clear, the next question is what adjusters look for and what moves the number. A handful of factors carry most of the weight, and each one pushes the valuation up or down in a way the adjuster can defend to a supervisor.
Liability percentage sits at the top. Because Texas reduces recovery by your share of fault and bars it past 50 percent, shifting blame toward you is the most valuable move an adjuster can make. A few percentage points can swing the number by thousands.
Medical specials, the total of your treatment bills, anchor the rest of the calculation. Adjusters apply a rough multiple to that total to estimate pain and suffering. The type of care counts as much as the amount. Treatment from an orthopedist or surgeon is weighted more heavily than the same dollar value of chiropractic visits.
Consistency is its own factor. Gaps in treatment read as a minor injury, and prior imaging lets the adjuster blame your pain on a pre-existing condition rather than the crash.
The nature of the injury drives the widest swings. A soft-tissue strain is valued far below a fracture, and adjusters lean on property damage as a proxy in the low-impact assessment, arguing that light vehicle damage means light injuries. The same logic drives valuations in heavier commercial truck claims.
That proxy is weaker than it sounds, since modern bumpers can hide serious force, but it anchors the adjuster’s first read anyway.
Future medical needs work in the other direction. A documented projection of surgery, ongoing therapy, or permanent impairment pulls the number back up. A claim assessment that stops at today’s bills leaves real money on the table.
Claims-Handling Software and Algorithmic Valuation
For a large share of claims, the first valuation is not made by a person at all. Major insurers run claim data through software that assigns a dollar range before the adjuster applies judgment, and that output quietly sets the terms of everything that follows.
The programs are built to standardize payouts across thousands of adjusters, which sounds neutral until you see what it rewards. The software prizes documentation it can code and count, and it discounts anything it cannot, pushing certain real injuries below their actual worth.
Understanding how these tools work explains why two people with similar pain can receive very different offers. It also points to the one thing that reliably moves the software’s number: a demand package built to speak its language.
How Colossus and Similar Tools Assign Value
The most widely used of these programs is Colossus, which several large carriers rely on to value bodily injury claims. It works by converting your file into coded inputs, matching your diagnoses and treatment against a library of roughly 600 injury codes and thousands of built-in rules.
From those inputs it produces a suggested settlement range that becomes the baseline for the adjuster’s authority request. Because the number reflects only what was entered, a claim documented in the software’s preferred terms scores higher than an identical injury described in plain language. The output is only as strong as the file fed into it.
Why Soft-Tissue and Chiropractic Claims Get Discounted
Soft-tissue injuries and chiropractic care fare worst under this kind of software. Sprains, strains, and whiplash lack the clear imaging and objective findings the programs reward, so they are scored low almost automatically, regardless of the pain they cause.
Chiropractic treatment is discounted the same way, treated as low-value care even when it is exactly what the injury required. The system undervalues a whole category of genuine injuries because they do not fit the data fields the program measures.
A claimant with real, lasting pain can watch the number stay low for reasons that have nothing to do with the truth of the injury.
How a Demand Package Forces a Manual Override
The software can be beaten, but only with a file built to answer it. A strong demand package documents the injury in the objective terms the program weights heavily, with imaging, specialist findings, and a clear causation record tied to the crash.
It also supplies what the software cannot measure on its own, including the effect on work and daily life, so the adjuster has grounds to request authority above the baseline.
A well-built package arrives in a predictable order: a liability summary, the full medical record with billing, a wage-loss calculation, and a specific demand figure supported by each. That structure forces the adjuster to answer the claim point by point rather than hide behind a single software number.
Some attorneys argue that leaning on that output to deny a fair evaluation can amount to bad faith, though that remains a contested position rather than settled law.
How the Recorded Statement Shapes the Evaluation
The recorded statement is one of the most important inputs the adjuster collects, and it is gathered early on purpose. Within days of the crash, before you know the full extent of your injuries, the adjuster asks to record your account. That recording becomes the fixed reference point everything else is measured against.
The questions are shaped to produce answers that lower the evaluation. You are asked how fast you were going or how you feel right now, when you cannot answer precisely. A cheerful “I’m okay” at the scene, offered out of shock or politeness, becomes a note that your injuries were minor.
The damage surfaces later, when the adjuster lines your statement up against your medical records. If you said you felt fine but sought treatment a week later, that gap reads as inconsistency rather than the normal delayed onset of pain.
This is why represented claimants are advised not to give recorded statements to the other side’s insurer. There is no legal duty to provide one to the at-fault driver’s company.
If you already gave a statement you worry about, it is not the end of the claim. An attorney can obtain the recording, identify the answers the adjuster is likely to use, and place them in context with medical evidence gathered afterward.
How Legal Representation Changes the Adjuster’s Evaluation
The single change that most alters an adjuster’s evaluation is the arrival of a lawyer. It shifts the file from a claim the insurer expects to settle cheaply into one that carries litigation risk, and that risk is priced into every number that follows.
An unrepresented claimant is unlikely to file suit, and the adjuster knows it. A represented claimant can. The insurer now weighs the cost of defending a lawsuit in the Harris County courts, where a Houston jury may hear it, and the exposure that carries. That calculation often unlocks a higher authority range than the adjuster could request before.
The Insurance Research Council, an industry-funded group, has reported that represented claimants recover several times more on average than those who go it alone. The figure is debated and newer analyses complicate it, but the direction has held for decades.
The mechanism counts more than any single number. An attorney controls the information the insurer receives, declining the recorded statement and the blanket authorization that would otherwise feed the evaluation. The demand package arrives built to the adjuster’s own criteria, and the option to escalate to a lawsuit is real.
None of this rests on intimidation. It rests on changing the inputs the adjuster’s model runs on, and on making a low offer cost the insurer more than a fair one.
How Johnson Garcia LLP Can Help With Your Claim
An adjuster values your claim through a specific, learnable process, and understanding it is the first step to a better outcome. Software sets a baseline, authority limits cap the offer, and the way your claim is built can move both.
The lawyers at Johnson Garcia LLP bring over 35 years of experience and more than $200 million recovered for Texas clients. The firm builds demand packages that address every factor the adjuster measures and gives the insurer a reason to move off its opening number.
Call 832-844-6700 or reach out online for help navigating a Houston car accident insurance claim.
