Where This Fits in the Claim Process
An “evaluation” is typically the insurer’s internal value range or offer based on the records it has, how it views fault, and how it expects a jury might react. This usually happens after the insurer has some medical records and bills, and it may happen before your treatment is fully documented or before all wage-loss proof is in. A low evaluation often means the insurer believes something is missing, unclear, or disputed—not necessarily that your injuries are being ignored.
Practical Steps That Usually Help
- Get the insurer to explain the “why” behind the number: Ask what it accepted and what it discounted. Common sticking points include whether all visits were related, whether the treatment was “reasonable and necessary,” whether there were gaps in care, and whether the insurer is applying a fault argument.
- Strengthen the documentation (without overcomplicating it): A well-organized package often helps more than more pages. This usually includes (a) a clean treatment timeline, (b) complete records and bills, (c) a wage-loss statement or other proof of missed work, and (d) a plain-English summary of how the injuries affected daily life.
- Address causation head-on: If the insurer is implying the treatment was unrelated (or partly unrelated), the response should tie symptoms to dates, visits, and objective findings where available. Consistency across records matters.
- Be careful with statements and “quick calls”: Low evaluations sometimes come with pressure to “just talk it through” or to give another recorded statement. In many cases, it is safer to keep communications controlled and documented so the claim file does not end up with inconsistent descriptions of symptoms or limitations.
- Evaluate risk points unique to North Carolina: North Carolina follows contributory negligence in most negligence cases. That means if the insurer believes it can prove you were even slightly at fault, it may argue that recovery is barred. A low evaluation sometimes signals the insurer is leaning on a contributory negligence defense.
- Consider escalation paths (without threats): If the adjuster is not engaging, your attorney can request supervisor review or send a more formal written response that clearly states what evidence supports a higher valuation and what issues still need to be resolved.
Common Mistakes to Avoid
- Negotiating without knowing what’s missing: If you do not know whether the insurer is discounting treatment, wage loss, or pain-and-suffering support, you can waste time arguing the wrong point.
- Letting the claim file become inconsistent: Off-the-cuff explanations about symptoms, prior issues, or activity levels can be misunderstood or later used to challenge credibility.
- Assuming “more treatment” automatically increases value: Insurers often focus on whether treatment looks medically connected and reasonable for the mechanism of injury and the documented findings, not just the number of visits.
- Waiting too long to protect deadlines: Negotiations can take time. You do not want ongoing back-and-forth to push you close to a filing deadline.
How This Applies
Apply to your facts: Because the evaluation was based on treatment (including chiropractic care), wage loss, and pain and suffering for injuries involving multiple body areas, a productive next move is usually to (1) confirm the insurer has all records and itemized bills, (2) provide a clear wage-loss verification, and (3) present specific, consistent examples of daily-life impact tied to the treatment timeline. If the insurer is discounting certain visits or questioning whether all complaints relate to the incident, your response should directly address those causation and reasonableness points with a clean chronology and supporting documentation.
Conclusion
If the insurer’s evaluation feels too low, focus on why it is low and respond with organized proof that addresses the insurer’s specific concerns—especially causation, wage loss documentation, and a clear picture of how the injuries affected your life. In North Carolina, fault arguments can also heavily influence valuation, so it helps to keep communications consistent and well-documented. One practical next step is to have your attorney request the insurer’s written explanation of the valuation assumptions and then submit a targeted, evidence-backed response.
