Insurance adjusters evaluate a California car accident claim by answering three questions: who caused the crash, how badly the person was hurt, and how much the law and the policy allow them to pay. Every document you send, every statement you give, and every gap in your medical treatment feeds into that evaluation.
Most people only see the result, a settlement offer or a denial letter. The work that produced the number happens out of view. Knowing how it works helps injured people avoid the mistakes that shrink a claim before it ever reaches a lawyer.
The defense side of that process is rarely explained by people who have seen it firsthand. Brett Sachs, founder of the California car accident lawyers at MVP Accident Attorneys, spent part of his early career at an insurance defense firm representing some of California’s largest medical providers before moving to the plaintiff side. That kind of dual experience is useful here, because the steps below are the same ones insurers use whether a claim comes from Los Angeles, Irvine, Sacramento, or Riverside.
Step 1: The Adjuster Decides Who Was at Fault
The first question is liability. The adjuster reviews the police or CHP collision report, photos, vehicle damage, statements, and any video.
California uses pure comparative fault. Your damages are reduced by your percentage of blame, but you are not barred from recovery even if you were mostly at fault. That rule shapes adjuster strategy. Instead of denying a claim outright, an adjuster may try to assign you 20%, 30%, or 40% of the fault to cut the payout.
What helps: Clear photos of lane positions, damage on both cars, and witness contact information taken at the scene.
Step 2: The Adjuster Asks for a Recorded Statement
Soon after the crash, the other driver’s insurer may call and ask to record your account. You are generally not required to give a recorded statement to the other driver’s insurance company.
Adjusters use these statements to look for:
- Admissions, such as “I didn’t see them” or “I’m sorry”
- Statements that you feel fine or were not hurt
- Details about speed, phone use, or distractions
- Differences from what you later tell doctors
Your own policy may require you to cooperate with your insurer. That is a different situation from talking to the other side.
Step 3: The Adjuster Reviews Your Medical Records
The second big question is damages. Adjusters look closely at:
- When you first got treatment. A delay of days or weeks is often used to argue the crash did not cause the injury.
- Gaps in treatment. Missing appointments can be used to argue you recovered.
- What you told providers. Notes that mention an old injury or a later accident get flagged.
- The type of injury. Soft tissue injuries are valued lower than fractures or injuries confirmed by imaging.
Some insurers use claims software, such as programs like Colossus, to help score injuries based on the codes and notes in medical records. The way treatment is documented can matter as much as the treatment itself.
Step 4: The Adjuster Applies California Damages Rules
California has several rules that directly change what an adjuster will pay.
Medical Bills Are Measured by What Was Actually Paid
Under the California Supreme Court’s decision in Howell v. Hamilton Meats & Provisions (2011), recovery for past medical bills is generally limited to the amount actually paid or owed, not the higher amount first billed. Adjusters build this into their numbers.
Uninsured Drivers Lose Pain and Suffering
Under Proposition 213, now California Civil Code Section 3333.4, a driver who was uninsured at the time of the crash generally cannot recover non-economic damages, like pain and suffering, from the at-fault driver. They can still recover economic losses like medical bills and lost wages. Adjusters check this early.
Policy Limits Set a Ceiling
California raised its minimum auto liability limits in 2025 to $30,000 per person, $60,000 per crash, and $15,000 for property damage. If the at-fault driver carries only the minimum, the adjuster’s offer will usually be capped there, even if the injuries are worth more. That is when your own underinsured motorist coverage matters.
Step 5: The Adjuster Considers Who Is Representing You
Adjusters weigh the risk of a lawsuit. A claim with organized medical records, clear liability evidence, and a demand that cites California law is harder to undervalue. Insurers also track which law firms take cases to trial and which tend to settle quickly.
What Deadlines Must California Insurers Follow?
California regulates how insurers handle claims through the Fair Claims Settlement Practices Regulations, enforced by the California Department of Insurance. Key rules include:
- Acknowledgment: An insurer generally must acknowledge a claim within 15 calendar days.
- Decision: It generally must accept or deny a claim within 40 days after receiving proof of the claim, or explain in writing why it needs more time.
- Written denials: A denial must be in writing and explain the reasons.
If an insurer ignores these rules, you can file a complaint with the California Department of Insurance.
How Can You Protect Your Claim From Day One?
You can protect your claim by giving the adjuster less to argue with.
- Get medical care right away and follow your treatment plan.
- Tell every provider about the crash and all of your symptoms.
- Keep copies of the collision report, photos, and repair estimates.
- Avoid giving a recorded statement to the other driver’s insurer before getting advice.
- Do not post about the crash or your injuries on social media.
- Track missed work, mileage to appointments, and out-of-pocket costs.
- Do not sign a release or accept a check until you know the full extent of your injuries.
How Long Do You Have to File in California?
Most California personal injury lawsuits must be filed within two years of the crash. Property damage claims generally have three years. Claims against a city, county, or state agency usually require a written government claim within six months.
The insurance claim process does not pause these deadlines.
Insurance Adjusters Want the Lowest Claim Possible
- Adjusters evaluate fault, injuries, and the legal and policy limits on what they can pay.
- California’s pure comparative fault rule leads adjusters to argue over percentages rather than deny claims outright.
- Medical records drive value, and delays or gaps in treatment are used to lower offers.
- Howell limits medical bills to amounts actually paid, and Proposition 213 bars uninsured drivers from recovering pain and suffering.
- California regulations require insurers to acknowledge claims within 15 days and generally decide within 40 days.
An adjuster’s job is to close the claim for as little as the facts allow. Understanding how they reach a number is the first step to making sure the facts support a fair one.