An insurer does not judge an auto accident claim in one sitting. It scores the file part by part. As an auto accident lawyer in Houston, we take each of those parts in turn: what the adjuster looks for, why it matters under Texas law, and what our attorneys, most of whom once worked for insurers, do about it.
Automobile Accident Lawyers Houston is published by LAWBOSS – Harris, Nelsen & Uvalle, PLLC, and the people who handle calls from this site work out of our Houston office on Memorial Drive, beside Memorial Park and just west of downtown. Jonathan Harris, who leads the firm’s litigation from that office, is the attorney responsible for this site and everything written on it.
Why we describe the claim from the insurer’s side of the desk
Before he joined our firm in 2017, Jonathan Harris spent more than a decade as a senior trial attorney for a major automobile insurance company. Ian Nelsen handled claims as an adjuster before he defended insurers in court as an attorney. Howard Hill put in over 20 years with two of the nation’s largest auto and commercial insurance carriers. Each of them has worked inside the process that decides what an injured driver is offered.
What that work teaches is that the claim is not one big question about whether you were hurt. It is a string of smaller questions, and each answer moves the file up or down. A Houston auto accident lawyer who has asked those questions for an insurer knows which answers count. Below are the parts an adjuster examines, in about the order they come up, and the work we put against each one.
Liability: how much of the crash the insurer can put on you
Fault comes first because Texas ties the money to it. Under Civil Practice and Remedies Code section 33.001, a claimant whose percentage of responsibility is greater than 50 percent may not recover damages. Under section 33.012, a claimant at 50 percent or less does recover, but the amount is reduced by that claimant’s own percentage.
So when an adjuster calls, the early questions are often about you rather than the other driver. Were you a few miles over the limit? Did you look down at the radio? Did you roll past the stop line before the light changed? Each slice of responsibility the insurer can hand you is a slice it does not pay, and a share above 50 percent closes the claim entirely.
What we do about it. We build fault from evidence that does not shift with memory: where each car came to rest, the crush pattern on both vehicles, lane markings and signals, the timing of the light, statements from people with nothing at stake, and video from dash cameras, nearby businesses and traffic cameras when it exists. We also look for phone use. Reading, writing or sending a message on a portable device while the vehicle is moving is an offense under Transportation Code section 545.4251, and proof of it belongs in the liability picture.
What does an adjuster take from the crash report?
When an officer investigates a crash that involves injury, death or apparent property damage of $1,000 or more, the officer must file a written report, the Texas Peace Officer’s Crash Report (form CR-3), electronically with TxDOT within 10 days (Transportation Code section 550.062). The insurer usually orders that report before it ever speaks to you.
Adjusters read it for the contributing factors the officer checked, the diagram, any citation and the list of witnesses. A crash report does not decide who pays. Still, an adjuster tends to treat a favorable report as a reason to move the claim along and an unfavorable one as a reason to hold the line.
What we do about it. As your auto accident lawyer in Houston, we order the full report ourselves. The people involved, their authorized representatives, the vehicle owners and the insurers can all obtain it under section 550.065, through TxDOT’s Crash Report Online Purchase System for a small fee. Then we compare it with the photographs and the damage. If the report puts a car in the wrong lane, leaves out a witness or lists a factor the physical evidence does not support, we gather the proof that answers it so the report is not the only account the adjuster sees.
Gaps in treatment
Insurers read the calendar of your medical care as closely as the care itself. A week between the crash and the first doctor visit, or a month with no appointments in the middle of treatment, gets read as a sign that the injury was minor, that it healed, or that something other than the crash caused it.
Most gaps have ordinary causes: a boss who would not give time off, no one to watch the kids, a clinic with no opening for three weeks. None of those reasons reach the adjuster unless somebody writes them into the file.
What we do about it. A Houston auto accident lawyer cannot erase a gap, but can explain it. We ask you to be seen promptly, to keep your appointments and to tell every provider about each symptom, even the ones that seem minor. When a gap did happen, we document the reason, in your words and with records where they exist, so the explanation is already there before the insurer raises it.
Recorded statements
A few days after a crash, the other driver’s insurer may call and ask to record your account. The adjuster is polite and the call feels routine. On the insurer’s side, though, it is evidence gathering. The adjuster is listening for a guess at your speed, a remark such as ‘I’m okay’, or an apology that can later be read as an admission of fault.
What we do about it. Once you hire us, the other driver’s insurer deals with our office instead of with you. If your own insurer needs a statement for a PIP or UM claim, we prepare you for it and take part. If you already gave a recorded statement before calling us, tell us at the first meeting; we ask for a copy and plan the claim around what it says.
The property damage claim and the injury claim are separate files
Most auto claims split early into two tracks. One covers the car, a rental or loss of use, and things that were damaged inside it. The other covers medical care, lost income, pain and the ways the injuries change everyday life. Different adjusters often handle the two.
The car usually settles first, and there is nothing wrong with that. The danger lies in the paperwork and the photographs. A release worded too broadly can reach further than the vehicle, and pictures that make the damage look light are later used to argue the impact was too small to injure anyone.
What we do about it. We read every release before you sign it, keep a property settlement limited to property, and make sure your vehicle is photographed on every side before it is repaired, so the injury claim keeps the evidence it needs.
Why we open PIP and UM claims first
Clients are often surprised that one of the first claims their auto accident lawyer in Houston opens is with their own insurer. Personal injury protection comes with a Texas auto policy unless it was rejected in writing (Insurance Code section 1952.152), and the law does not require coverage above $2,500 per person (section 1952.153); your declarations page shows the amount on your policy.
PIP is paid without regard to who caused the crash (section 1952.155), and the insurer has to pay within 30 days of satisfactory proof of the claim (section 1952.156). That money can cover medical bills and lost income while the argument over fault is still going on.
Uninsured and underinsured motorist coverage is also part of every Texas auto policy unless a named insured rejects it in writing (section 1952.101). It becomes important when the at-fault driver has no insurance, or carries only the 30/60/25 minimums set by Transportation Code section 601.072 and the injuries go past those limits.
What we do about it. At the first meeting we ask for your declarations page, and we give your insurer notice of the PIP and UM claims at the start, so that coverage is ready before anyone needs it.
Want to know how an insurer is likely to read your claim? Call our Houston office and speak with our team. The consultation is free, and someone answers the phone 24/7.
How the adjuster turns the file into an offer
With fault, treatment, statements and coverage sorted, the adjuster weighs what is documented. A bill tied to a diagnosis tied to the crash carries weight. A complaint that never made it into a chart, missed work with no pay record, or pain nobody wrote down carries very little. The number that comes out reflects the insurer’s view of the file, and it is not a measure of what the crash cost you.
What we do about it. We write the demand for that reader. It explains how the crash happened and why the other driver is responsible, links each injury and each bill to the collision, proves the lost income, and shows how the injuries affect your days, with a record behind every point. Whether to accept any offer is your decision; we give you our honest view of it first.
What if the insurer still will not move?
Some files only move once a lawsuit is on file. In Texas, a personal injury suit must be brought no later than two years after the day the cause of action accrues (Civil Practice and Remedies Code section 16.003). Our page for anyone hiring an auto accident attorney in Houston walks through what changes when a claim becomes a case. If a bus, a work truck or a company van was part of your crash, our vehicle accident lawyer in Houston page covers the extra rules and policies those bring.
What you can do this week
- See a doctor and keep each follow-up appointment.
- Photograph your car on all sides before it goes in for repair, and keep the estimate.
- Find the declarations page of your own auto policy.
- Write down what you remember about the crash while it is fresh, and keep those notes for your lawyer.
- Hold off on signing any release until a lawyer has read it.
Questions people ask
Does the crash report settle who was at fault?
No. The report is one piece of evidence that insurers rely on heavily. Fault is decided by the evidence as a whole, and when the report is wrong we gather the photos, witness accounts and video that show what happened.
Should I take calls from the other driver’s insurer?
You can report the crash, but think twice before agreeing to a recorded statement without advice. Once we represent you, the other insurer contacts our office instead of you.
Why would I make a claim on my own policy if the other driver caused the crash?
PIP pays regardless of fault and has a 30-day payment rule once proof is in, so it can help while the liability claim is pending. UM and UIM coverage can matter when the other driver’s coverage is missing or too small.
I missed a few weeks of treatment. Is my claim over?
Not necessarily. Gaps are common and usually have ordinary reasons. Tell us what happened so we can document it, and get back to your doctor as soon as you can.