When a doctor sees a patient with an injury, they immediately grade its severity. A minor injury could include small bruises, scrapes, cuts, and mild sprains. These injuries can all heal on their own. A moderate injury would be a broken bone, joint dislocation, or other condition that requires medical care. A severe injury moves into the life-threatening category.
Each level includes grading systems for burns, soft-tissue tears, and traumatic brain injuries.
Insurance companies grade injuries too. They are not using the same scale.
If another person’s negligence caused your injury, you’re entitled to seek compensation for your medical expenses and your lost wages. An adjuster’s read of how badly you were hurt is what moves that number, which makes their assessment worth understanding before you hand them anything.
The Role of Hawai‘i No-Fault Insurance Laws
When it comes to car accidents, Hawai‘i is a no-fault state. That doesn’t mean no one is ever blamed for a collision. It means every driver has to carry Personal Injury Protection benefits, and after a crash your own PIP pays your medical bills first, whoever caused it.
PIP has a ceiling. Most people assume that once it runs out, the next step is suing the driver who hit them, and in Hawai‘i that step isn’t automatic. State law sets aside tort liability for motor vehicle injuries except in defined circumstances, including a death, a significant permanent loss of use of a part or function of the body, a permanent and serious disfigurement causing mental or emotional suffering, or personal injury protection benefits that reach the state’s tort threshold. Whether your injury clears one of those lines decides what your claim can become.
That is exactly why a dispute over severity is never just paperwork. When a carrier reads an injury as less serious than your doctor does, the practical effect is a smaller claim and a closed door. An attorney can take the lead on the initial filing, and on a civil complaint if the filing goes nowhere.
How Insurance Adjusters Calculate Medical Damages
Every insurance claim is assigned to an adjuster who acts on behalf of the insurance company to evaluate its merits. Larger claims are often split between two adjusters, one handling property damage and another handling personal injury.
On the personal injury side, the adjuster starts with hard evidence of past expenses, covering everything from the day of the accident to the day the claim is submitted. That means bills and receipts for:
- Emergency room visits
- Diagnostic exams
- Surgeries
- Hospitalization
- Doctor appointments
- Prescription drugs
- Physical therapy
Depending on the injury, the adjuster also has to estimate what treatment will cost going forward, including ongoing care, future surgeries, or medical equipment. They don’t guess at those figures. They rely on medical consultants the insurance company retains.
Documentation drives everything on this side of the claim. Diagnostic imaging tends to carry more weight with an adjuster than pain a patient reports but nothing measures, and treatment from an orthopedic surgeon or a neurologist reads differently than routine visits to a general practitioner.
Evaluating Pain, Suffering, and Non-Economic Loss
Your claim isn’t limited to what the injury cost you. Non-economic losses cover what it took from you, and they include:
- Physical pain
- Emotional distress
- Loss of enjoyment of life
- Disfigurement
If you are married, your spouse may also have a claim of their own for loss of consortium, which belongs to them rather than to you.
There are no receipts for any of this. Adjusters fall back on two informal methods, and neither one is a legal standard in Hawai‘i or anywhere else. The multiplier method multiplies your economic damages by a figure the adjuster selects based on how severe the injury is. The per diem method assigns a daily rate across the recovery period, which suits an injury like a broken bone with a finite number of recovery days.
Some insurers also run claims through software that assigns values from past settlement ranges. It’s efficient, and it removes the human element entirely. An algorithm can’t tell how much you’ve suffered.
Evidence Needed to Support a High-Value Claim
Proving a personal injury claim means proving two things: that someone else is responsible, and how badly you were hurt. Your own account matters, and it will not carry the claim by itself. Here’s what an adjuster actually responds to:
- Complete medical records, including the first visit and every follow-up
- Opinions from your treating physicians, and from a specialist where the injury is permanent
- Wage statements, tax returns and receipts tying your financial losses to the injury
- A record of what you can no longer do, from family and coworkers as well as from you
- The police report and any agency findings
- Surveillance footage, which insurers gather too, so write and post as though it exists
Assembling all of that while you’re still recovering is its own full-time job, and it arrives at the worst possible moment.
Wayne Parsons Law Office Stands With Injured Hawai‘i Residents
An adjuster who has never met you is putting a number on the worst year of your life, using a scale nobody explained to you. That’s the part families find hardest, and it’s the part our firm handles every day. Wayne Parsons Law Office has represented Hawai‘i residents hurt by someone else’s negligence for decades, and our experience negotiating with insurance companies puts us in a strong position to take on the adjusters.
If you’ve been injured in an accident, you owe it to yourself and your family to understand your options before you accept anyone’s assessment of them. Reach out to Wayne Parsons Law Office for a free consultation today.