Resolving auto liability injury claims is growing more complex and costly thanks to industry trends like climbing medical costs, earlier interventional treatments, and aggressive plaintiff attorney tactics.
In our latest webinar, hosted by PropertyCasualty360, our panel of industry analysts and experts discussed these trends in greater depth and offered claims managers tips to modernize their negotiation strategies to stay ahead.
Escalating Frequency and Severity
Among all lines of business in auto insurance, liability injury claims are arguably the most difficult. "There's an argument that casualty is far and away the most challenging, and specifically liability injury claims," said CCC's Director of Industry Analytics, Erik Bahnsen.
The data backs that up. While property damage and first-party injury claim frequencies have declined, Bahnsen urges insurers to "look at the contrast for bodily injury... we've got a shrinking pool of property damage claims, and yet a growing number of injury claims within that shrinking pool."
What this means is a growing concentration of injury-related claims in a smaller volume of total incidents, putting greater strain on claims teams.
Severity is also surging. "The average paid per feature for all personal auto bodily injury has been increasing at a pretty significant rate over the last four years," Bahnsen continued. "It's up 36% in four years, so 9% per year – well in excess of any metrics of economic inflation."
Driving this increase is the growing frequency of outpatient surgery and radiology, which are not only more common but are being administered earlier in the treatment cycle.
More Procedures, Sooner – Especially for Younger Claimants
Claimants are undergoing advanced procedures like spinal injections much sooner post-accident. "For example, back in 2021, we saw cervical spinal injections on average 251 days out from the date of loss, and now we're seeing these 191 days out," Bahnsen said.
He explained that the cost has soared to $3,600-$3,700 per spinal injection, and, considering these claimants often require multiple injections, the total amount grows to roughly six-fold.
Surprisingly, younger individuals are receiving these procedures at high rates. "The vast majority of these procedures occur for injured parties that are 50 and under," Bahnsen said. "In fact, that’s 63% of the population." The largest cohort was the 41-50 age group, followed by 21–30. These are not cases driven by co-morbidities alone – they represent a shift in the way treatment is being delivered across the board.
Causation and Medical Inflation Concerns
Perhaps most troubling is the disconnect between impact severity and medical escalation. Two-thirds of third-party injury claims reviewed had a delta-V (change in speed during impact) of 9 mph or less – typically insufficient to cause more than a soft tissue strain. Yet this same population often receives advanced and costly procedures. This inconsistency raises questions for insurers about both the legitimacy of treatments and the alignment between care provided and actual injury severity.
The Plaintiff Attorney Playbook
Insurers often find themselves outmaneuvered during negotiations – not because the cases are stronger, but because plaintiff attorneys execute a consistent, tactical playbook. "Their styles are different, but the strategies are almost always the same," said webinar panelist Jim Kaiser, Casentric® CEO.
Common moves include:
- Creating artificial time pressure to force early settlement offers.
- Anchoring discussions to inflated medical bills or emotionally charged narratives.
- Deflecting scrutiny of treatment types or diagnosis with objections like "You're not a doctor."
These tactics work because they shape the conversation around treatment quantity rather than injury severity. As a result, adjusters often find themselves playing defense, chasing a number rather than evaluating the legitimacy of the claim.
How Insurers Can Shift the Narrative
To counteract these tactics, insurers must develop their own negotiation playbooks – grounded in evidence, structured discovery, and a proactive mindset. The key is to reclaim the initiative by anchoring negotiations in what’s proven, not just what’s claimed.
"Injury makes the treatment. Treatment does not make the injury," Kaiser said, adding that auto liability injury claims evaluation should be handled in the following two phases:
- Evaluation Phase: Begin with the injury, not the treatment, and establish the severity based on clear criteria:
- Is there documented impairment of function?
- Was conservative care (like physical therapy or chiropractic) attempted and failed?
- Are diagnoses consistent and clinically justified?
- Negotiation Phase: Shift to a discovery-based strategy, ask questions instead of making statements, and use thoughtful inquiries to challenge the necessity and sequencing of care:
- "Why did the provider deviate from the original treatment plan?"
- "Can you point to specific limitations in activities of daily living?"
- "Why were pain management injections used when the patient was reporting minimal discomfort?"
This approach not only strengthens the insurer’s position but also forces the opposing party to confront gaps in their own case. Kaiser recommends this method because it creates a foundation for rational negotiation. “Start from what’s proven, then assess how risks like bills and treatment types can influence people,” he said.
Real-World Results: The Power of Questions Over Statements
This strategy isn't theoretical – it works. Webinar panelist Taylor Quarles, Managing Casualty Claims Director at Amica Mutual Insurance Company, shared a real-world case study involving a claimant who denied injury at the scene, later submitted $31,000 in medical bills, and then demanded the $50,000 policy limit.
"Based on this discovery approach of negotiation, we were able to resolve the case for $18,000," Quarles said. He explained that this was accomplished by asking the following questions, which exposed inconsistencies and gaps:
- Why did the claimant deny prior injuries to her treatment provider when there was evidence showing prior accidents?
- Can you point to where the medical records reflect that your client’s activities of daily living were impacted?
- Why did the treating physician recommend a medial branch block, but administer an epidural steroid injection instead?
- Why were osteoarthritic changes not considered in the diagnosis and treatment plan?
"The goal is to have the claimant or the representative look at the records and provide answers," Quarles noted. By posing direct, discovery-based questions to the claimant’s representative – rather than countering with immediate offers – the adjuster was able to reframe the negotiation.
Redefining "Winning" in Casualty Claims
"Inflated medical billing is not really the root of the problem," said Quarles. "Unjustified treatment is." Insurers need to focus less on the total bill and more on the evidence supporting the care.
Winning in this environment doesn’t mean underpaying claims or dragging out settlements. It means arriving at a fair outcome based on what’s clinically justified and legally provable. Inflated bills are often a red herring; the true issue lies in unjustified or premature treatment escalation.
Defining a "win" today means:
- Anchoring negotiations in the burden of proof and making first offers based on the claim, not anecdotal evidence.
- Focusing on impairment and injury, not just treatment types or costs.
- Using questions to clarify, not accuse – which builds a foundation for fair, evidence-backed offers.
In a complex and inflationary claims environment, claims managers who adopt a structured, discovery-based approach grounded in questions, not assumptions, are best positioned to negotiate smarter – minimizing unsupported treatments and reaching fair outcomes.
As Kaiser concluded, "If you want to change the outcomes, you'll have to change the process." And this means shifting from reacting to leading.
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Resolving auto liability injury claims is growing more complex and costly thanks to industry trends like climbing medical costs, earlier interventional treatments, and aggressive plaintiff attorney tactics.
In our latest webinar, hosted by PropertyCasualty360, our panel of industry analysts and experts discussed these trends in greater depth and offered claims managers tips to modernize their negotiation strategies to stay ahead.
Escalating Frequency and Severity
Among all lines of business in auto insurance, liability injury claims are arguably the most difficult. "There's an argument that casualty is far and away the most challenging, and specifically liability injury claims," said CCC's Director of Industry Analytics, Erik Bahnsen.
The data backs that up. While property damage and first-party injury claim frequencies have declined, Bahnsen urges insurers to "look at the contrast for bodily injury... we've got a shrinking pool of property damage claims, and yet a growing number of injury claims within that shrinking pool."
What this means is a growing concentration of injury-related claims in a smaller volume of total incidents, putting greater strain on claims teams.
Severity is also surging. "The average paid per feature for all personal auto bodily injury has been increasing at a pretty significant rate over the last four years," Bahnsen continued. "It's up 36% in four years, so 9% per year – well in excess of any metrics of economic inflation."
Driving this increase is the growing frequency of outpatient surgery and radiology, which are not only more common but are being administered earlier in the treatment cycle.
More Procedures, Sooner – Especially for Younger Claimants
Claimants are undergoing advanced procedures like spinal injections much sooner post-accident. "For example, back in 2021, we saw cervical spinal injections on average 251 days out from the date of loss, and now we're seeing these 191 days out," Bahnsen said.
He explained that the cost has soared to $3,600-$3,700 per spinal injection, and, considering these claimants often require multiple injections, the total amount grows to roughly six-fold.
Surprisingly, younger individuals are receiving these procedures at high rates. "The vast majority of these procedures occur for injured parties that are 50 and under," Bahnsen said. "In fact, that’s 63% of the population." The largest cohort was the 41-50 age group, followed by 21–30. These are not cases driven by co-morbidities alone – they represent a shift in the way treatment is being delivered across the board.
Causation and Medical Inflation Concerns
Perhaps most troubling is the disconnect between impact severity and medical escalation. Two-thirds of third-party injury claims reviewed had a delta-V (change in speed during impact) of 9 mph or less – typically insufficient to cause more than a soft tissue strain. Yet this same population often receives advanced and costly procedures. This inconsistency raises questions for insurers about both the legitimacy of treatments and the alignment between care provided and actual injury severity.
The Plaintiff Attorney Playbook
Insurers often find themselves outmaneuvered during negotiations – not because the cases are stronger, but because plaintiff attorneys execute a consistent, tactical playbook. "Their styles are different, but the strategies are almost always the same," said webinar panelist Jim Kaiser, Casentric® CEO.
Common moves include:
- Creating artificial time pressure to force early settlement offers.
- Anchoring discussions to inflated medical bills or emotionally charged narratives.
- Deflecting scrutiny of treatment types or diagnosis with objections like "You're not a doctor."
These tactics work because they shape the conversation around treatment quantity rather than injury severity. As a result, adjusters often find themselves playing defense, chasing a number rather than evaluating the legitimacy of the claim.
How Insurers Can Shift the Narrative
To counteract these tactics, insurers must develop their own negotiation playbooks – grounded in evidence, structured discovery, and a proactive mindset. The key is to reclaim the initiative by anchoring negotiations in what’s proven, not just what’s claimed.
"Injury makes the treatment. Treatment does not make the injury," Kaiser said, adding that auto liability injury claims evaluation should be handled in the following two phases:
- Evaluation Phase: Begin with the injury, not the treatment, and establish the severity based on clear criteria:
- Is there documented impairment of function?
- Was conservative care (like physical therapy or chiropractic) attempted and failed?
- Are diagnoses consistent and clinically justified?
- Negotiation Phase: Shift to a discovery-based strategy, ask questions instead of making statements, and use thoughtful inquiries to challenge the necessity and sequencing of care:
- "Why did the provider deviate from the original treatment plan?"
- "Can you point to specific limitations in activities of daily living?"
- "Why were pain management injections used when the patient was reporting minimal discomfort?"
This approach not only strengthens the insurer’s position but also forces the opposing party to confront gaps in their own case. Kaiser recommends this method because it creates a foundation for rational negotiation. “Start from what’s proven, then assess how risks like bills and treatment types can influence people,” he said.
Real-World Results: The Power of Questions Over Statements
This strategy isn't theoretical – it works. Webinar panelist Taylor Quarles, Managing Casualty Claims Director at Amica Mutual Insurance Company, shared a real-world case study involving a claimant who denied injury at the scene, later submitted $31,000 in medical bills, and then demanded the $50,000 policy limit.
"Based on this discovery approach of negotiation, we were able to resolve the case for $18,000," Quarles said. He explained that this was accomplished by asking the following questions, which exposed inconsistencies and gaps:
- Why did the claimant deny prior injuries to her treatment provider when there was evidence showing prior accidents?
- Can you point to where the medical records reflect that your client’s activities of daily living were impacted?
- Why did the treating physician recommend a medial branch block, but administer an epidural steroid injection instead?
- Why were osteoarthritic changes not considered in the diagnosis and treatment plan?
"The goal is to have the claimant or the representative look at the records and provide answers," Quarles noted. By posing direct, discovery-based questions to the claimant’s representative – rather than countering with immediate offers – the adjuster was able to reframe the negotiation.
Redefining "Winning" in Casualty Claims
"Inflated medical billing is not really the root of the problem," said Quarles. "Unjustified treatment is." Insurers need to focus less on the total bill and more on the evidence supporting the care.
Winning in this environment doesn’t mean underpaying claims or dragging out settlements. It means arriving at a fair outcome based on what’s clinically justified and legally provable. Inflated bills are often a red herring; the true issue lies in unjustified or premature treatment escalation.
Defining a "win" today means:
- Anchoring negotiations in the burden of proof and making first offers based on the claim, not anecdotal evidence.
- Focusing on impairment and injury, not just treatment types or costs.
- Using questions to clarify, not accuse – which builds a foundation for fair, evidence-backed offers.
In a complex and inflationary claims environment, claims managers who adopt a structured, discovery-based approach grounded in questions, not assumptions, are best positioned to negotiate smarter – minimizing unsupported treatments and reaching fair outcomes.
As Kaiser concluded, "If you want to change the outcomes, you'll have to change the process." And this means shifting from reacting to leading.
