You know what a Vogon is, right? And have you ever seen Trainspotting? Now, imagine Mark Renton as a Vogon except instead of heroin, he does insurance claims. Now, recall the scene where Lizzy has just broken up with Tommy, and Tommy is coming 'round to Mark, asking about [del]heroin[/del] claims adjusting. Well, Tommy, what exactly interests you?
I can tell you a bit about how it works in 'merika, maybe it’s similar in your land. My claims experience started when my company was putting together a team dedicated to settling automobile total losses. This was good–someone would wreck their car and I would buy it off them. The vast majority of the cases were run of the mill vehicles that you could place a reasonably solid value on in a few minutes, but every now and then you get a challenge like a riced out Accord or a heavily customized Harley Davidson, or a '47 Rolls Royce Silver Wraith (that was a tough one, it had been flooded with ocean water from Hurricane Katrina’s surge–it still looked mint but was a mandatory total loss per Texas legal codes). The hard part was learning people, and how to deal with people who are not at their best (car wrecks are stressful, as it turns out) and who have been told all their lives that your sole role in the matter is to screw them over. So you do your best to determine a fair and defensible value for their vehicle and proceed to quietly undermine the personal baggage between you and your unwilling customer’s trust. Once you settle on a price you work with the owner, their bank if there’s a loan, and manage the title work and run the vehicle through the salvage auction. Did that for like 7 years and was burned out after settling around 10,000 cars(really!). My boss finally took pity on me and traded me to an Injury team.
So I’m in my 8th year of working with people who have been injured to various degrees in car wrecks. My second day doing this job (no shit), Grandma got distracted and drove off the road and crashed into the Colorado River. It was November. She and her daughter were able to get out, but her 7 year old granddaughter did not. Sad right? 3 days later, the car was found and the little girl was still strapped in to her seat. Grandma was describing this to me, and I could tell she was building a safe place in her mind for all this so I just let her, “…and when the pulled the car out, I was there, and M was still in the car strapped in her seat. And I felt better right away because I could tell she hadn’t suffered–she was still smiling like a little angel.” I found out later the coroner and police worked out M had been struck hard in the back of the head during the crash over the cliff and was likely unconscious before the car hit the water. The “smile” was most likely a death grimace following 3 days’ immersion in nearly freezing water. This was 8 years ago, and I’ve worked with the families of probably a dozen dead children since then–this one is still difficult for me to think about. Most of the injury claims I get are neck sprains from rear-end collisions, the occasional broken arm, sometimes very odd consequences like: fairly minor accident causing a run-of-the-mill whiplash injury -> pain -> poor sleep for days -> exhaustion -> crash an already compromised health condition -> month in hospital & loss of job…
But the job is the same in every case: find out which version of the truth is most probable (everyone involved has their own perspective and they don’t always match up, and it’s not usually because someone is lying–you get comfortable with understanding reality is mostly subjective), what is the injury, is it likely the injury was caused in the accident?, what are the consequences of the injury, what do you owe, and what is a jury likely to award if they have all the evidence you have right now. Because that’s where the cases end up if you don’t settle, in front of a jury. So you learn through experience and working with defense attorneys what information can get to a jury, and how different jury pools view different kinds of cases. You get familiar with medical records, various injuries and how they present and heal, tort legal concepts and procedures, biomechanics, mechanical mechanics & accident reconstruction. You also learn which plaintiff lawyers you can trust and which are revictimizing their clients, and which physicians and other experts are ‘plaintiff whores’ and how to tear their arguments apart. You get good at taking an irate phone call and just listening through the bullshit and anger to get to the root of the person’s frustration, and then getting them to calm down and trust you enough to learn what they need to do in order to resolve their issue.
It’s an art, and it most certainly does require professionalism and the ability to see when you’re being baited and to stay calm and not hit the bait. You’ve got black and white regulations you cleave to while you manage cases that are all various shades of gray. My boss is very fond of saying “good judgment comes from experience, and experience comes from previous bad judgment.”