10 Key Factors Driving Claim Settlements and Denials
Posted by Wetherington Law Firm | Articles
When someone is hurt due to another’s carelessness, our legal system is supposed to offer a path to fairness. But this path is changing in Georgia, and it’s important to understand how.
Preventable accidents are a growing crisis, happening more frequently despite advancements in safety and technology. Consider this alarming statistic from the National Safety Council (NSC): since 1992, the death rate from these avoidable incidents has tragically doubled. By 2022, this rate reached 66.5 deaths per 100,000 people. This stark 100% increase demonstrates a worsening public safety issue.
As more people suffer from preventable harm, their ability to seek fair compensation and hold responsible parties accountable becomes even more vital. Georgia’s new law, Senate Bill 68 (SB68), has fundamentally changed how injury claims are valued and decided in Georgia. These changes impact many of the traditional elements that determine whether a claim is settled or denied, and for how much they might settle for.
To help make sense of these new challenges, we turn to Matt Wetherington, founder of the Wetherington Law Firm. For three consecutive years, fellow lawyers across Georgia have voted his firm as the #1 personal injury law firm in the state. Here, Wetherington discusses key factors that drive settlements and denials and what individuals can do about them.
Key Factors Determining Personal Injury Settlements and Denials
1. Proving Responsibility (Liability)
The first major step in any injury claim is determining who was at fault and to what degree. This involves looking at everyone’s actions, including your own.
Georgia law considers whether your own actions contributed to your injuries. If a jury finds you 50% or more responsible for what happened, you cannot recover any compensation. If you are found to be less than 50% at fault, your compensation will be reduced by your percentage of fault. For example, if you are awarded $100,000 but found 20% at fault, you would receive $80,000.
One of the first hurdles is proving who was at fault. Georgia uses a “comparative negligence” rule: if you are found to be 50% or more responsible for your own injuries, you cannot recover any compensation. Identifying everyone who might have contributed to the injury is crucial.
It’s important to investigate and identify every person or entity whose negligence might have contributed to your injuries. This could include not just an obvious party (like another driver in a car accident), but also less obvious ones. For example, in a case involving a tire that blows out, the tire manufacturer or a tire service provider might also be at fault.
Identifying all potentially responsible parties is vital for several reasons. It increases the potential sources of recovery (more insurance policies, more assets). It also ensures that when fault is ultimately divided up by a jury (a concept called “apportionment”), all negligent actors are considered. If a responsible party isn’t identified, the remaining defendants might try to shift blame to that “empty chair,” potentially reducing their own share of responsibility and, consequently, your ability to achieve a full and just recovery.
For car accidents, a major change under SB68 is that your failure to wear a seatbelt can now generally be used as evidence. This can be used to argue that you share some of the fault for your own injuries (contributing to your comparative negligence percentage) or that your injuries would have been less severe if you had been wearing one.
If you were injured by a criminal act on someone else’s property (like an assault in a poorly lit parking lot) and the incident happened on or after April 21, 2025, SB68 makes it much harder to hold the property owner responsible. You now generally need to prove either that the owner had a “particularized warning” of an imminent specific threat, or that “substantially similar” criminal acts had happened there before.
These new proof requirements are very difficult to meet, significantly limiting the ability of many people injured by crime on poorly secured properties to get justice from negligent property owners. Furthermore, the new law requires that blame be divided among the property owner, the person who committed the crime (who may be unknown or have no money), and anyone else at fault. This often means that even if the property owner was negligent, the amount an injured person can actually recover from them is reduced, sometimes drastically.
2. Strength and Quality of Evidence
Even when liability is clearly established in a case, without robust evidence to support duty, breach, causation and damages, insurance adjusters can still deny a claim. A robust evidentiary foundation is non-negotiable.
Strong evidence – medical records, police reports, witness statements, even data from devices like fitness trackers – is the backbone of any successful claim. Gaps in medical treatment, for example, can be used by insurers to argue your injuries weren’t serious.
SB68 allows defendants to try to get your case dismissed before they even formally respond to your lawsuit. Crucially, when they do this, your ability to gather evidence through the legal process (“discovery”) is automatically paused for 90 days or until the court rules.
This creates an early hurdle. You might not have access to information you need to effectively fight off a dismissal, potentially ending your pursuit of justice before it really starts. It can also be used as a tactic to delay your case and pressure you into a lower settlement.
3. Accurate Assessment of Economic Damages
Successfully proving fault is only half the battle. You also need to prove the extent of your losses, both financial and non-financial.
Poor assessment of economic and non-economic damages accounts for why many claim amounts are drastically reduced. Economic damages like medical expenses, lost wages, and future care costs require precise calculation to ensure fair compensation.
There is need for comprehensive documentation, including projections of long-term expenses, such as ongoing therapy or lost earning capacity. Employing financial experts to model these costs accurately can be beneficial, a step often overlooked in less experienced practices.
4. Valuation of Non-Economic Damages
Non-economic damages, covering pain and suffering, emotional distress, and reduced quality of life, are inherently subjective, making them a focal point of contention. It’s another area where insurance adjusters pay attention to by either completely denying your claim or reducing it by a huge percentage.
SB68 severely limits how lawyers can talk to juries about the monetary value of these non-financial losses. Suggesting specific figures to “anchor” the jury’s thinking is now generally banned, with very narrow exceptions. This makes it much harder for juries to assign a fair value to these profound human losses.
It can lead to less predictable and potentially much lower awards for pain and suffering, which can feel like a denial of full justice for the true impact of an injury. Wetherington advocates the multiplier method, where economic damages are multiplied by a factor (typically 1.5 to 5) based on injury severity.
5. Timeliness and Adherence to Statutory Deadlines
In the United States, most states have statutory deadlines for specific claim types called statute of limitations. States like Georgia, Texas, California, Alabama, Virginia, and many others have a two-year hard deadline for personal injury claims. Missing this deadline results in automatic denial, regardless of a case’s merits.
In Georgia, the statute of limitations for most personal injury claims is two years from the date of the injury. Texas, California, Alabama, and Virginia also follow the two year rule. However, these time limits can vary. Some states have shorter deadlines (as little as one year).
6. Navigating Comparative Negligence Challenges
In many states, the comparative negligence rule creates a significant obstacle for personal injury claimants, as those found more than 50% at fault have their claims entirely denied, regardless of injury severity. In states like Georgia and Colorado, insurers exploit this rule to shift blame, using evidence such as traffic footage or witness statements to argue that the claimant’s actions, such as a minor traffic violation or distraction, caused the incident, justifying a complete denial.
A good strategy requires claimants to meticulously document their case early to counter insurer tactics and avoid crossing the 50% fault line that eliminates recovery. Even when claims are not denied outright, comparative negligence allows insurers to reduce settlements substantially by assigning partial fault to the claimant.
For instance, a claimant deemed 30% responsible for a $100,000 accident may receive only $70,000. Insurers leverage detailed investigations, often employing experts or private investigators, to inflate the claimant’s fault in complex cases like multi-party collisions or slip-and-falls. To overcome this, it is advisable to secure strong evidence, including medical records, independent testimonies, and expert analyses, to minimize attributed fault and protect their compensation.
7. Countering Insurance Company Tactics
Despite having insurance, claimants should understand that adjusters prioritize the company’s interests, employing various tactics to minimize payouts. These include denying liability by shifting blame with evidence like traffic footage, questioning injury severity by highlighting treatment gaps or pre-existing conditions, or rejecting claims outright.
Such strategies exploit claimants’ vulnerabilities, especially post-injury, making legal support essential to deal with adjuster interactions effectively. Insurers also offer premature lowball settlements to settle claims quickly before damages, like future medical costs, are fully known.
For example, a $5,000 offer for a car accident may seem appealing but could undervalue significant expenses. Claimants should avoid accepting early offers and seek legal counsel to assess their claim’s true value, ensuring negotiations secure fair compensation reflective of all losses.
8. Medical Causation and Pre-Existing Conditions
Establishing that an injury was directly caused by the incident, rather than a pre-existing condition, is a major and contentious issue in personal injury litigation, especially during trials where causation is closely examined. Insurers and defense attorneys often exploit medical histories, arguing that conditions like chronic pain or joint issues predated the incident to reduce or deny liability.
For example, in a car accident case, a defendant might use prior records of back pain to claim a plaintiff’s new spinal injury was unrelated, creating doubt about the crash’s impact. All of this is aimed at undermining the plaintiff’s case by challenging a core element required for compensation.
9. Availability of Insurance Coverage
The scope and availability of insurance coverage significantly influence potential settlement amount. Exploring all applicable policies, such as uninsured/underinsured motorist coverage or third-party liability policies is important to maximize your claim. Thorough policy analysis ensures claimants access all available resources, a step that can salvage cases involving insolvent defendants.
10. Strength of Legal Representation
An attorney’s skill in negotiation, litigation, and strategy directly shapes personal injury claim outcomes, determining compensation and success. Strong negotiation counters insurer tactics like lowball offers, using robust evidence to secure fair settlements for damages. In litigation, persuasive cases built on testimonies and documentation are vital, especially in trials. Strategic planning anticipates defenses and optimizes timing to maximize claim value.
Integrating traditional advocacy with AI-driven innovation improves settlement outcomes by utilizing data to predict settlement ranges and refine strategies. AI can analyze insurer trends, like undervaluing certain injuries, to strengthen negotiations or trial arguments. Combining these tools with classic advocacy, such as compelling storytelling, ensures attorneys secure favorable settlements or court victories, significantly boosting a claim’s success.
Matt notes that an “insurance company’s goal is to pay as little as possible, not what’s fair, and certainly not what’s needed. Documentation is everything. If it’s not in the record, it doesn’t exist as far as the insurance company is concerned.”
Overall Impact of the 2025 Georgia Tort Reform Law on Injury Claims
On April 21, 2025, Georgia enacted sweeping tort reform through Senate Bills 68 and 69, signaling a significant recalibration of the state’s civil litigation framework. While proponents claim these reforms will reduce “frivolous lawsuits” and lower insurance costs, the practical effect is a substantial restriction on injured plaintiffs’ ability to recover fair compensation, particularly in premises liability and motor vehicle accident cases. These reforms arrive amid a climate of increasing claim denials and heightened insurance scrutiny.
Impact Injured Plaintiffs
The law, comprising Senate Bills 68 and 69, introduces changes that could limit compensation for injured plaintiffs:
- Stricter Liability Standards: Negligent security cases now require proof of prior wrongful conduct within 500 yards of the property. This may reduce successful claims against property owners in cases like assaults or slip-and-falls.
- Lower Damage Awards: Evidence of actual medical costs paid (not billed) and bans on “anchoring” pain and suffering damages (e.g., referencing unrelated high figures) could lead to smaller awards.
- Procedural Challenges: Bifurcated trials (separating liability and damages) and allowing seatbelt evidence in auto cases may reduce payouts, as non-use of seatbelts could mitigate damages.
- Funding Restrictions: Limits on third-party litigation funding and transparency requirements may hinder plaintiffs’ ability to finance lawsuits, potentially reducing access to justice.
These reforms may lower the volume of litigation, but they do so by narrowing access to justice, not by resolving the root causes of injury or overburdened courts, Matt noted.
Impact on Plaintiffs’ Attorneys
The law creates challenges for attorneys representing plaintiffs:
- Fewer Cases: Stricter liability and damage rules may discourage taking on cases with lower potential payouts, especially in negligent security or smaller claims.
- Increased Complexity: Bifurcated trials, new dismissal motion timelines, and restrictions on voluntary dismissals increase litigation costs and time.
- Reduced Attorney Fees: Eliminating double recovery of attorney fees and regulating litigation funding could lower earnings.
- Strategic Shifts: Attorneys may need to focus on high-value cases and adapt to new evidentiary rules, such as seatbelt evidence, requiring changes in case selection and preparation.
- Automatic Stay of Discovery: When a defendant files a motion to dismiss, discovery is automatically stayed for 90 days. This provision can delay the gathering of evidence, potentially impacting the plaintiff’s ability to build a strong case promptly.
- Limitations on Damage Arguments: Attorneys must ensure that any suggested amounts for non-economic damages are substantiated by trial evidence, restricting the use of persuasive analogies or comparisons during closing arguments.
Georgia’s 2025 tort reform law significantly alters the balance of power in civil litigation. Though framed as a cost-control measure, it reduces jury discretion, imposes stricter liability standards, and introduces procedural hurdles like bifurcated trials. These changes not only burden plaintiffs and their attorneys but also demand greater legal precision to achieve fair outcomes in an increasingly defendant-friendly system.
— Matt Wetherington, Wetherington Law Firm.
About Matt Wetherington
Matt Wetherington, founder of Wetherington Law Firm in Atlanta, Georgia, is a nationally recognized personal injury and wrongful death lawyer known for handling high-stakes cases and achieving record-setting verdicts across Georgia. A first-generation college graduate from Climax, Georgia, Matt was inducted into the ALM Verdicts Hall of Fame by age 30 and named to the Daily Report’s “On the Rise” list. He is a leading advocate for consumer rights and legal innovation, especially in the ethical use of AI in law. His firm was voted Georgia’s #1 personal injury firm by peers in 2022 and 2023, and he co-founded the Legal Accelerator Network to empower both lawyers and clients.
Resources: