By ALLEN MCQUISTONJemez Insurance Agency
Serving Los Alamos Since 1963
Most people don’t realize this, but injury claims almost never go to trial. About 95 percent of them settle, often quietly and without fanfare. A settlement spares everyone the stress, uncertainty, and time that come with going to court.
But then there’s the other 5 percent — the claims that don’t settle.
These are the ones that drag on, end up in litigation, and usually come with far more frustration for everyone involved.
So what separates the 5 percent from the 95 percent?
What specifically made those cases break the pattern?
Across countless claims, the reasons tend to fall into three consistent categories.
1. The evidence wasn’t clear — or was actively disputed
Insurance companies don’t make decisions based on gut feelings; they follow the paper trail.
The 5 percent of cases that end up in litigation often involve unclear or conflicting documentation such as:
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Missing medical records
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Gaps in treatment
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Contradicting statements about what happened
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Unclear proof of lost wages or long-term injuries
When a claim doesn’t tell a clean, consistent story, the insurer becomes hesitant — and that hesitation often leads to court.
Why it matters:
- Organized, continuous documentation (medical visits, symptoms, photos, receipts, timelines) can make or break a claim. The cleaner the evidence, the smoother the process.
2. There was a major disagreement about fault
Most claims settle because both sides more or less agree on who caused the incident.
In the 5 percent, that agreement breaks down.
In the 5 percent, that agreement breaks down.
These cases usually involve:
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Each driver claiming the other was at fault
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Witnesses providing conflicting accounts
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Disputes about whether an area was safe or maintained
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Situations with no witnesses at all
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Unclear video or no video
If fault is uncertain or contested, insurers cannot fully accept liability — and everything slows down.
Why it matters:
- Simple steps at the time of an incident — photos, names of witnesses, notes about conditions — can be incredibly powerful later.
3. The two sides were too far apart on the value of the injury
Even when everyone agrees on what happened, there can still be a huge disagreement over what the injury is worth.
The 5 percent of litigated cases often involve:
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Long-term injuries that are difficult to quantify
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Disputes between medical experts
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Questions about whether all injuries were caused by the incident
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A claimant expecting significantly more than the insurer believes is justified
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Complex injuries where future impact is uncertain
When expectations and evidence don’t meet in the middle, settlement becomes nearly impossible — and litigation is the only path left.
What this means for the average person
Understanding the 5 percent doesn’t just explain why claims go to court — it helps people protect themselves long before anything ever happens.
The smoother claims almost always involve:
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Clear documentation
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Clear evidence of fault
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Reasonable, well-supported medical evaluations
When those three pillars are solid, claims tend to follow the 95 percent path: quicker, simpler, and far less stressful.