The role of adjusters in resolving claims is to evaluate and settle those injury claims on behalf of the accident insurance company. When making a claim for medical expenses related to an accident, you should be aware of your own rights when dealing with adjusters and take proactive steps to protect your interests during the claims process.
While claims representatives’ primary role is to facilitate claims processing, knowing the inside scoop on how insurance adjusters evaluate medical claims can help injured parties with a much smoother path toward a satisfactory monetary recovery. This is especially true when the accident is not a minor fender-bender but results in serious injuries.
Adjusters are generally friendly and positive. That is how they get people to accept less than fair value. They are not neutral third parties who are objective in their evaluation of your claims. They work for the insurance company, and their job performance reviews are based on how well they protect the insurance company and its assets, not the policyholder or the claimant.
How to Resolve Injury Claims with an Insurance Company
Accidents which cause lifelong permanent injuries with medical expenses into the millions of dollars sadly happen on a daily basis. When you need legal representation for a major car accident claim, finding an experienced catastrophic personal injury attorney should be your first step.
It is important to remember that the insurance company’s loss adjuster is not your advocate in resolving your accident claim or issuing full compensation for your medical expenses.
Your attorney (and their team) is your advocate and will work on your behalf to obtain maximum compensation.
Claims adjusters may not disclose to you that their goal is to settle the claim for as little money as possible. Remember, the adjuster’s job is to protect the interests of the insurance company, not you.
Their first offer, regardless of any statement made to you otherwise, is almost never the best or final offer. If you accept a starting point in the negotiation that is too low, you may have to settle for less than the policy limit would have allowed. Attorneys skilled in negotiating with insurance companies know how to obtain a disclosure of the policy limit amount, and thereby set you up for the best negotiation possible.
Hiring legal representation to assist in negotiating your recovery can avoid additional losses related to an unskilled negotiation attempt.
Adjusters may request a recorded statement from a policyholder or claimant, which can then potentially be used to dispute the claim. If you agree to record a statement, you should be cautious about what is said. If you have hired an attorney to represent you, forward any communications from the insurance company or adjuster to your attorney.
Am I Required to Give a Recorded Statement?
Many people ask, “Am I required to give a recorded statement to an insurance adjuster?” If an insurance adjuster is calling you to request a recorded statement, ask them if they have any legal authority to require you to give a recorded statement. If they say that you do, tell them you want to contact a personal injury attorney to verify that before you do so. Better yet, let them go to voicemail and contact the personal injury attorney first.
Adjusters may not emphasize the importance of thorough documentation of damages and losses and may not request such materials from you.
If you are asking them to process your claim on your own, make sure to provide any photographs or other contemporaneous documentation, such as recorded video or audio statements. Keep a detailed (and dated) chronology related to the claim, including both the events of the claim and medical treatment and your communications with the insurance adjuster. Keep all expense records. Make a record of the names of personnel and statements made by professionals involved, including dates, times and locations. Contemporaneous documentation is given extra weight in evaluating validity of evidence, so make sure to keep track of events as they happen. Put dates and times on your notes and timestamp any screenshots, photographs or video clips that may be evidence for your case.
Claims Investigation and Loss Assessment
Claims adjusters conduct investigations that may involve interviewing witnesses or obtaining additional documentation. The adjuster’s assessment of the loss usually does not align with the claimant’s perception. Disagreements over the extent of injuries and the extent of related damages are common.
You will need to be able to prove your total direct losses with receipts and invoices for your medical expenses. If you are claiming pain and suffering or emotional impact, you will also need to support those claims with evidence, which can include witness statements. You will need names and contact information for your potential eyewitnesses, and any other fact witnesses for your claims. A personal injury attorney can help you navigate this process and ensure a serious recovery for your serious injuries.
How Insurance Adjusters Are Not On Your Side
- Medical Estimates – Adjusters may provide medical estimates that are lower than what your own medical professionals would suggest.
- Policy Interpretation – Adjusters usually interpret policies, where there is discretion, in favor of the insurance company.
- Negotiation Tactics – Adjusters may use negotiation tactics to pressure an injured party into accepting a premature or low settlement.
How Attorneys Can Help
- Obtaining Policy Limits and Coverage Information – Attorneys will formally request information and documents from the insurance company related to policy and coverage limits.
- Negotiating a Settlement – Personal injury attorneys, like those at Wallace Wason, PLLC, are skilled negotiators who know how to best present your case and fight for your maximum compensation.
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