I. Dealing With Insurance Adjusters
Motor vehicle accidents have historically been one of the leading causes of accidental deaths and injuries across the United States. While an injured driver can seek compensation for their losses through civil action against a driver who has caused an accident with them, the first step in an injured driver’s recovery after a motor vehicle accident is typically an insurance claim.
Every driver must purchase and carry auto insurance that complies with their state’s minimum insurance requirements. Unfortunately, dealing with insurance adjusters is rarely an easy or pleasant experience, and many injured claimants face unfair delays, denials, and even bad faith dealings in some cases. If you need to file an auto insurance claim after an accident, it’s vital to know how insurance adjusters operate and the best way to handle them in your situation.
II. What Does an Insurance Adjuster Do?
Insurance companies operate on a simple yet largely one-sided business model: in exchange for coverage, policyholders pay premiums each month. The amount paid in premiums generally reflects the scope of the policyholder’s coverage. A minimal policy for a low-risk policyholder would likely require a much lower premium payment than a more expansive insurance policy for a high-risk policyholder.
Insurance companies increase their profits by collecting premium payments from their policyholders, but they lose money when they must pay out on claims. The role of the insurance adjuster is to investigate a claim for coverage and essentially look for any and all justification to reduce the claim amount or flatly deny the claim. While the federal government requires that all insurance companies operate in good faith and process insurance claims honestly, some insurance adjusters engage in manipulative or even outright deceptive tactics to dupe or pressure claimants into accepting low-ball settlements.
III. Time Is a Critical Factor for a Claimant
It does not cost an insurance claim adjuster or their employer anything to allow the clock to keep running when a claim is filed. However, an injured claimant will likely experience mounting economic distress the longer their claim remains unpaid. When dealing with claim adjusters, time is on the side of the insurance adjuster, not the claimant.
A. Understand Insurance Adjusters Tactics
An insurance adjuster will first review a claim to ensure it is legitimate. You should expect the insurance adjuster handling your claim to be very suspicious of any inconsistencies or irregularities with your claim. It is not uncommon for adjusters to look for anything they can use as leverage against a claimant that will eventually compel them to accept a lower settlement amount than they rightfully should.
Insurance adjusters are also trained to use conversational tactics to manipulate claimants. For example, when an insurance adjuster meets a claimant in person to discuss their claim, they may ask a question. After the claimant responds, they will simply wait and not say anything. This creates the impression that the adjuster is expecting to hear more and creates an uncomfortable silence. In most cases, the claimant will want to break this awkward silence, and adjusters use this to basically trick claimants into offering more information than they should.
IV. What Is Insurance Bad Faith?
While many insurance adjusters engage in questionable or unethical tactics to gain leverage over claimants, these actions are largely legal. However, bad faith insurance tactics are not, and any such behavior is a violation of the insurer’s obligation to process claims in good faith. Bad faith insurance practices can potentially include:
- Deliberately delaying a legitimate claim to pressure a claimant into accepting a lowball settlement.
- Misrepresenting or lying about the terms of the policy in question in an insurance claim.
- Intimidating a claimant or threatening them with undue legal consequences if they do not drop their claim.
- Ignoring or obfuscating elements of a policy that would justify a claim.
- Intentionally ignoring communications from claimants.
- Denial of a legitimate claim without investigation or justification.
These are only a few examples of how some insurance adjusters might violate claimants’ rights. If you have experienced any of this type of behavior during a recent exchange with an insurance adjuster, speak with an experienced attorney as soon as possible.
V. How Can an Attorney Help With An Accident Claim?
While it’s possible to encounter problems with an insurance adjuster in many different situations, car accident claims are by far the most common reason for Americans to file insurance claims. An experienced attorney can not only help a client with their insurance claim after a motor vehicle accident but also potentially assist them in pursuing additional legal actions against the party responsible for their injuries.
Your attorney can communicate with an insurance adjuster on your behalf. They can even help you draft your initial demand letter for coverage, reducing the chance of an adjuster unfairly pushing back since you will have professional legal backing behind your claim. In most cases, if an insurance adjuster notices that a claimant has had an attorney draft their demand letter, the adjuster will not even bother trying to push back against the claim unless there is a clear and legally valid reason to do so.
An experienced attorney will help to ensure their client receives the greatest settlement possible for their claim, and it is also possible for an attorney to help their client explore additional legal options. For example, if you must file an insurance claim against an at-fault driver’s auto insurance policy after they hit your car, your claim payout may be as much as the policy allows. However, it could still be insufficient to fully cover your losses. In this situation, your attorney can help you file a civil action against the at-fault driver.
If you or a loved one recently sustained an injury and need to file an insurance claim to recoup your losses, it’s best to have an experienced attorney assist you with the process. If you have already filed a claim and encountered what you believe to be bad faith practices from the insurance company’s adjusters, talk with our firm. The right attorney can help you determine the best available legal options in your situation. Easton & Easton has the resources and experience to assist with the most difficult insurance issues following personal injuries. Contact us today to learn more about the legal services we can provide and how we can help you deal with insurance adjusters with greater confidence.
VI. Ways That Insurance Companies Avoid Claims
Getting into a car accident is jarring. Whether you’re physically injured or just emotionally shaken, the aftermath can drag on for months, and it sometimes feels like no one will help you. Unfortunately, this is not a mistake. Though they claim to protect their customers, insurance companies ultimately act as businesses looking to make and save money. They do everything in their power to delegitimize claims and leave victims without compensation.
Even if a claim is irrefutable, insurance companies have several tactics to avoid paying what they owe. These tactics lead to frustration for most, and for some, the lack of compensation can wreak havoc on their lives and bodies. If you’re dealing with an insurance claim from an auto accident, watch for these ways in which the company may be avoiding paying you what you’re owed.
A. Unresponsive Insurance Adjusters
Many people involved in a car accident expect an insurance adjuster to contact them with the next steps. However, this is not always the case. Insurance adjusters often have high caseloads, and response times are astronomically long. If you are representing your claim in a dispute, you can expect that an adjuster will avoid returning your calls or speaking with you at all costs.
B. They Ask for a Statement
Many insurance companies will request a statement from you when they aren’t required in most cases. The purpose of these statements for the insurance company is to create loopholes for your case. If you say something that they can twist to fit their argument, they will do so to avoid paying the full amount that you deserve. These statements are often requested very soon after an accident occurs before many injuries have fully developed.
Many people find that they haven’t even had time to see their doctor before the insurance company calls for information. This is all intentional. If they can make your claim seem less severe by pointing out that you haven’t rushed to the hospital, they will. If you end up giving a statement, the insurance representative will likely ask long and confusing questions. These questions often lead to answers that will minimize your case and allow them to pay less legally.
C. They “Claim Responsibility”
One of the trickiest tactics that insurance companies utilize is claiming that they accept responsibility and that you do not need to hire an attorney. If you accept these statements, they will likely draw out the process and behave unreasonably during the entirety. In the end, they will offer a fraction of what you deserve, knowing that they’ve coerced you into representing yourself, and without an attorney, you don’t have the system knowledge and resources to fight for more.
D. They Delay
Many insurance companies work large delays into their claims processes. These delays allow them to waste time right after the accident when details can be easily remembered. They know that if they get within a few weeks of the statute of limitations, it will be hard for you to find a lawyer to take your case. In California, the statute for personal injury from car accidents is only six months, so delaying even a few weeks can hinder your chances at a fair settlement.
E. They Ask for Unnecessary Medical Records
While it’s reasonable for an insurance adjuster to ask for medical records that have to do with the accident and its aftermath, some will try to ask for more extensive medical records. In these cases, they demand to see records from your whole life, presumably to find pre-existing conditions so that they can claim your injuries were not a result of the accident. Without an attorney, they can easily intimidate people into signing over their information. An attorney will argue the reasoning behind this request, and often the request is dropped.
F. They Spy On You
It may seem extreme, but the insurance company will go so far as to spy on you in some cases. This generally happens in cases in which a higher settlement is at stake. The “investigators” for these types of missions often blend into their surroundings, acting as neighbors in a car or another shopper in a store. Their goal is to see if you are doing physically taxing tasks that are incongruous with your injury claims. For example, if you are claiming to have a bad back due to an injury and they see you mowing your lawn, they may use that information to de-legitimize your claim and avoid paying.
When dealing with insurance claims, the only way to be sure you’re getting a fair settlement is to hire a qualified attorney. A lawyer will be able to spot these insurance company tactics and fight for what is fairly owed to you.
VII. Can I file suit if I’m partly responsible for my accident?
In many traffic accidents, one party is clearly at fault. For example, one driver was stopped at a stoplight when another driver failed to hit the brakes in time and collided into the rear of the first driver’s car. In this type of accident, a court would almost certainly find that the second driver caused the accident through negligence, and therefore should be held liable for the damages suffered by the first driver.
However, many car accidents are not so simple. Often, both drivers did something that contributed to accident, or worsened the damages of an accident. For example, imagine an accident where Driver A is driving over the speed limit when Driver B, distracted by a text on his cellphone, crosses lanes and collides with Driver A’s car. Driver A is badly injured, requires expensive medical treatment, and is unable to return to work.
Does the fact Driver A was speeding disqualify her from filing a personal injury lawsuit against Drier B so that she can collect compensation for her damages?
In California, the answer to this question is no. California law follows a doctrine known as comparative negligence, which allows a person in Driver A’s position to collect damages from Driver B in proportion to Driver B’s share of fault for the accident.
At trial, a court would, using a long list of guidelines, determine the percentage of fault each driver bears for the accident and its resulting damages. Let’s say the court determines that Driver B was 85% at fault for the accident, but that Driver A shares 15% of the fault because she was speeding. In this case, the court would reduce by 15% the amount Driver A could collect in compensation.
California’s comparative negligence law is known as pure comparative fault, and follows the general outline in the example above, no matter how much fault the plaintiff bears for the accident. Theoretically, Driver A could collect compensation even if she were 99% at fault for the accident. However, in that case, the amount of her recovery would be reduced by 99%.
The injured and their families should speak to a personal injury lawyer about their options after a car accident. They may have more options than they knew.
VIII. How can I get my child’s claim into court?
A previous post on this blog discussed how many victims of bicycle accidents are minor children, which is not surprising since the bicycle is one of the best ways for Orange County children under 16 or so to get around independently.
While many of these bicycle accidents are relatively minor, some are, sadly, quite serious and leave a child hospitalized with broken bones or other serious injuries. In the most serious accidents, a child could even die or come out of the accident with a permanent disability that will haunt them for the rest of their lives.
California parents in these situations are entitled to seek legal justice for their child if a negligent driver caused their accident. However, it is important for these parents to remember that, legally, children do not have the right to file a lawsuit on their own behalf.
Rather, a child in California who is under 18 will need a guardian ad litem to file suit on their behalf. While the phrase guardian ad litem also is used in the family law context, in a personal injury case, a guardian ad litem is simply a responsible adult who will help handle the lawsuit on the child’s behalf. A parent or someone who already has guardianship over the child can act as a guardian ad litem.
To be a guardian ad litem, one needs to file a special request with the court that will be hearing the case. While these requests are often uncontested, it is still an important detail that someone, particularly someone trying to handle his or her child’s case, can overlook.
There are also other special considerations when an Orange County child has been injured on a bicycle and needs to sue a negligent driver. An experienced attorney can be helpful in navigating through these considerations.
IX. Would settling your claim better serve your interests?
The first thing your mind registered was that the scenery suddenly looked different. Perhaps the next thing was the sound of crunching metal and the smells of antifreeze, gasoline and electrical components. By the time you realized you were just in an accident, it was over. An investigation into the crash indicates that the other driver caused it.
The insurance company may have already contacted you to offer you a settlement, but you aren’t quite sure whether you should take it. More than likely, the offered settlement is less than the real value of your case. You may consider filing a personal injury claim but wonder if settling would better serve your interests. In order to preserve your right to file a claim in a California civil court, you might choose to file a lawsuit, but that doesn’t mean you can’t continue to negotiate a settlement. Before taking any of these actions, and before you talk to the insurance company, it’s a good idea to consult with an attorney.
A. Pursuing a settlement
It’s important to know that, if you accept a settlement offer, you will give up your right to continue or initiate a lawsuit. Even so, depending on the specific facts of your case, it may be better to take a settlement, although you should talk to an attorney before doing so. The benefits of settling outside of court include avoiding the expense and time of litigation. This is just one reason why many personal injury claims settle without going to trial.
However, if the insurance company refuses to cooperate and refuses to pay out what you are owed for medical costs and other damages, litigation may be the best way to seek the full and fair compensation you need.
While you focus on healing, a personal injury lawyer can handle all negotiations with the insurance company and fight to maximize your compensation.
B. Finding support
The settlement process may not sound difficult, but determining how much your claim is actually worth can be challenging, if not impossible, without the help of a lawyer. Furthermore, the insurance company has attorneys and adjusters on its side attempting to find ways not to pay you the full amount you deserve. It is wise to have an advocate by your side through this process to help ensure that you receive the compensation you need.
The republication of this article was made possible by a collaboration between Flock of Legals and Easton & Easton. The original article may be found here: https://www.eastonlawoffices.com/blog/2021/01/14/dealing-with-insurance-adjusters/
