What do an insurance claim representative and insurance adjuster do?
When you’ve suffered personal injuries after an accident, navigating an insurance claim can be frustrating and overwhelming. What many accident victims don’t realize is that insurance adjusters and insurance claim representatives are trained to minimize payouts, potentially leaving you with a settlement offer that falls far short of covering your medical bills, pain and suffering, and other expenses.
While you should promptly notify your own insurance company after an accident and provide them with the information they need to process your claim, stick to the basics and never admit fault. if the at-fault party’s insurance company contacts you, contact a lawyer to handle all communications with them.
If you’ve never had to file an accident claim before, you may not know what tactics your insurance adjuster uses to calculate a settlement offer. Here we will take a look at some of the tricks insurance companies use to help you recognize a lowball insurance offer and when you should seek legal representation.
What do an insurance claim representative and insurance adjuster do?
Claim representatives for insurance carriers are professionals, and experts whose job is to have your claim cost the insurance company as little as possible. That means for you to get as little as possible, as opposed to a “fair and reasonable” settlement amount.
What are some tactics insurance adjusters use?
If you are hurt, unrepresented, and unfamiliar with personal injury claims, the hardball tactics used by some claims representatives can leave you feeling frustrated and confused. You are likely to feel that you are being taken advantage of in the process.
Often, the claims representative will pressure you to settle right away. However, settling quickly may not be in your best interest, depending on the type of injury you sustained and the type of treatment needed to recover from your injuries. What you don’t know really can hurt you.
The claim rep will tell you that you can save money by not hiring an attorney because you won’t have to pay the contingency fee that personal injury attorneys usually charge. The claim rep will tell you the insurance company will work with you and that you do not need an attorney.
More than likely after an accident, the claim representative will contact you soon after the crash, likely the same day. One of the first things they may try to get you to do is to make a recorded statement. Be cautious when communicating with any car insurance adjusters, taking care to avoid talking about the accident and disclosing medical records. Revealing too much can jeopardize your claim and financial recovery.
What the insurance company won’t tell you
While an insurance adjuster may seem helpful on the phone, their main objective is to lower their company’s payouts, not to ensure you receive fair compensation. They don’t normally disclose the various tactics they use to lower the value of your claim, so understanding some of their strategies can be useful.
A experienced and skilled personal injury lawyer can level the playing field. They can handle all communications with the insurance company, protect you from inadequate offers, and fight for the compensation you deserve.
Determining fault
Every state has rules governing liability and negligence in personal injury cases that can affect the value of your claim. These rules determine how fault is assigned in an accident and that can significantly impact your compensation. Insurance claims adjusters know these laws and how to use them to their advantage.
For instance, an insurance adjuster might try to shift all or some blame for a car accident on you. Depending on your state’s laws, sharing any liability for the accident that harmed you could substantially weaken your car accident claim and lower the insurance company’s payout.
An experienced car accident lawyer can help you understand your state’s specific liability laws and how they affect the value of your car accident claim. A car accident attorney on your side can also counter the insurance company’s tactics and fight for your maximum compensation.
Recorded statement
When the claim representative requests a recorded statement, they don’t tell you that you have a right to refuse or that you are entitled to a copy of your recorded statement, whether they transcribe it or not.
The claim rep will tell you that all they need to get things started is your recorded statement to determine liability (that is, whose fault it is), or that their insured has not reported the accident so they need your version of what happened. Then the claim rep will ask not only a number of questions about how the accident occurred, but also about the property damage, your injuries, your prior health condition, and other personal information.
If you give a recorded statement, you are simply giving the insurance company ammunition they will use against you later in settlement negotiations and at trial. What you say can and will be used against you by the insurance company.
Prior injuries/prior claims
They don’t tell you about the Claim Index Database System maintained and used by most insurance companies to track and secure the claims history of every claimant (that means YOU). The claim rep requests your full name, address, date of birth, and social security number. To relieve your apprehension about providing personal information, they tell you that this information is essential to their investigation and processing of your claim.
What they don’t tell you is that this information is being used to search a national database (paid for by the insurance companies) with a list of your prior claims for:
- Bodily Injury
- Auto
- Workers’ Compensation
- Homeowner Insurance
This information also includes:
- The coverage for which you filed the claim
- The date of the incident
- The type of injury
- The settlement for you and anyone else who resides in your household.
This information is provided to any insurance company that pays to subscribe to this service – and almost all of them do. The database service also sends an alert to every insurance company that has an open claim for you.
During the recorded statement, when they are inquiring about your injuries from the crash and asking about any prior injuries and prior claims, they probably already know the answer. If you have been involved in an automobile accident or worker’s compensation claim, they will already know because they will have already run your name through the Claims Index Database or received an alert. If you were not in the Claims Index Database before the crash, you will be.
Surveillance
What they won’t tell you is that the claim rep may request video surveillance of your activities, especially if you have a pre-existing condition or prior injuries. If the claim rep thinks any of this information is different or contradicts anything you told the claim rep about your injuries and pre-existing conditions, they will use it as an excuse to delay your claim, pay you less, or refuse to compensate you at all. They are trying to cast doubt on your injury or blame it on a pre-existing condition, just to have an excuse to portray you as a dishonest person.
Medical Authorizations
After the recorded statement, the claim rep will send you medical authorizations and perhaps a release. What they won’t tell you is that the claim rep will often use your medical authorization to not just obtain your treatment records, but also to obtain your prior, unrelated medical records.
The claim rep or adjuster will ask you to sign a medical authorization so that the insurance company can obtain your bills and medical records from the collision. In addition, the authorization will normally also allow them to talk directly to your doctor about your injuries, your condition, your progress, and your treatment. By the time you are finished treating, the insurance company will know more about your injuries and health conditions than you do – thanks to your recorded statement, the Claims Index Database, and your medical records and information obtained through your medical authorization.
Settlement
What the adjuster also won’t tell you is to “hold off on settling your case until you are released from medical treatment.”
You don’t know how you will be feeling weeks or months after the crash and you should not rush to settlement. If you have not recovered from your injuries and are continuing medical treatment, you should not settle your case. Your doctor is better at determining your course of treatment – how long to treat, what type of treatment, and the likely recovery period from your injuries. This should not be determined by a claim representative. You would be taking the risk, settling before the true extent of your injuries and losses are known. You may be settling too soon and too cheap, which may please the insurance company, but is certainly not in your best interest.
Claim representatives are aggressive in their methods to:
- Contact you
- Obtain a recorded statement
- Have your authorization signed
- Secure your medical records
- Get you to settle, and
- Sign a release
This allows them to save them money, and prevent you from getting a free consultation with an attorney. Insurance companies even have a name for this process; it’s called “controlling the case.” They know that if you see an attorney, they’ll end up paying more money.
Contact an Allen & Allen personal injury lawyer today
If you’ve been injured in a car crash or other kind of accident through no fault of your own, a personal injury lawyer with Allen & Allen can protect you from some of the tactics an insurance claims adjuster may use to minimize your claim’s value.
You need someone who is knowledgeable and experienced on your side, and who will fight for your maximum compensation. Call the experienced and compassionate attorneys at Allen & Allen today for a free consultation at 866-388-1307.
