Smoke and Mirrors: Tips for Dealing with Adjusters

Adjusters exist to separate you from the money you're entitled to.  Don't deal with them without a strategy.

Adjusters exist to separate you from the money you're entitled to.  Don't deal with them without a strategy.

Insurance adjusters are your main point of contact when you open a personal injury claim after a car accident.  Many of them are great folks, but it's like I said a couple weeks ago; as nice as your adjuster might be, you have to be cognizant of the fact that he or she is employed for the sole purpose of saving the insurance company as much money as possible.  That means that you need to take great care when you're dealing with adjusters, because even minor missteps can be fatal to your claim.

So what is an insurance adjuster, anyway?

In my haste to pour my entire brain into this blog over the past several months, I've never really stopped to explain what exactly an adjuster does.  Insurance adjusters are guys and gals just like you and me, who are employed by the insurance company to (i) investigate new claims, (ii) communicate with claimants, and (iii) evaluate the viability of claims.  Once you call the Claims Department and open your claim, an adjuster is assigned to the claim.  That adjuster is going to look at the facts and circumstances of the case, assess whether their insured was at fault, and if the claim is determined to be viable, attempt to settle the claim out of court for as little money as possible.

A couple things to keep in mind here.  Number one, insurance adjusters are professionals at what they do.  They spend every hour of every day determining liability, viability, and value of claims.  They have a massive amount of resources and information available to them, allowing them to predict what your claim is worth and whether you'd be likely to prevail in court.  That means that every trick, tactic, and strategy for limiting your recovery is at the adjuster's fingertips at all times.  

Number two, the adjuster's position and performance are both crucial to the insurance company's survival, and the insurance company pays them handsomely for their work.  The person you're dealing with is paid anywhere between $40,000 and $80,000 a year to keep your recovery as low as he or she possibly can.  In many cases, adjusters are offered raises, bonuses, and performance-based perks based on how many cases they settle and how low their average settlements are.  Put (far) more succinctly, the adjuster assigned to your claim has a direct, personal, economic interest in keeping money out of your pocket.  Keep that in mind.

That's scary!

I don't say these things to frighten or intimidate you; I just don't want you to walk into such an important undertaking without knowing what to expect.  As long as your expectations are reasonable and you're willing to do a little arguing, you'll be fine.

Is there anything I should know before the adjuster calls?

Absolutely.  There are a lot of little tricks and games that adjusters will try to play as a way to frustrate you, incentivize you to walk away as soon as possible, or even trick you into volunteering harmful information.  Some of the more common pitfalls are as follows:

1.  Early settlement.  Like I said in my last article, it's really common to see adjusters calling injured claimants before the claim has even been opened; like the next day or even later on the day of the accident.  The adjuster will tell the claimant that since liability is clear, they're going to go ahead and graciously make an offer of $500, $1,000, or some other pittance.  Too often, the injured party goes ahead and accepts this offer, not knowing that once the offer is accepted, the insurance company is no longer liable for any of the claimant's damages.  To that end, I say this; never, ever, ever accept any settlement offer until you know exactly what your damages are.  That means that your car is fixed or replaced, your lost wages and fuel costs are itemized and calculated, you're done treating with all of your medical providers, and, if you've suffered a permanent injury, you know what your permanent injury rating and future damages are.  Does that mean waiting a few extra months for your money?  Yes it does.  It also means that you can rest assured knowing that all of your damages are being taken care.  Trust me; it's worth the wait.  Print out our Damages Diary, complete it, and calculate all your damages before you accept any settlement offer from the adjuster.

2.  Recorded statements.  It's very common for adjusters to call unrepresented claimants and ask them to give a recorded statement about what happened.  The claimant, because he or she thinks that a recorded statement is mandatory as part of the claim, ends up saying something unfortunate on the record.  Know that you never have to give a recorded statement when you're dealing with the at-fault party's liability carrier.  They're not entitled to a recorded statement from you, and they aren't allowed to deny your claim based on a refusal thereof.  If you're dealing with your own UM/UIM carrier, or if you have a claim for medical payments coverage, your carrier might be entitled to a statement, but make sure that you check the policy language carefully to determine whether this is the case.  If you do have to give a recorded statement, make sure that you keep it really simple.  You were driving, you were hit, you were injured.  Period.  The rule of thumb is that the more detail you give, the more opportunity the adjuster has to poke holes in your story.  Stick to the bare facts and keep your version of events watertight.

3.  Delay.  You have a damaged car, and the medical bills are piling up.  You need money soon, and the adjuster knows that.  They might make a low initial offer, then tell you that it's going to take weeks or months to evaluate whether they can increase it.  Along the same lines, the adjuster might advise you not to seek further medical treatment, asserting that the carrier won't cover it if you do.  If this happens, make sure to remind the adjuster about bad faith, like we learned about a couple weeks ago.  The adjuster has a legal obligation to deal with you in a reasonably expedient manner, and if they don't, they can quickly run afoul of North Carolina's insurance bad faith laws.

4.  Medical releases.  It's likely that the adjuster will ask you to sign a form authorizing the release of your medical records.  Don't ever do this.  The adjuster is going to use that release to go back as far in time as he wants and get all of your medical records, not just the records that are pertinent to the claim.  He's going to pick your records apart to find anything that could conceivably be interpreted as a pre-existing condition, and use that as leverage to devalue or even deny your claim.  Wait for your treatment to complete, get the records yourself, and then turn over the pertinent records to the adjuster.  If there are things in the pertinent records that don't make your case look great, keep in mind that you're allowed to redact them.  You aren't in court yet, and you aren't obligated to turn over your complete medical records.  If you need a HIPAA-compliant release, let me know and I'll be happy to give you one.  Make sure to request your records under HITECH as well and save yourself some money.

5.  The statute of limitations.  This goes along with the "delay" discussion above, but your claim has an expiration date; what we call the statute of limitations.  This is the amount of time that you have to bring your claim in court.  Keeping in mind that the insurance company is liable to you for exactly nothing after the statute of limitations runs, it's incredibly important that you settle your claim, or file your lawsuit, before that happens.  Generally, in North Carolina the statute of limitations for negligence (which is mostly what car accidents will contemplate) is three years from the date of the accident.  There are exceptions where the plaintiff is a child or was mentally incompetent at the time of the accident, but generally you're looking at that three-year window.

Any other tips?

Basically, I would advise you to keep it civil and remember that an adjuster is a person just like you are.  You're going to catch more flies with honey than with vinegar.  It's possible to be simultaneously civil, firm, and persistent, and it's important for you to take that approach into every conversation with the adjuster.  If the adjuster starts throwing around legal advice, gently remind him that he isn't a lawyer, and that the unauthorized practice of law is something the State Bar takes very seriously.

In the same vein, if you get in over your head, go and talk to an attorney.  While I always try to stay away from guarantees and predictions, I can tell you that claimants are typically going to get higher settlement amounts when they're represented.  Adjusters often find it all too easy to manipulate laypersons, and they often get a lot more serious about the claim when the calls are coming from an attorney's office.

Finally, if you have questions or concerns, give me a call.  I'm happy to help you out in any way I can.  Good luck!