Woman dealing with insurance agent

In any personal injury claim, there is a high probability that you will be dealing with an insurance company. For example, in auto-accidents, the at-fault driver’s insurance provider will be involved with settlement talks. If a doctor is accused of medical malpractice, their medical malpractice insurance provider will deal with the case. If a homeowner is accused of premises liability, their homeowner’s or liability insurance will cater for the plaintiff. Since most personal injury scenarios involve an insurance firm, it is important to learn what dealing with these companies entails.

The Process of Negotiation

The negotiations process with an insurance adjuster begins once the claimant has sent a demand letter stating the amount of money they are claiming for personal injury. The adjuster normally telephones the claimant within 14 days to offer their response to the letter. However, the time it will take for an adjuster to respond to the claimant’s demands will depend on their schedule and the complexity of the case. If the insurance adjuster does not respond within 2 weeks, it is advisable to call the claims department and confirm whether they received the demand letter and when a response may be forthcoming.
The first thing that an insurance adjuster will send to the claimant is a letter known as the “reservation of rights”. This letter seeks to inform the claimant that the adjuster is investigating their claim and will withhold payment if the incident is not covered by the policy. This letter protects the insurance provider against future claims that because it started negotiations with the claimant, it recognized that the accident was covered by the policy. It is also a strategy aimed at hinting to the claimant that the insurance provider might not pay for their loss hence compelling them to accept a small settlement.

Subjects of Negotiation

During negotiations, insurance adjusters will ask a set of questions, and object to some facts, in a bid to reduce the value of the claimant’s compensation. The main disputes involve:

  • Coverage- Whether a claimant’s policy caters for the accident
  • Liability- The person to blame for the accident, and the degree of the complainant’s comparative negligence
  • The seriousness of the claimant’s injuries- Whether one’s injuries were disabling or permanent
  • The type of medical treatment- Whether certain procedures were necessary, and whether the claimant had pre-existing medical problems

After conducting investigations, the insurance adjuster will raise any of the above disputes to reduce the claimant’s offer. The claimant might concede to the adjuster’s arguments and propose a lower settlement amount. The adjuster will make another proposal and if the claimant accepts it, a settlement contract will be drawn and the issue will be concluded.

How An Insurance Claim May be Denied

Material Mis-Representation

Failing to indicate material information can be grounds for an insurance claim denial. No matter what type of insurance you are dealing with, it is regarded as failing to provide the insurance with up-to-date information. These simple issues can affect the rates of your policy. Therefore, if you have not reported material information, like the purchase of a new vehicle, moving to a new residence, or changing banks, to your insurance adjuster, this means you are not paying the correct rates, and are therefore committing fraud.

Fraudulent and False Claims

Many claims are turned down due to falsification of information meant to get a claimant more than they deserve. Falsification of insurance information may also lead to a black mark on the claimant’s record. This means it will be difficult for you to be compensated under a policy in future.

Unlawful Acts

For accidents that involve irresponsible behavior like drunk driving, distracted driving, stunt driving, or unlicensed driving, your claim is likely to be disbanded. Furthermore, you may lose your coverage, and become uninsurable in the future.

Uninsured Claims

One of the main grounds that insurance adjusters use to deny people of their claims is to dispute that an accident is covered by a claimant’s policy. In many cases, claimants think they are insured in certain conditions, but later discover they are not. It is important to study the provisions and exclusions of your policy.

Mistakes to Avoid When Negotiating a Settlement

Do not Agree to a Recorded Statement

Your adjuster could ask you to make your statements on record. You are not legally obliged to record statements. Insurers use recorded statements to minimize your settlement. If your lawyer is not present, refrain from recorded statements since anything you say is likely to be used against you.

Do not Give Your Adjuster Irrelevant Information

Insurance adjusters try their best to secure irrelevant information that can be used to compromise your recovery. Therefore, refrain from disclosing to the adjuster information about your family members, friends, or current and past employers, unless they are involved in, or important to your claim. Details of your prior medical condition are also irrelevant, and can be used to quash your settlement demands.

Do not Sign Medical Releases Prematurely

The ideal time to sign medical releases is when your treatment is nearing its end. These releases help you gain access to all your medical statements. These records are not required by the adjuster during the initial stages of the claim, but are only required when concluding your treatment. Giving your adjuster these records to early in the settlement process will lead to a low compensation award. It is advisable to hold on to these records until your doctor is sure about your medical condition, and that you are not likely to experience any future complications.

Settling too Fast

Many insurance adjusters pry on the claimant’s desire to settle quickly. While ending the heartache of a personal injury claim is the desire of every claimant, settling too fast can work against you. In some cases, the extent of one’s injuries or damages is not apparent until later. For instance, a sprained hand could in future turn out to be broken. This complication means more medical expenses, and may lead to loss of income, where a person depends on that hand to execute their employment functions. In such a situation, one is entitled to a higher compensation than that of a sprained hand. Therefore, settling early could make you lose out on higher damage awards.

What Insurance Adjusters Do not Want You to Know

Insurance Adjusters Want to Settle

While insurance adjusters will pretend that they care less whether you settle or not, they are actually determined to settle claims. When a case goes to trial, it is a huge loss to the insurance provider in terms of large settlement awards, and court expenses. Therefore, insurance companies opt to settle than pay for litigation fees, and high settlement amounts.

Insurance Adjusters Should Act in Good Faith

Insurance adjusters are required by law to act in good faith during settlement negotiations. These means they should justify their offers, should not tamper with evidence, or withhold information. An insurance adjuster is legally liable for actions that are done in bad faith.

Insurance Adjusters May Be Recording Your Statements

Insurance adjusters are sly when it comes to gathering information that helps them pay a low settlement. This includes recording your statements. When talking to an insurance adjuster, ensure your statements are not self-incriminating. It is better to have a lawyer by your side to both intimidate the adjuster and to keep you from self-incrimination.
The process of settling with an insurance company can be tedious. However, acquainting yourself with what it entails, and the basic pitfalls, can turn out to be worthwhile in the end. If you have more questions reach out to your personal injury attorney for a free consultation as soon as possible.