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8 QUESTIONS TO ASK INSURANCE ADJUSTERS

I am Chris Heavens. I have been a litigation attorney since 1991. I began my legal career working in a law firm that represented insurance companies and corporations. In those early years, I saw firsthand the inequities in our legal system. I saw how insurance companies took advantage of people who didn’t have an attorney. I also saw how inexperienced or incompetent attorneys could harm their clients as much as the money saving tactics of insurance companies.

Insurance companies are no different than people and families in that they have a desire to protect their own financial interests. In order to do this, insurance companies have the best attorneys on retainer 24/7 advising them. Unfortunately, most people and families do not have the financial resources to keep attorneys on retainer 24/7. The purpose of this document is to help those people and families.

For those people and families who do not have their own attorney, I recommend that the following questions be asked of any insurance adjuster.

Question 1: Will I get more money for my claim if I hire an attorney?

Answer: Don’t be surprised if the adjuster says “no” to this question. However, the truth is “yes” you will usually get more money for your claim if you hire an attorney. How do we know this is a fact? Ironically, the Insurance Research Council (a nonprofit group funded by major insurance companies across the nation) conducted a study called “Paying for Auto Injuries” that establishes this fact.  The study found that the average total payout on claims that involve an attorney is 4.8 times greater than those claims where the injured victim settled on his or her own. The same study showed that individuals who use an attorney receive 3.28 times more money after the attorney’s fee is paid. So don’t be surprised if an insurance adjuster tells you not to hire an attorney. They are just attempting to protect their company’s financial interests. Shouldn’t you do the same for yourself and your family?

Question 2: Will you provide me with a fair and reasonable settlement?

Answer: Of course the adjuster will tell you that his/her offer is fair and reasonable. The adjuster can’t tell you that everyone with similar injuries receives more because it would be counter-productive. The adjuster is there to protect the financial interests of his/her company and that goal is in direct conflict with your desire to obtain a fair and reasonable settlement. Adjusters get raises and bonuses for paying you less, not for paying you more. Unless you are in the business of negotiating and settling injury claims there is little chance you will know whether the settlement amount that is being offered is fair. By negotiating and settling the claim yourself without using the assistance of a professional (i.e., personal injury attorney) you run the risk of accepting a sum that may turn out to be much less than what is considered reasonable for your type of claim. Having this knowledge is invaluable. An attorney has his personal experience along with data from other civil trials to use to help evaluate your case and tell you what is reasonable.

Question 3: Why do I have to give you a recorded statement?

Answer: The answer to this question should be obvious. Do you think adjusters want to take your recorded statement to help you? Recorded statements are a critical tool used by insurance companies in denying claims or devaluing claims. Adjusters want people to say “it could have been my fault” or “I’m not that hurt” so that their attorneys can use the statement against you later when the adjuster low balls you and you belatedly decide to hire an attorney to fight back. By that time, however, the damage will have been done. Your decision to trust the adjuster and give the recorded statement in hopes of a quick and fair settlement will be a life lesson that you can share with family and friends so that they will not have to read this document.

Question 4: If I give a recorded statement, can I then get a recorded statement from your insured (the person who caused my harm)?

Answer: Guess what the insurance adjuster will tell you if you ask for a quid pro quo on the recorded statements? You guessed it. Insurance adjusters will not share any information with you that harms their company’s financial interests.  If the other driver tells the adjuster in a recorded statement that he was texting or he dropped his coffee at the time of the accident, it doesn’t take a rocket scientist to know that the insurance company is going to withhold that recorded statement. On the other hand, if you make such a statement, it will be played back to you every time you complain about how unfair the adjuster is being in his/her settlement negotiations. When you eventually must sue the other driver after you have been low-balled repeatedly, the other driver will then have a savvy insurance defense attorney preparing him for deposition and court proceedings.

Question 5: Why do I have to give you an unrestricted medical authorization before I can settle the claim?

Answer: The answer here is simple. Adjusters are trained to go on fishing expeditions into past medical records to find anything about your prior health that can be used to discredit you or assert that your present complaints are really the result of pre-existing conditions. If you sign a medical authorization without restrictions, not only will the adjuster have your medical records, but also your medical records may be shared with an indexing service. Essentially, your medical records could end up in the hands of persons and/or entities that have no business seeing them. On the other hand, if you have an attorney, the attorney can collect your medical records and craft an authorization that prohibits the insurance company from sharing your medical records with indexing services or any other entities. There are a number of good reasons to have an attorney assist you in this process, and the privacy and protection of medical records is at the forefront.

Questions 6: Do I have to complete my medical treatment and fully recover before I can settle my claim?

Answer: The answer to this question depends on the nature of your injuries and the amount of insurance. Adjusters will not tell you this. Adjusters are trained to tell people that they cannot get a settlement until they are finished with treatment. This causes some people stop treating even though they are still hurting or to hurry through treatment just to get a settlement offer. When the person is then low-balled by the adjuster and has to hire an attorney, the attorney is presented with a case where the client has stopped treatment, but still requires treatment. When the person attempts to re-initiate treatment, the insurance company then uses the lapse in treatment against them by arguing that they are just re-initiating treatment to attempt to milk the system. Most insurance companies have written directives to their claims departments to get people to quickly conclude treatment and settle their claims as soon as possible. This is to cut-off payments for any future medical problems that may not be fully recognized in a few weeks or a few months after an accident. If adjusters can get people to take a quick settlement and sign a release, it’s all over. People cannot come back for more benefits later. The moral of the story is that you should not stop treatment if you are still hurting or your doctor has ordered treatment. Your health is your wealth and this should be your primary focus, not the adjuster’s promise of quick money.

Question 7: Why hasn’t anyone told me about Uninsured Motorist (UM) or Underinsured Motorist (UIM) coverage?

Answer: Many people do not know that they may have additional coverage under their own policies that will pay for the injuries and damages caused by a car accident. If the at-fault driver has no insurance, or not enough insurance to pay for your damages, then your own insurance company is responsible for paying you additional compensation under the UM/UIM portion of your policy if you have this coverage. Adjusters have no legal obligation to disclose or explain insurance coverage to you. In fact, adjusters have a financial incentive to not disclose insurance benefits to you. If you are not an insurance adjuster or a litigation attorney, it is unlikely that you will be able to adequately protect your financial interests when dealing with an insurance company. There are simply too many pitfalls and opportunities for missteps confronting you.

Question 8: If my health insurance pays my medical bills, what happens if I settle with you? 

Answer: Adjusters may tell you that their settlement has nothing to do with health insurance. They do not want to discuss the legal principle of subrogation with you. However, after you settle and sign a release, you may be confronted with a subrogation lien from your health insurer that requires you to pay a large portion of your settlement or, worse, all of your settlement back to your health insurer. In short, if you settle with an insurance company without understanding your subrogation obligations, you may end up with nothing. The reason adjusters don’t want to tell you about subrogation is because they know you will do the math in your head and realize that you need to get much more money from them in order for their settlement proposal to make sense.

IMPORTANT FINAL NOTE

People involved in an incident that requires them to deal with an insurance adjuster should always contact an experienced attorney for a free phone consultation before signing anything or giving any statement. This is a no-brainer because the call and consultation are free and a person has no obligation to hire the attorney if he/she doesn’t like what they hear. If you want to speak directly to Chris Heavens, you can call him anytime on his cell phone at 484-467-8254.

CHRIS HEAVENS

Chris Heavens understands all the legal principles involved in injury and insurance litigation. He has successfully litigated injury and death cases. He has successfully sued insurance companies on coverage and bad faith disputes. If you are in need of an attorney, you need to have an attorney that has a track record of excellent results and a long list of satisfied clients. Chris Heavens is that kind of attorney. But don’t take our word for it, go to our web site, review our cases and see what our clients are saying about us at www.heavenslawfirm.com.

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