Insurance Claims Adjusting 101

Insurance companies like to portray themselves on TV as good citizens whose policies reflect fundamental fairness and dependability, but their claims adjustment practices often suggest otherwise. Most adjusters will not admit it, but the first rule of adjusting claims is to keep the injured victim away from an attorney. Here are some examples of information that adjusters may not share with claimants:

1. Regardless of whether a claimant has health insurance, the negligent driver and his insurance company are still obligated to pay the amount the health care provider charged. Many of my clients are routinely deceived in this manner prior to hiring me.

2. Likewise, even when the injured party has medical payments coverage and health insurance coverage, the defendant is fully liable for the amount charged by the health care provider.

3. The adjuster will not advise you with respect to the availability of additional uninsured or underinsured coverage from your own policy, should the defendant be inadequately insured. Yes, this means that under certain circumstances, there are four different sources of recovery available to an auto accident victim: health insurance, the negligent driver’s liability insurance, medical payments coverage, and in some cases, uninsured or underinsured motorist coverage.

4. The adjuster will not offer legal advice on whether you will have to pay your health plan back from settlement proceeds. Some plans are entitled, some are not. And in some unfortunate cases, plans will assert a right to be repaid when no right exists at all.

5. You are entitled to the value of lost time from work even if you got sick leave or were otherwise compensated for the time away from work due to accident related injuries.

6. An adjuster will not encourage you to get verification of the partial permanency of your injury from your doctor so it can be factored into the value of your claim. This verification often accounts for a significant portion of a settlement.

Perhaps most important, the insurance adjuster will not tell you the real value of your pain and suffering. This information is uniformly withheld from the injured victim, because otherwise, the adjuster will be expected to include it in any settlement amount. What the insurance company will do is tell you they are ready to send a check immediately, upon your signing a complete release of liability. Once the release is signed, the insurance company is off the hook for any subsequent accident related treatment.

Particularly in these tough economic times, many claimants are vulnerable to the offer of a quick settlement. Adjusters tell me they are having a lot of success these days settling claims cheap with quick payments. As one of them said, “I don’t want these folks to call you, Peter.” Many of the insurance adjusters I know are very nice people, but unfortunately, their job description does not include looking out for your best interest.

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