Tactics insurance companies use to reduce or deny claims

insurance company

Insurance companies are NOT on your side. Here’s what they’ll do to try and minimize or eliminate your accident injury compensation.

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About Dealing With Insurance Adjusters

You got into a wreck that wasn’t your fault and now you are injured. You have all sorts of stress on your hands. To add to that, you have to talk to an insurance adjuster. It’s a big, scary company, so you don’t know what to expect. Relax. We’ll tell you in this article.

Should I speak to the at-fault party’s insurance company?

No way! They’ll come off as friendly and nice, appearing to want to collect some information so they can do some paperwork, and write you a check. Sounds innocent enough, doesn’t it? BUT…their entire job is to adjust the amount of money their company would pay you to a lower number, one much lower than you deserve. The number never “adjusts” upward. Plus, they know you might be on pain medications, and still woozy from the accident. So they might get some good information out of you that supports their case, not yours. That’s nasty, isn’t it? If the other insurance company calls you, call a personal injury lawyer instead.

Do I have to talk to the claims adjuster?

No. Never. No matter how they present it to you, you do not have to speak to them. If you do speak to them – many times they want a recorded statement – you should only do so if you have an attorney who participates in the call or meeting with you.

If the insurance company’s attorney calls do I have to talk to him/her?

This appears a little more intimidating. But, their attorney has no more authority than their claims adjusters. The insurance company may use their lawyer to put a little more fear in you. Sometimes, if the insurance company doesn’t have a local claims office, they’ll hire a local attorney instead. Again, you don’t need to worry if a lawyer calls you. And just like you would with a claims adjuster, don’t talk to them on your own. Their mission is the same – to find out what not to pay for.

About Making Recorded Statements

In only one situation should you ever make a recorded statement after your car accident: when the facts of your case can’t be argued. For example, you got rear-ended by someone going 45 mph while you sat stopped at a traffic light.

Aside from blatantly obvious circumstances, you shouldn’t make a recorded statement to the insurance company. The claim adjuster’s job is to ask you questions to get you to say things in ways that harm your credibility.

They do this 40-60 hours per week for years on end, so they’re pretty good at it. If a recorded statement is absolutely necessary you should make sure you have a personal injury lawyer participating so they can make sure the claims adjuster is asking you fair questions.

What’s the big problem with giving a recorded statement?

Insurance companies use recorded statements for one thing, and one thing only: trying to find a way to minimize or eliminate any money they might owe you. Remember, they are multi-billion dollar corporations who only care about making billions more.

Their strategy in using recorded statements usually revolves around two things: 1) Getting you to say something that harms or discredits your case outright, and 2) hoping you say something that hurts your case when read on a transcript.

How you verbally respond can sound much different when written down on paper. And remember, claims adjusters do this work 40 hours per week for years. They know how to ask questions without “right” answers. And they’re skilled at what they do.

They often ask questions in ways that lead you to discredit yourself. It’s their job. And they get paid more for minimizing or denying your personal injury claim entirely.

What should you do when the adjuster asks you for one?

In some situations, the value of your claim is so small that lawyers’ fees would eat up anything you might win. This might be the case if you’re in a minor fender-bender. An honest lawyer will tell you that. So occasionally, it makes sense to talk to the claims adjuster on your own.

If that situation applies to you, stick only to the facts. Get a copy of the police report. Tell the insurance company the same thing you told the police. Don’t chatter. Say only what’s necessary. Write it down first beforehand and talk through the story a couple times first with someone in your family. Don’t change even the slightest detail. You should be okay if you go that route.

However, if you get into a bad accident, don’t talk to the insurance company at all. Let your Dallas injury lawyer do the heavy lifting. You focus on getting better from your injuries.

And if you’re not sure, you can always reach out to a personal injury attorney for a free consultation. Look for one with a perfect A+ BBB rating (there’s no good reason, only excuses, to have anything less) and who’s a member of “Texas Super Lawyers.”

They’ll be honest and forthright with you, and let you know whether they can help you, and how to talk to the insurance company if they can’t help.

Tactics Insurers Use to Reduce or Deny Claims

They’ll Try to Settle Your Claim ASAP

So let’s say you contact the other driver’s insurance company and explain the situation. It’s clear they’re at fault, and you have a police report backing up your position. You will get a call literally the next day from the other drivers’ claims adjuster. They’ll offer you a settlement amount on the spot.

You can agree right then and there, and you can even go to the company and pick your check up in the next 2-3 days, after they talk to their driver. Whoa! Now that’s fast customer service. It’s funny how quickly things happen when the insurance company stands to benefit.

Why are they so eager to help you? Well, in Texas you have a 2-year statute of limitations on personal and property damage for auto accidents like these. So, the insurance company knows that if you are seriously injured, you could have thousands of dollars in medical expenses for years to come.

But, if you settle the claim now, they only have to pay for any medical expenses through the date you sign their form, agreeing to settle the claim. That minimizes their payout (and maximizes their profit) if you agree to close out the claim now.

And they know if they dangle a lump sum of money in front of you and can get it to you fast, you’re more likely to act irrationally and accept less than you legally deserve.

The Adjuster Will Be Eerily Nice to You. Here’s Why.

Wouldn’t it be great if you could call your insurance company and get this good of service all the time? Why are they so concerned with the harm you’ve experienced, and so friendly and nice? They’re not treating you like a number, routing you through an endless phone maze, like they normally would if you called any other time.

Don’t fall for it! It’s all an act. First, they’re being nice and friendly because they want you to cooperate with their agenda of minimizing their payout. They know that if they’re nice and appear to be on your side, you’re more likely to go through their process, thinking you’re getting a good deal. Second, they’re hoping you’ll reveal details in your recorded conversations that they can use to reduce what they pay you.

Adjusters May Say You’ll Get Less Money if You Hire a Lawyer. It’s Not True.

Blatantly FALSE! You will have to pay your attorney. But only as a part of your settlement value after you win your case. In the vast majority of cases, you will still end up with more money than you would if you settled your case on your own.

Attorneys are expensive, aren’t they? Some are. And let’s be honest: some lawyers only want to get your money. But, many are fair and honest and act with integrity.

Insurance companies will try to tell you that you’ll lose money when you hire an attorney because attorney’s fees will take away most of your claim. Or, they’ll say researched statistics prove this.

Ask to see such statistics. Here’s a hint: they don’t have any such statistics. You most certainly will get more money when you hire a skilled personal injury attorney with integrity.

They May Ask to See All Your Medical Records. Don’t Do It.

At first, it sounds fair, doesn’t it? They need this information to calculate a fair settlement amount. Don’t do it. Here’s where that obnoxious term “pre-existing condition” comes in. They want to find one to minimize or eliminate your payout entirely. No law requires you to give them this information, so don’t.

They’ll Offer To Give You Money if You Sign Their Release. Don’t Do It.

Remember, if you sign their release now, you can never ever get compensation for your injuries again. There’s absolutely no appeals process for this. Once it’s done, it’s done forever. The insurance company knows you’re feeling pressure because bills are piling up. And they don’t want to pay for injuries and medical treatment in the future.

Remember, your injuries may hurt now. But you don’t know exactly how long they’ll last. It could be years. And the insurance company wouldn’t be responsible for paying for those if you sign their release now. That’s not fair to you.

They’ll Secretly Video You to Prove You’re Not Really Hurt

Never thought you’d have the Paparazzi on your tail, did you? Well, this isn’t the Paparazzi exactly. But insurers will hire private investigators to spy on you and take video of you to disprove your claim.

So, it’s important to be honest about your injuries. And don’t “push” yourself to get better too quickly – that can be argued as your injuries not being that severe in the first place.

They’ll Bait You Into Making Statements that Will Minimize Your Claim

Adjusters record what you say. They will imply law requires you to make a statement. But, the key word is “imply.” Adjusters have to imply the law says this because law forbids them from saying it explicitly.

You don’t have to say a thing to an adjuster unless you want to. And you should only talk to them by yourself when the facts of your motor vehicle collision are indisputably straightforward.

They’ll Claim Someone Else Was at Fault for Your Injury

The insurance company could suggest you were partially or mostly at fault. They could also say a third party was at fault. They’ll interpret circumstances any way they can to show they don’t have to pay.

Remember, claims adjusters get paid based on how little they pay you, how quickly they settle your claim, and whether they keep lawyers out of it.

They’ll Delay Acting on Your Claim

Insurance companies will ignore you within the limits of the law, and sometimes even beyond that. They say they’ll “call you back.” They’re “still processing your paperwork.” They’ll give you an intentionally low settlement offer.

They just want to see what you’ll put up with. They know many consumers feel powerless and afraid, and they play on that.

If an insurance company owes you money, and you feel you’re not getting a fair shake, that’s when it makes sense to call a personal injury lawyer. Remember, Texas law favors insurance companies, and you’re acting fully within your rights when you seek help from an injury lawyer.

They’ll Look for Evidence of Fraud

Okay, so insurance companies have legitimate reasons for investigations too. They’re not all bad.

They want to make sure you don’t commit “hard fraud,” which is an organized conspiracy to lie about your claim. And they want to prevent “soft fraud” too, which is inflating the value of your claim.

They’ll Look at Your Social Media Profiles

To find evidence of fraud, or to minimize or deny your claim, insurance companies now check your social media profiles. Remember, many networks let you see private information without actually being someone’s friend.

So if you get injured Wednesday, and you have a hard time walking, don’t take pictures of yourself country line-dancing with friends on Thursday.

They Try to Find a Way You Violated One of Their “Exclusions”

Most insurance policies have an “insuring clause” that tells you what your policy covers. After that, the real fun begins! At least, fun from their viewpoint anyway.

They list dozens of paragraphs, and thousands of words even highly intelligent human beings and experienced lawyers don’t understand. These sections are called “limitations” or “exclusions.”

And the basic point is that they’re written with such complex language to make it as easy as possible for insurance companies to deny or minimize the value of your claim.

You Don’t Need to Talk to Insurance Companies… Ever

At the end of the day, you have the right to talk with an insurance company (or not). What you have to remember is you have no legal obligation to do so. And keep in mind they’re not on your side, no matter how nice and accommodating they seem.

The good news is you never have to talk to an insurance company if you don’t want to. Call a personal injury attorney instead. They will advise you what to do, even if they can’t represent you.

About Delaying Medical Treatment

It’s scary immediately after an auto accident. You know the financial damage will be intense. But, you don’t know what it’s going to be or how you’ll be able to afford it.

So, it’s easy to convince yourself to delay or skip medical treatment. Insurance companies love it when you do this because delaying treatment can be used against you later on. They’ll say that if you’re really hurt, why would you wait to get medical attention?

About Seeing the Insurance Company’s Doctor

Current law allows you to see any doctor you want for your injuries. The insurance company pays their doctors, and the doctors know that. If the doctors find things that don’t support the insurance company, they lose their revenue.

Insurance companies will imply you can only see the doctor they choose. But, law doesn’t require that at all. See the doctor you want so you get a fair and objective point of view.

Signing a Release of Your Full Medical Information

It’s okay to sign a form to release the medical information related to your current accident. However, insurance companies may send a release for all of your medical information.

Why? They want access to all of your past medical records – whether relevant or not – to try and suggest your injuries or damages were related to a pre-existing condition.

Insurance Companies Urge You to Act Fast, So Take Your Time

When you get hurt, you’ll be surprised at the initial kindness of the insurance adjuster. You’ll also notice how quickly they can get you payment – literally within just a week of your car accident.

Don’t fall for it! It’s all a ruse. They’re trying to play you for a fool.

They know you’re more likely to make a mistake and let something slip by that harms your settlement when you act fast. And, they also know you’re more forthcoming with information when they’re so nice.

Give them the facts. Think things through carefully before you act. And talk to a personal injury lawyer if you feel overwhelmed.

They’ll Try Using Comparative Negligence Against You

In Texas, you can be held partially at fault for an accident. This is by far the most common defense in car accident cases.  Even in a rear-end collision the insurance adjuster or defense attorney can argue you swerved or stopped suddenly. Or, they might say you failed to use your turn signal.

How We Overcome This Defense: Credible witnesses, common sense, and consistent statements. We seek out independent witnesses who can provide evidence of how the collision actually took place.  We prepare clients for recorded statements so that they can respond to questions with common sense responses that illustrate the at-fault party was the sole and proximate cause of the collision. We refresh client’s recollections so that statements provided in court and to insurance adjusters and defense attorneys are consistent with prior statements that were given.

You Already Had Some of Your Injuries

If they can’t get you on partial fault, the adjuster or defending attorney might try to minimize your claim by suggesting you had pre-existing injuries or that the car accident wasn’t the cause of your injuries. For example, let’s assume you went to the hospital twice in the two years leading up to the car accident complaining of back pain.

Following the wreck you complain of back pain and discomfort. Are the adjuster and defense attorney going to suggest you already had a bad back? You bet.

How We Overcome This Defense: A paper trail showing your medical history, or lack thereof can often be the best evidence to dispute claims that your injuries were pre-existing or that the collision was not the cause of your injuries. In addition, focusing on any new symptoms that developed following the wreck is very important.

For example, if during the pre-accident hospital visits you didn’t complain of numbness, tingling, or radiating pain and those symptoms only developed following the wreck a jury could easily conclude that it is more likely than not that the new symptoms were directly caused by the motor vehicle collision.

Imply You’re Doing it for the Money

Insurance adjusters and defense lawyers seldom call accident victims “greedy.” After all, jurors would likely be offended if a lawyer attacked a person in such an outright manner. However, they will certainly ask questions in such a manner that they imply you are motivated by money or are not being completely truthful.

How We Overcome This Defense: We provide a logical and legally sound argument as to why you’re seeking the amount of damages you claim. Adjusters and jurors need to be reminded that our system of justice is not perfect.

In an ideal world an innocent victim who had to have a leg amputated because of another driver’s negligence would be provided a time machine to go back in time and avoid the wreck before it happened. Time travel is obviously not possible and monetary damages are the sole remedy to compensate victims for their injuries.

They May Attack Your Personal Credibility

The adjuster or defense attorney is also unlikely to call you a liar. After all, such an attack would likely seriously damage negotiations or offend jurors. They are, however, exceedingly likely to casually suggest you’re exaggerating your story so you win the case or get more money.

How We Overcome This Defense: Our injury attorneys will build the case that you’re a decent, honest Texas citizen who doesn’t want any trouble – only fair compensation for your injuries. We will point to positive factors such as community involvement and work history. We will meet any arguments head-on and make sure jurors understand what the defense attorney is really suggesting if litigation is necessary.

The above tactics are straight out of the insurance company playbook. They use them time and time again.

But don’t worry…we’ll make sure you’re ready for them so you can win your claim and get fair compensation… and 90% of claims are settled out of court. That’s yet another reason why you look for the very best Dallas personal injury lawyer you can hire…not just the first one you can find.

Talk to a Lawyer Before You Talk to an Adjuster

One exception to this rule is that some cases have such low settlement values that it makes no sense to spend weeks or months going through legal processes just to get a few hundred dollars more. But, you can still call a personal injury lawyer to ensure you’re getting a fair deal.

The important thing to remember is you have 2 years to settle your claim and have no obligation whatsoever to do what the insurance company asks (they’ll make it seem like you have 1-2 weeks). You can speak to a personal injury attorney at any time, and it’s wise to do so before you talk to the insurance company.

The law is tricky, isn’t it? What might seem to be an obvious case to any reasonable person could actually hinge on a complex legal issue.  Insurance adjusters and insurance defense attorneys are often tasked with muddying the waters. They are often instructed to throw as much as they can against the wall and hope at least some of it sticks. That’s what adjusters and insurance defense attorneys do. It’s their job.

When Should You Handle Your Claim Yourself?

You don’t hear this advice often. But in some cases, it makes sense to not involve a personal injury lawyer.

Such cases typically involve very straightforward liability and no allegation of injury.

For example, you were stationary at a red light and someone hit you. Fault is clear in that case. You also didn’t experience any injuries requiring medical treatment, so no medical expenses are involved. And you have high confidence you didn’t aggravate an injury that could appear weeks or months down the line.

If your claim is small and straightforward like that, you’re probably okay handling it yourself. Rehearse the facts of the accident before you talk to the adjuster to make sure you tell the story exactly as it happened.

You’ll likely be fine.

For Everything Else, At Least Run It By a Lawyer

The other driver’s insurance company should repair your vehicle or replace your car at fair market value if it’s totaled. They should cover all your medical expenses.

Typically, you should retain a lawyer if you were injured in the car wreck. You will want to retain counsel before giving any statements to the adjuster – especially if there’s any possibility liability could be questioned.

Some people try and go it alone for a period of time but quickly get frustrated when the adjuster starts questioning why they have to keep going to the doctor or why they are having to miss work.

What if You Feel You’re Not Getting Fair Treatment?

Sometimes, your gut instinct tells you something isn’t right. You may try to handle the personal injury claim yourself and suddenly get overwhelmed. If that’s the case, contact a personal injury advocate and tell them about the details of your claim.

Since they offer free consultations, you have nothing to risk. The worst you can possibly learn is that you don’t need their services and are getting a fair offer.

And, you’ll have the confidence that the insurance company isn’t shorting you in any way. Remember, you can do this at any point in the process – even if you’ve already spoken with the claims adjuster.

How are Insurance Adjusters Paid?

Here’s where the rubber meets the road. They’re paid based on 3 criteria:

  1. How little of the insurance company’s money they spend on settlements
  2. How quickly they settle claims
  3. How many claims they can settle without using their company’s lawyers or the help of their supervisors

Most adjusters have to manage 50-100 claims per month. Inexperienced adjusters can settle dollar amounts between $5,000 – $10,000, while experienced adjusters handle cases ranging from $10,000 – $20,000. As you can see, it is in their best material interests to talk you down as much as possible. Stay away no matter how friendly they seem!

Don’t ever believe an insurance company is on your side. Their employees get paid more money when they pay less to you in personal injury claims. They make more compensation when they minimize your payout. If they pay too much to too many people, they get fired. It’s that simple.

While laws regulate what they can and cannot do, many are happy to exploit the law to their maximum advantage. Others will break the law outright, knowing that you don’t know what the law says. Here’s what they might say or do – and what you can do to protect yourself.

In Texas, the unfortunate reality is that insurance companies have laws written in their favor. That’s the world you live in, whether you want to or not. They have power like this in many states. But, Missouri, where our other office is located (in St. Louis), has much fairer laws.

It’s too bad things work out that way. But, they do. Insurance companies do give a lot of lip service to covering your accident fairly. It makes them look good. And it minimizes the chances legislators would ever get on their case. But, don’t fall for it! When you watch their actions, a far different story comes to the surface.

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