How to Scare an Insurance Adjuster in Personal Injury and Property Damage Claims
Creating Fear: A Step-by-Step Guide to Motivating the Claim Adjuster to Stop Stalling and Make a Fair Settlement Offer
Insurance adjusters are crucial in resolving tort claims seeking damages for personal injury and property loss; they hold the insurance company’s checkbook.
Your ability to persuade the insurance adjuster that you have a viable legal claim will determine whether you get a fair auto accident settlement out of court or must go to trial.
Many claim adjusters act in good faith and make settlement offers they believe are fair – though you may disagree with the amount.
Other adjusters, however, push ethical boundaries and use aggressive tactics to get claimants to drop their claims or accept low settlement offers.
This article gives information to scare the insurance adjuster into treating you honestly when negotiating the value of your motor vehicle collision crash or property damage claim (or any other type of insurance claim). Following these steps and hiring a skilled personal injury attorney will help you motivate the claim adjuster to offer a fair settlement amount.
Keep reading to learn more.
Then complete the online contact form or call my law firm at (804) 251-1620 or (757) 810-5614 for a case evaluation.
See why past clients and other attorneys have voted me one of Virginia’s best lawyers for auto accidents, traumatic brain injuries (concussions), construction accidents, and workers compensation. And what I can do for you.
Understanding the Insurance Adjuster’s Responsibilities and Role in Your Claim
The insurance adjuster is significant in settling your automobile accident claim.
This article’s next section analyzes the adjuster’s role in first and third-party insurance claims.
You can use this knowledge of the adjuster’s job duties to know what actions will encourage a better settlement offer.
What is an Insurance Adjuster?
The adjuster represents an insurance carrier in investigating, evaluating, adjusting, and negotiating the value of your claim for payment under an insurance policy written by the company represented.
This person will decide whether you have a valid claim under the insurance contract and, if so, how much money you get.
The insurance adjuster position has different titles at some insurance companies. For example, the insurer you are dealing with may use these job titles: claim examiners, claim agents, claim representatives, investigators, or claim auditors.
But generally, these various titles have the same roles in legal claims.
Who Employs the Claim Representative?
Many insurance adjusters are employees of the insurance company represented in your claim. Therefore, all the claims handled by this adjuster involve the same insurance company. For example, an adjuster employed by GEICO will handle only GEICO claims.
However, other claim representatives work for third-party administrators (TPAs), which are firms hired by various self-insured companies and insurance carriers to adjust claims. For example, Sedgwick CMS and Gallagher Bassett are TPAs.
Or the insurance adjuster may be independent, meaning they handle claims for multiple insurance companies.
Why Does the Adjuster Type Matter?
Although many adjusters of all types have crushing caseloads, inadequate monetary authority to settle claims involving severe injuries without getting permission from others, and limits on how much they can spend to go in the field to investigate, the employment relationship for the assigned adjuster matters to you for a few reasons.
First, independent adjusters generally have more limited or no decision-making authority. Instead, these outsourced adjusters report their findings to someone else who decides whether and how much to pay on the claim. This can make it more difficult to resolve your claim promptly because the “decision maker” is far removed from your claim’s facts.
Second, there is a potential difference in fee structure between the adjuster types. For example, direct employees are often salaried and feel pressured to close/resolve claims. In contrast, independent or non-staff adjusters may receive more compensation if the claim remains open and goes into litigation. And this incentive is at odds with your goal of a fair and quick resolution.
Typical Responsibilities of the Claim Representative
The insurance adjuster’s responsibilities to the company or insurer represented are the same regardless of the employment relationship.
Ultimately the adjuster’s goal is to dispose of your claim as quickly and cheaply as possible.
And the job duties involved in meeting this goal include the following:
- Review the auto insurance policy to determine if it covers the claimed loss.
- Determine if other insurance policies may apply to the insureds or offer coverage that pays the claimed losses, such as rideshare insurance after an Uber accident.
- Investigate your insurance claim.
- Take your recorded statement (hint: do not give one).
- Take statements from witnesses.
- View the accident scene and take photographs or videos.
- Get a copy of the police crash report to assess liability.
- Review your injuries, diagnosis, and prognosis to determine medical costs.
- Contact your doctors to get more information.
- Determine if expert witnesses are necessary to determine liability, medical and legal causation, or future medical costs.
- Hire a private investigator to conduct surveillance if there are questions about credibility or the nature and extent of your injuries. With this tactic, the claim adjuster’s goal is to determine if the insurer has a malingering (faking disability) defense.
- Decide if vocational rehabilitation will help you find employment if you have light-duty restrictions (in workers comp cases)
- Determine whether to refer you for a defense medical examination (DME/IME) to create adverse evidence.
- Analyze the medical, wage loss, and other evidence.
- When processing and evaluating your claim, serve as the primary contact between you and the insurer.
- Communicate with your attorney.
- Decide if defense counsel is needed.
- Review any liens against the personal injury claim, such as the workers comp lien.
- Decide how much to pay.
- Negotiate settlements.
Is the Claim Representative a Licensed Attorney?
Maybe.
Some claim representatives graduated law school, received admission to the bar, and practiced law with private firms before becoming insurance adjusters.
But most did not.
However, do not underestimate an insurance adjuster without a law degree.
You will find that experienced adjusters in a specialized area of the law will have more knowledge of the substantive law (negligence, no-fault, etc.) and medicine (in personal injury and workers comp cases) than many insurance defense attorneys. This is because they have been through the process hundreds of times and developed strategies and tactics to get you to accept less money than your claim is worth.
In addition to their experience, claim adjusters also use insurance company software and databases to see how much past cases with similar variables to yours have settled for during pre-litigation.
How Do I Get the Most Money Out of My Insurance Adjuster?
Claim adjusters have several tactics and tricks used to irritate claimants and persuade them to accept a reduced settlement.
But you can overcome the adjuster’s efforts and get a fair amount by following the steps below.
The Top Eleven Things to Do When Dealing with the Auto Insurance Adjuster
Here are actions you can take to get a successful resolution of your insurance claim.
Be Polite
You may disagree with a lot of what the claims adjuster says. That’s okay – and expected.
But treat the adjuster respectfully anyway.
Doing so ensures the disagreements focus on your claim’s merits, not personality conflicts where the claim representative acts or ignores you out of spite. And remember – the goal is to get more money for your losses, not win every discussion with the adjuster.
Ask for a Copy of the Other Driver’s Insurance Policy to Know the Policy Limits
Getting a large jury verdict is useless unless the defendant has assets or insurance to collect payment from.
And often, the insurance coverage amount (policy limits) is the maximum you will collect if you get a favorable judgment.
Therefore, this information is critical in evaluating settlement offers. And I recommend requesting a letter stating the defendant driver’s insurance policy limits early in the case.
Paper (Document) the File: Ask the Adjuster, “What Do You Need from Me?” And Get That Information if Possible
One of your goals when talking with the claim adjuster is to find out what the adjuster considers essential when deciding whether to accept your claim and how much to pay.
Ask the claim representative what additional documents they need. And if it makes sense and does not harm your claim, get the papers.
Though obtaining proof of losses is inconvenient, you will know what the adjuster finds relevant and what evidence you may need to develop to get a better settlement.
Follow Up Often
Because of their heavy caseloads, insurance adjusters spend a lot of time putting out fires as they come up instead of methodically resolving claims in the order they get filed.
Therefore, you must make your claim stand out to get the adjuster’s attention and a fair settlement offer.
One way to stand out is to follow up often.
This means calling, emailing, or writing the adjuster regularly (every 30 to 45 days) to give updates on disability (lost wages), medical care, and symptoms
Listen to What the Adjuster is Saying
Even though you suffered a bodily injury or damaged property, talk less than the claim representative during your conversations.
You can learn more by talking less and listening more.
Here is an example.
Let’s say the claims adjuster denies your claim.
If the adjuster says it is because you were at fault, you need to focus on the liability part of your claim.
Or, if the adjuster makes a low offer because you have a pre-existing condition, such as degenerative disc disease (DDD) or spinal stenosis that required a lumbar fusion, you need to focus on getting a medical opinion that the accident aggravated or exacerbated that condition.
Use the insurance adjuster’s answers to determine why you have not received a fair payment. Then gather evidence to defeat the claim representative’s justification for a lowball offer.
Finish Your Medical Treatment
When liability is clear, and the negligent driver has sufficient insurance coverage or assets to pay a judgment, the biggest mistake you can make is to settle before you reach maximum medical improvement (MMI) for your injuries.
There are two reasons for this.
First, the more medical care required for your injuries and resulting conditions, such as PTSD, depression, or CRPS, the greater your claim’s value.
Second, settling the case too soon may cost you tens of thousands of dollars if you find out you need surgery a few months later.
If you want to scare your claim adjuster, tell them you will discuss terminating your claim once you recover fully or your medical treatment plateaus.
Send a Detailed Demand Letter
A detailed settlement letter outlining the facts and evidence supporting liability and damages (including pain and suffering) can persuade the adjuster to offer a fair amount. And provide a thorough explanation of why you will win at trial that the adjuster can forward to other decision-makers.
Click here if you are looking for a sample settlement demand letter for workers compensation cases.
Ask the Adjuster to Explain the Basis for the Settlement Offer
You may presume the adjuster has valid reasons for making the offer they did.
Sometimes that’s true. But not always.
The adjuster could have forgotten to review some documents, minimizing your claim’s potential value.
Or they may still need to submit all the documents to the computer software used by the insurer to value claims, resulting in an incomplete evaluation.
Whatever the reason for the limited settlement offer, you have a better chance of persuading the adjuster to increase the amount if you can point to specific damages the adjuster has undervalued.
Be Patient and Silent
Your silence can scare the insurance adjuster because they won’t know what you are thinking or planning. For example, taking your time to respond to a settlement offer may cause the adjuster to worry you are hiring an attorney.
Use the adjuster’s discomfort to get a better offer.
Try to Keep the Defendant (the Insured) Informed
The defendant driver may know little about your claim, settlement negotiations, or litigation. Indeed, insurance companies often fail to ask their insured for input on responding to settlement overtures.
Though it seems counterintuitive, the insured defendant may be one of your best advocates for a settlement up to the insurance policy limits because the defendant must pay a judgment or jury verdict that exceeds the policy limits. Therefore, the defendant driver is interested in the claim’s outcome and avoiding a trial court’s award for more than insurance covers.
To the extent allowed by law, keep the negligent driver in the loop.
In turn, the defendant may pressure the claim adjuster to pay more to terminate your claim.
File a Complaint
Insurance is a heavily regulated industry.
If the claim adjuster is acting unethically or ignoring you for an extended period, send a letter to the adjuster’s supervisor or even the company president. And consider submitting a complaint to your state’s regulatory authority (the State Corporation Commission in Virginia).
The Top Six Things to Avoid When Talking with Insurance Adjusters
When you are dealing with an insurance adjuster, I recommend that you never do the following things:
Don’t Admit Fault (Wrongdoing)
Fault matters in the American legal system.
In most cases, you must prove the other person’s negligence harmed you, or else that person’s insurance company will not pay for your losses.
If you are partially to blame for the crash, a court may reduce a jury verdict by the percentage of fault assigned to you. This system is known as comparative negligence.
However, in some states, proving someone else’s fault is not enough. You must be blameless.
In states that follow the contributory negligence doctrine, such as Virginia and Maryland, you may forfeit the right to get money for your losses if you contributed to the accident and injuries – even a little bit.
Therefore, any comment that you were at fault may result in the adjuster denying or delaying payment of your claim.
Though your words do not mean you caused the wreck, the claim representative could twist these words and use them against you.
Don’t Threaten
Threatening to hire an attorney or file a lawsuit if you don’t get your way is a mistake.
Some claim adjusters may want you to hire a lawyer to get the file off their desk and into defense counsels’ hands or because your relationship with them is broken beyond repair, and they would rather talk to someone else.
Instead of making threats, take intelligent, legal actions that will scare the insurance adjuster.
Don’t Give a Recorded Statement
In my experience, recorded statements rarely help you get more money and often result in denials.
Therefore, the risks of giving one outweigh the rewards.
Click here for more information on how insurers use recorded statements in injury and workers comp claims.
Don’t Sign a Blank Medical Release
The claim representative needs medical reports to evaluate your claim.
However, it would help if you kept as much control over this process as possible.
Suppose you sign a blank medical records release. In that case, the insurance adjuster can pry into other health conditions unrelated to the claim or look for old records to support a defense that your current complaints are related to a pre-existing condition.
Click here for guidance on responding to a request to sign a blank medical authorization form.
Don’t Discuss Your Family’s Financial Situation
Telling the claim adjuster about your financial situation may seem like a good idea, hoping it results in a quick payment.
Don’t.
Instead of worrying about the insurer’s exposure to an award for pain and suffering or punitive damages, the claim adjuster may interpret this information to mean you are desperate and willing to accept a low offer to relieve the financial stress.
Don’t Accept a Denial
You may receive a letter from the adjuster denying coverage of your claim for losses.
But you don’t have to accept this decision and give up.
Instead, call an attorney to discuss your rights, including filing a lawsuit.
We Deal with the Insurance Adjuster So You Can Focus on Your Physical and Mental Recovery
Negotiating with a claim adjuster to get the most money possible is challenging.
But there are things you can do to maintain leverage and control of your claim, increasing its likely settlement value.
Call me at (804) 251-1620 or (757) 810-5614 if you want an experienced and skilled attorney to deal with the insurance adjuster for you. My law firm has helped hundreds of accident victims get fair compensation. And we want to get to work for you.
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