How assessors might try to lower your insurance claim
Written by: Enjuris Editors
You’ve already been hurt once by an accident; you can’t imagine getting hurt again.
But that’s sometimes what happens with the insurance system.
When a company exists to make a profit, there are going to be casualties. Nobody likes to think that it might be them. If the odds are that it’ll be somebody else, you’re willing to play the game.
Let’s say you’ve been in an accident, motor vehicle or otherwise. You call your insurance company and expect them to help you with your claim. Insurance adjusters will look at your policy and attempt to justify a payout that coincides with your coverage. The number has to make sense with what you pay for.
However, you have to remember that an insurance company is a for-profit entity, and they’re going to try to pay out as little as possible. That’s just reality. As such, they will ask for documentation, evidence, medical notes and receipts in order to build a file that supports whatever number you’re requesting for your settlement. The more evidence you provide, the higher your number is going to be. This is why the insurance company attempts the following tactics to bring your number down.
Tactics the insurance company uses
Speaking with your doctor (attending physician statement)
Adjusters will often call or meet with your physician and ask pointed, closed-ended questions that don’t allow him to follow up with the complexities of your condition. This makes the insured look less injured than he actually is and works in the insurance company’s favor.
Independent medical examination
An insurance company will choose a doctor to perform a medical exam on the insured that follows a specific set of rules and a uniform battery of tests. Attorneys generally loathe these and sometimes will not let clients participate unless they are present, or sometimes not at all. They are felt to be biased in favor of whoever is paying for them (which, in this case, is the insurance company). See more about independent medical exams (IMEs).
This is the one that scares everyone. If the settlement numbers are considered to be high enough, insurance companies will actually hire private investigators to follow the insured with cameras in order to catch footage of them doing something he or she claims to be unable to do: carrying groceries, playing baseball, looking pain-free or walking without a limp.
These are done early in the process with highly-trained adjusters who ask closed-ended questions intended to elicit information. These assessors are so well trained that they can use this information to poke holes in an insured’s story later on and lower the number on a claim that way.
This is a newer way that adjusters gather information on claimants that people unfortunately don’t think to censor. Everyone has a tendency to verbally vomit online, and adjusters will hop onto Facebook or Instagram to see what has been made public. This is also a first stop for attorneys these days as well, who will print out any relevant posts to be used as exhibits in their cases.
Calling you right after the accident
This might seem like concern – like a good friend, even – but you’re not in a good headspace. You wouldn’t want to take a test or do anything else heady right after an accident, and since this leads directly right into the next point (the recorded statement), you’ll see why this is important.
The recorded statement
The insurance adjuster will likely ask if he or she can record your statement. Of course, you’ll think. For posterity.That’s a bad idea. Everything you say can be held against you. Again, you’re not thinking clearly after an accident, even if you think you are. You’ve just been through a significant trauma that takes time to process. You need at least a week or two to settle and regroup. Anything you say to this insurance agent is going to be replayed and parsed until they find something they can use against you.
An insurance agent might try to pressure you into a quick settlement, scaring you with the thought of an exhausting settlement process that might take months or years. If you take the quick option, you’ll be done in no time – and you’ll have money now! Even if it’s less, it’s a bird in your hand. You don’t know how many birds in the bush there are, but at least you’ve got what you have. And you can’t change your mind if it turns out you are actually more hurt than you thought. See more on Maximum Medical Improvement (MMI) and how that impacts your timing.
An insurance assessor might also attempt to have you sign a medical authorization. This seems reasonable, right? Wrong. These authorizations aren’t just for your accident; they’re for all your medical records. This is so they can look for preexisting conditions and try to blame whatever your current injury is on something that you already have. “You say that you hurt your neck in this car accident? Well, you fell off a ladder in 2009, it must be related to that,” they say. Then you spend thousands of dollars fighting that instead of focusing on the actual problem.
Disputing medical bills
This one can be a head-scratcher. Insurers will say, “Yes, you’re injured. But are you really that injured?” They won’t believe you need six months of physical therapy rather than the standard three, or that the physical therapist has referred you to aqua therapy. Insurance companies go strictly by the book, and when anything deviates from that book, they will fight you until the end.
Denying liability, in whole or in part
“You couldn’t possibly have been injured!” This is used when the property damage is considered to be minimal. Insurers pull this card when they are trying to see how far you’re willing to go in pursuing a claim.
Misrepresenting the law
The one thing you should not do is accept legal advice from an insurance company.
When every other tactic doesn’t work, you might find that suddenly, it’s very difficult to reach your insurance agent. The phone keeps going to voicemail. Emails go unanswered. Days pass… and still there is silence.
Don’t worry. This is a strong-arming tactic that is classic in the insurance industry. Your adjuster will say he’s checking with his boss or something to that effect, but really he’s waiting you out. Stand strong. Don’t lower the number you have in your head. Just keep checking in periodically, keeping in mind the statute of limitations for your claim. Make sure you have a number that you’re willing to compromise with, but don’t make the first move.
Keep these in mind when you speak with your insurance adjuster. Have a number in your head that you want to reach for your settlement; have a lesser number that is your absolute floor, your go-no-lower-than-this.