10 Tactics

INSURANCE COMPANIES USE TO DENY CLAIMS

(AND THE TEN COMPANIES MOST LIKELY TO EMPLOY THEM)

Have you always been under the impression that insurance companies exist to help the injured by paying claims?

WELL, THINK AGAIN!

This is a common misconception that we are prepared to clear up for you right now, before you make a mistake that could do irreparable harm to your injury case.

When you’ve been seriously injured as a result of someone else’s negligence, or if a family member has been killed in a car accident or a premises accident, or as a result of a defective product, a dog bite, medical malpractice, or other type of accident that was someone else’s fault, you can expect to hear from the insurance company that wrote the liability policy for the person who caused the injury or death.

Insurance adjusters are usually quick to act and hope to catch you off guard, before you’ve had time to hire a lawyer to represent you and before you’ve had time to determine the extent of your injuries.

Adjusters are usually affable types who are able to engage you in conversation and draw you out. While outwardly friendly and concerned, they are not interested in your well-being and, although they will probably make representations to the contrary, they are not there to help you. They are there to protect and promote the interests of the company that pays them.

Every insurance adjuster, like Felix the Wonderful Cat, has a bag of tricks to use on the insurance company’s behalf.

These are ten of the most common tactics they’ll use to deny or diminish your case:

1

Claiming to have your back and to be on your side, and promising to get you a fair settlement.

Never forget that the adjuster is your adversary. The adjuster’s salary, job security, and future position with the company depend on the ability to save the corporation money. The company’s interests are not your interests; in fact, they are diametrically opposed.

Remember, the insurance adjuster is not your friend!

2

Telling you that you don’t need a lawyer, suggesting that you’ll be better off not having to pay a percentage of your settlement to an attorney.

You will make the adjuster’s day if you buy into this. While on the surface it might appear to make sense, research has shown that claimants with experienced legal representation consistently walk away with more money in their pockets than those who settle directly with the insurance company.

There is very little that makes an insurance company happier than dealing with a claimant who has no lawyer. Adjusters handle claims every day.

When was the last time you negotiated a settlement for an injury claim? It’s simply a matter of experience; you need a seasoned professional on your side to level the playing field when negotiating with the insurance company if you want a fair settlement.

3

Asking for a recorded or written statement.

Sure, you’ll provide information about the accident in due time, but adjusters are trained to get you to say something they can use against you, even if it requires being taken out of context. Here’s a simple example.

Adjuster: Good morning! How are you today?

You, giving a stock polite response: I’m fine, thanks.

Whoops! You just told the adjuster you’re feeling fine!

The insurance company will say you admitted to being “fine” and not having any serious injuries. Never give an insurance company’s representative a recorded or written statement unless instructed to do so by an experienced personal injury attorney.

4

Asking you to sign a general medical authorization that will give them the ability to obtain records of any medical treatment you have ever received.

This enables the insurance company to go on a fishing expedition to discover personal information about you. They will then attempt to use anything they dig up to erroneously claim that your injury was pre-existing, or to attempt to discredit you because of information contained in psychiatric or psychological records. Insurance companies already have access to a medical claims database that gives some limited information about prior insurance claims. There is no reason for them to have any medical records before a lawsuit has even been filed.

Don’t sign any authorization for information unless your lawyer tells you to.

5

Offering a quick settlement with the signing of a full release.

The adjuster will often offer to give you a small amount of money on the spot in exchange for a full release—before you’ve even had a chance to get to a doctor and before you know the full extent of your injuries. This sometimes happens right at the accident scene. Some insurance companies dispatch their representatives to the accident scene before it is even cleared away.

Getting money on the spot may be tempting, but when you sign a full release and then find out over the next several days that you have serious injuries that were not obvious at first, you can’t go back and make a claim to recover for those injuries later on.

Many injuries are not immediately apparent, even very serious ones, such as a slow bleed in the brain, or a herniated disc, for example. Until you have reached your maximum level of medical improvement, no one can say accurately what a fair value for your case might be. Don’t risk losing your right to recover for all of your injuries.

6

Delaying payment of your claim.

When you’ve been injured, you may be facing financial difficulties because you are unable to work and have high medical expenses.

Insurance companies are aware of this and will often delay the processing of your claim until you are desperate enough to settle for anything they offer.

If you are facing severe financial difficulties and are tempted to take a settlement for less than the full value of your case, your lawyer can often make suggestions that will help you weather the storm so you’ll be able to stand firm in demanding what you are rightfully owed.

7

Conducting surveillance.

When you make a claim for a serious injury, the insurance company will usually hire investigators to follow you around and photograph or video you doing some activity that would indicate that your limitations are less significant than you’ve claimed. Honesty is the best policy, and you should not claim injuries you don’t have, which could ruin your credibility.

But even when you’ve been completely honest, a well-staged photo could create a false impression, so be aware that you are probably being watched.

8

Misrepresenting the amount of insurance coverage available to pay your claim.

The adjuster may tell you that the party responsible for your injuries or a death in your family carried only the minimum required liability insurance. Don’t take the adjuster’s word for it.

In many cases, there is more coverage than the adjuster will admit to.

Your lawyer will need to read the policy carefully to identify all coverages that apply. Insurance policies are often written in dense “legalese,” making them difficult for the layman (or even an inexperienced lawyer) to understand, so you need an attorney with personal injury claims experience to analyze the policy and determine what coverage is available.

If the at-fault driver is uninsured or underinsured, you will look to your insurance policy. In Arizona, an insurer must offer you uninsured motorist coverage equal to the amount of bodily injury coverage you carry. If you decline, you must sign a statement indicating that it was offered and you chose not to purchase it. Your insurer may deny that you have UM coverage. If they cannot produce the signed statement declining coverage, they must cover you. Your lawyer will know how to handle a denied UM claim.

9

Denying liability, either all or in part.

These are some of the ways they will attempt to deny or limit their liability for paying a claim:

  • Saying the accident was your fault, not the fault of their insured.
  • Saying the accident was only partially their insured’s fault, but that you contributed to the  accident and were also at fault.
  • Claiming that another party was entirely or partially at fault.
  • Arizona uses a pure comparative fault tort system under the Uniform Contribution Among  Tortfeasors Act (UCATA) to ensure that the liability for the accident is apportioned fairly. This means  that a jury must consider the fault of every party that contributed to the injury, death, or other  damages, even if that contributor is not a named party to the action.

Under the UCATA, fault means “an actionable breach of legal duty, act, or omission proximately causing or contributing to injury or damages sustained by a person seeking recovery, including negligence in all of its degrees, contributory negligence, assumption of risk, strict liability, breach of express or implied warranty of a product, products liability and misuse, modification or abuse of a product.”

If the injured party—the plaintiff—contributed to the accident, the recovery will be reduced by the percentage of responsibility the victim contributed to causing the accident. A defendant can name a nonparty as being at fault, even if the plaintiff is not able to sue or recover from that nonparty.

10

Disputing your damages and the necessity of medical treatment, or attributing the injury to a pre-existing condition.

If you had a medical degree, would you be working for an insurance company as a claims adjuster? Highly unlikely. But an adjuster will often decide that certain treatments were unnecessary, or that treatment for your injuries took longer than it should have.

Your medical treatment should be determined by your doctor, who is a trained medical professional, not by an insurance adjuster who looks at a chart to see average recovery times or typical treatments for a particular injury.

Medical care must be individualized to meet the patient’s needs, something beyond the abilities of an insurance adjuster.

The 10 Worst Insurance Companies in America
for Implementing these Tactics


Surely all companies don’t use these tactics? You might ask. The American Association for Justice has put together a list of the nation’s worst insurance companies for denying claims.