How an Insurance Adjuster Works to Limit Your Settlement

Every year, insurance companies spend vast sums of money training their claims adjusters how to pay as little as possible on as few claims as possible. Any claim submitted to an insurance company is immediately challenged, both in its validity and in the value of the claim. This is why it is so important for accident victims to have legal advice when negotiating with an insurance company. The claims adjuster is tasked with working against your financial interests.

With the experienced legal advice of a personal injury attorney, personal injury victims can protect their legal interest in fair compensation for their financial losses. Whether you have been injured in an auto accident, a slip and fall accident, by medical malpractice, burned, bitten by a dog, or injured by consumer products, the Dolman Law Group Accident Injury Lawyers, PA can help protect you during negotiations with an insurance company claims adjuster.

What is an Insurance Adjuster?

An insurance adjuster is an agent of an insurance company sent out to investigate any submitted claims. Insurance companies cannot go off of documentation and the word of a plaintiff alone so they utilize insurance adjusters to go out and ensure that the claim is legitimate. As part of an insurance adjuster's investigation, they help the insurance company determine exactly how big a settlement should be. Insurance adjusters will determine a claim's worth through a series of methods that all have the same end goal. Payout as little as possible. The insurance company always will pay the least amount possible because they are a business after all but with a skilled lawyer on your side, you can combat their efforts and avoid a minimal settlement.

Not All Insurance Adjusters are the Same

While most insurance adjusters one will encounter will be employed by the insurance company a claim was submitted to, they can actually come from several sources. There is the most typical of insurance adjusters that is a member of the insurance company's insurance adjusting department's staff and is officially a direct employee of the company. There are also independent adjusters which can be employed both by an insurance company and a claimant. Last, there are public adjusters that are typically employed by a claimant. The different kinds of adjusters ensure that the evaluation of a claim is as unbiased and accurate as humanly possible.

Should I Hire a Public or Independent Insurance Adjuster?

Hiring a public or independent insurance adjuster depends on the case. Sometimes a claimant may feel they are receiving a grossly unfair settlement estimate from an insurance company or an insurance adjuster may have demonstrated a bit too much bias in their process. In these cases, it is best to get your own insurance adjuster. If it comes to this, be sure to hire your own adjuster as soon as possible in the claims process in order to get the best chance at a better settlement estimate.

Insurance Adjuster Investigation

A more accurate name for an insurance adjuster would be “insurance minimizer”. In their efforts to investigate and limit your claim, an insurance adjuster will explore all aspects of whatever incident lead to your claim. Insurance adjusters can be dispatched to all kinds of insurance claims ranging from car accidents to slip and fall injuries. The bottom line remains the same between all of them and its to look out for the interests of the insurance company. Insurance adjuster investigations will be both focused on documentation and be surprisingly hands on for some. They will leave no stone unturned and talk with any useful witnesses in person as well as take their statements, speak to emergency responders,  and inspect any relevant accident sites themselves in order to determine the appropriate size of a settlement. The insurance company's idea of an appropriate settlement at least.

What to Do if the Insurance Company Denies Liability

The first and most direct method of attacking a claim is to deny responsibility altogether. If a defendant is not legally responsible (“liable”) for causing an accident, then his or her insurance company is not obligated to compensate victims who are injured as a result. This is why insurance companies conduct investigations to determine who was “at fault” for a car accident. Liability is also assigned in premises liability cases, such as slip and fall injuries at stores or restaurants. Private homeowners can also be liable for injuries which occur on their premises. Many claims are denied at this initial phase. Luckily, injury victims have recourse when a claims adjuster denies liability.

Often, a denial of liability will require a victim to file a lawsuit, in order to let a judge or jury determine who was liable for the accident. In some cases, the mere act of filing a lawsuit will cause the insurance company to accept liability. Other times, it does not, and the case must proceed to a trial. In either event, the injury victim has the right to let another party make the determination of liability. An initial denial of liability by a claims adjuster does not mean the end of an injury victim's claim.

How Claims Adjusters Dispute the Value of a Claim

There are many tactics insurance companies use to reduce the value of a claim. One popular tactic is to target those areas of compensation which are subjective, and thus difficult to compensate with a specific dollar value. Pain, suffering, loss of consortium, and other intangible losses are very real and compensable injuries. But they can also vary greatly from victim to victim. Some victims are allergic to certain pain medications, and must, therefore, endure greater pain as a result of their injuries. Some victims choose to restrict their pain medications due to pregnancy. These conditions can exacerbate a victim's suffering as a result of an accident, but claims adjusters rarely take such considerations into account when making an offer of compensation for pain and suffering.

Insurance Adjusters Use Pre-Existing Conditions to Limit Claims

Worse, some insurance adjusters will claim that their defendants are not responsible for triggering pre-existing conditions. This is a blatant misstatement of the law. The “eggshell plaintiff rule” is a general theory of law which holds a defendant legally responsible for exacerbating underlying conditions. The defendant is not responsible for the condition itself, but any additional pain or suffering the plaintiff endured because of the condition is still attributable to the defendant. Unfortunately, many insurance companies attempt to take advantage of the subjective value of pain, and the difficulty in separating the pain of a pre-existing condition to that which is attributable to the defendant's conduct.

Future Expenses are Targeted by Insurance Adjusters

Another way in which claims adjusters attempt to devalue a claim is by challenging future expenses. Defendants who have been found negligent are responsible for compensating all future financial losses which are attributable to their negligent conduct. This can include a decrease in the victim's future earning potential, future medical expenses, long-term nursing care or rehabilitation, and any other costs which are the direct result of the accident. Unfortunately, many of these expenses can only be projected during the settlement of a claim, as they have not yet actually been incurred by the victim.

Personal injury claims are subject to statutes of limitation which fall before all medical treatment and accident-related expenses may have been incurred. In this event, the injury victim must project what these expenses will be, and support the projections with expert testimony or calculations. Medical experts may be required to testify about the surgeries, rehabilitative services, or other medical expenses which will be required over the years as a result of the accident. An injury victim may need to hire an economist who can testify about the wages he or she has lost and the projected decrease in earning potential over the victim's lifetime.

Insurance Adjusters Challenge Medical Treatment Necessity

Finally, a claims adjuster may challenge the cost or necessity of medical treatment which was obtained. Emergency services or surgical care is common after a car accident, but less-traditional services such as chiropractic care or acupuncture are often disputed by insurance companies. Again: injury victims need not be bound by an insurance adjuster's determination of what treatment was necessary. These costs can be submitted to litigation so that a judge or jury can determine whether they were necessary. While litigation can require an investment of time, money, and energy, it is sometimes the only way to achieve a fair result in a personal injury case. With experienced legal representation, personal injury victims need not hesitate to reject an unfair settlement offer and submit their cases to litigation.

Experienced Representation for Your Personal Injury Claim

After any slip and fall accident, contact the Dolman Law Group Accident Injury Lawyers, PA as soon as possible in order to ensure that your legal rights are protected. Whether you have been injured in a slip, trip, or fall, we will aggressively protect your right to be compensated for your injuries. Call our office at (727) 451-6900 to schedule your free consultation with an experienced Clearwater personal injury attorney. Our personalized service, highly-skilled attorneys, and friendly staff will ease the burden after an accident so that injury victims can focus on their recoveries.