Personal injury Library

How Do Insurance Adjusters Really Work?

It's important to know the role of the car accident insurance claims adjuster.

People often assume that the best thing to do after they've been involved in a car accident it to file a claim with the other driver's insurance carrier and play nice with the claims adjusters. That may not be the case. In this article we'll look at the role of the claims adjuster and what their main objective is in your car accident claim.

  • What exactly is an insurance claims adjuster and what do they do?
  • Does the claims adjuster want to help me recover my losses?
  • Why wouldn't I simply answer all the questions the claims adjusters ask me?

The claims adjuster exists to save the insurance carrier money by undermining your claim.

Claims adjusters are responsible for investigating insurance claims following a car accident, on behalf of the insurance company. Adjusters gather information, which involves matters like interviewing the person making the insurance claim, evaluating the police report that was made after the accident, gathering medical records, and inspecting the crash scene.

It is important to remember that the insurance adjuster is working for the insurance company and not you, so do not be fooled. The insurance industry attempts to make you believe that the adjuster that they send to review your claim is your friend or confidant. However, this is far from the truth. The adjuster is not on your side. Your attorney should send a "demand letter" which would include your counter-offer, or the amount that you believe that you deserve to receive. This should only be done with the help of a skilled attorney.

Are all insurance claims adjusters the same?

There are two types of insurance adjusters:

  • Property-Damage Adjuster - This adjuster will evaluate the damage that has been done to the building, automobile, or whatever structure is covered under insurance.
  • Injury Adjuster - An injury adjuster or personal injury adjuster is the employee of the insurance company that is responsible for evaluating your injuries and determining how much the insurance company can pay out to you in order to make your case go away. These adjusters are, once again, employees of the insurance company and therefore all of their actions in reviewing your claim are in the best interests of the insurance company, not your physical well-being. They would prefer to give you as little money as they can get away with.

Most of what we're describing applies to the injury adjuster. The property adjuster doesn't have a lot of room to negotiate. They're required to pay a reasonable amount, and that's easy enough to figure out. But there is no Kelley Blue Book for injuries. What we mean is, a jury in Dallas might decide that your injury claim should be awarded more than a jury in Houston. It's more subjective.

The most basic duties of insurance adjusters.

There are several duties that are in the job description of an insurance company adjuster that they must follow in order to adequately perform their job, along with some duties that are implied. It goes without saying that their main goal is to save money for the insurance company, and serve as a liaison between the other adjusters and the in-house counsel. They are here to save money for the defendant insurance company and to provide some administrative functions, such as record keeping and taking photographs of the injuries/property damage. A few of the duties that may be expected of the insurance adjuster are listed below.

  • Search background information on you
  • Inspect the damaged automobiles that were in the accident
  • Determine if the medical professionals who attended to you performed "too much" medical care
  • Meet with legal counsel
  • Interact with claimants like you, if they can

The real duties of an insurance adjuster . . .

It's not a negotiations process. It's a negotiation under the law process. Your leverage comes from knowing and exploiting the law.

It would not be too far-fetched to say that insurance adjusters prioritize tricking you into damaging your own case. From the beginning, their agenda is to look for any reason by which they may be able to deny your claim, which could be in a number of different ways. They may attempt to rely heavily upon an unfavorable police report that makes your claim look weak or imply that you are the party that is primarily at fault. In addition, they may get a statement from you that could be easily contorted to make it appear as though you are admitting liability for the accident or that you may not be wholly honest. You probably will not be surprised to know that they may even trick you during a recorded statement, once again casting you in an unfavorable light.

If all else fails, then they may attempt to get you to actually thwart your own claim by manipulating you with empty promises and killing you with kindness. This is why it is essential that you are careful with what it is that you say to these people because they have no desire to help you. They may even send you on wild goose chases that involve asking you to submit medical records or other paperwork that will in no way assist in the success of your accident claim.

Every car accident victim needs to speak with a lawyer.

In sum, you must be very wary of what it is that you say or do not say to claims adjusters because you can easily sabotage your own claim without realizing that you have done so. You only get one bite at the apple with these claims, so you need to seek experienced legal counsel to ensure that you do not fall into any of the traps that these adjusters set up for you. A good lawyer can answer, thoroughly and realistically, these questions for you:

Common scenarios where an insurer denies coverage.

Of all the many types of cases we do---personal injury, work accidents, premises liability, etc.---insurance companies deny liability most of all in car accidents. Some insurance carriers (like Allstate) are notorious for frequently denying coverage simply as a matter of course. They are aware that you have the option to sue them, but they also know that you probably won't and are basically calling your bluff. They'll likely feed you some line about "disputed liability" or "unproved damages" or some jumble of legal-sounding phrases about your case that might even be made up from thin air.

We've had people come to us after an insurance adjuster tried to improperly claim the victims' immigration or marital status doesn't require the company to pay.

But as we discussed on our page about whether insurance companies have to pay your medical bills, there is no legal obligation for insurance companies to automatically pay you for what you've lost. Perhaps you've gotten something like this from an adjuster:

  • "We don't believe that our insured is responsible for the accident." In other words, they think it's your fault.
  • "Extensive evidence exists that a third party caused the incident." This is an attempt to offload blame onto someone other than you and the other driver. There may be some truth to this, but it's also a classic cop-out ploy.
  • "You've not proven your injuries, if any." While the insurer might not be disputing who's at fault, they're playing defense on having to pay.

As sad as it is to say, insurance companies play these games even when motorists and passengers die as a result. You would think that their best people would be placed on the file to help you get all you deserve. Instead, they put their best people on the case to deny your claim.

Even if an insurance company has denied your claim, we can help.

While it is best to involve an attorney at the very beginning of this process, even if you wait until your insurance claim is denied there is still something that can be done. We can launch our own investigation into your case to see what, if anything, the adjusters missed. Often enough, we find out that the police report put the other driver at fault or got the incident wrong.

Further, in cases where the insurance company claimed that you didn't have any actual injuries, we request our clients' medical records and also send them to our own medical professionals for assessment. Here again, we constantly find injuries the insurance company overlooked.

We then take all the relevant evidence and submit a demand to the insurance adjuster with a summation of our legal case, your actual medical records, and a deadline that if they don't pay you, we'll file a lawsuit. The prospect of having to hire their own lawyer and litigate a case in court means that not only might that have to pay your claim, but they'll surely incur lots of other costs.

Our attorneys at Grossman Law Offices have helped hundreds of clients with their insurance claims. We have 25 years of experience and know how to deal with insurance companies to get you the compensation that you deserve. Call today for a free consultation regarding your insurance claim at (855) 326-0000.

You can click on any of the articles below for more info about car insurance:

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