Insurance Adjusting Techniques: What You Need To Know

Contact the personal injury attorneys at Maya Murphy, P.C. today. We can help you get the just compensation you deserve for your injuries or those of a loved one. For a free initial consultation, call 203-221-3100 or email JMaya@Mayalaw.com.

To begin with,you have the obligation to prove who is responsible for your personal injury. Because this is a “comparative negligence” state, YOU also have to prove that YOU were NOT guilty of any negligence that may have contributed to you having sustained a personal injury. Then YOU have the obligation to “mitigate” (minimize) your damages and YOU have to prove your damages. Are you beginning to see a pattern here?

Just within the scope of what is discussed here, there are a few questions that could arise:

1. What constitutes “comparative negligence”?
2. How is negligence apportioned?
3. What is “reasonable mitigation”?
4. What constitutes proof of my damages?

These details and subtleties will not be discussed here. Remember . . . we’re trying to keep this simple. Suffice it to say, if any of these questions become a part of your claim, GET PROFESSIONAL HELP!

If liability is clear (other party struck you from the rear while you were legally stopped in traffic AND there is a police report to verify these circumstances AND the other driver was cited AND you received no citation AND you were wearing your seat belt at the time of the accident) . . . if your injuries were obvious at the accident scene AND the police accident report notes that you were injured . . . if the insurance company for the other party quickly commits to paying for your damaged vehicle AND puts you into a rental vehicle at no cost to you AND acknowledges they may have to pay you for any reduction in resale value of your vehicle after it has been repaired . . . if the adjuster advises you of the insurance policy coverage limits up-front . . . if those limits are sufficient to cover your expected damages (vehicle damage + diminished resale + rental car costs + medical expenses + lost wages + projected future medical expenses + “pain & sufferance” compensation with NO expected residual disability) . . . AND you are comfortable dealing with the insurance adjuster yourself, then you will PROBABLY not need professional help. After all, some Personal Injury Claims actually are simple and some insurance companies will actually step-up, treat you with respect and pay what they owe. However, if your situation does not meet ALL of the criteria specified above, we suggest you consider talking with an Attorney.

Now that we have discussed your obligations, let us review the obligations of the insurance company. This part is simple. Once you have proven their insured is 100% liable for you damages and you have proven your damages, then the other party’s insurance company has an obligation to protect the interests of THEIR INSURED by paying for your damages. Did you notice that? THE OTHER PARTY’S INSURANCE COMPANY HAS NO OBLIGATION TO YOU! Their obligation is to their own insured.

Understanding Adjusting Techniques

In the opening text we touched on a form of “perverted logic” that occasionally seems to be an underlying factor when consumers are involved in dealings with the other party’s insurance company. That perverted logic manifests itself when the other party’s insurance company is rude and indifferent to you . . . almost as though they are trying to drive you to an attorney. Well guess what . . . THEY ARE! Let me take a stab at trying to explain why. First of all, if you take this abuse you will wind up settling cheap and the insurance company saves money. If you go to an unqualified attorney, there is a better than average chance they will be able to force a cheap settlement on you through that attorney. Again, the insurance company saves money. If you get a qualified attorney they will have to pay full value to settle your claim. Even then, there is benefit for the insurance company AND the insurance industry in general. Every couple of years the insurance industry tries to push some type of Insurance Reform Bill through the Legislature. When they do, they point out how many consumers hire attorneys to help them resolve their claims and it is these “greedy” attorneys that are driving up the cost of auto insurance. The insurance industry points their collective finger at personal injury attorneys as being the reason why insurance companies keep raising their auto insurance premium rates. Have you ever noticed that when you are pointing your finger (your index finger) at somebody else . . . you have at least three (3) more fingers pointing right back at YOU! Well, the same rule holds true when insurance companies try to blame rising auto insurance premiums on personal injury attorneys.

When insurance industry lobbyists fund campaigns, vacations and employment opportunities, they can usually find legislators with attentive EARS! Then, when the insurance industry tells their story, Bills start getting submitted to the Legislature. That’s when consumers, YOU and I, have a problem! When the insurance industry is pushing for Insurance Reform Legislation, you can bet they’re not doing it to benefit consumers.

Now, do you see the logic in having insurance companies “drive” consumers to seek the help of an attorney? We could go on and on discussing the uncontrolled and unwarranted increases in auto insurance premiums and the ways in which the auto insurance industry manipulates the truth in an effort to deprive consumers of their rights, but then, that is a separate matter that we will be addressing later on as this web site grows and expands.

The recorded statement:  Most insurance companies have now gone to the practice of having their adjusters tape record their phone conversations with you. By rights, the adjuster should let you know when your conversation is being recorded. There are multiple reasons for recording these conversations:

1. The Adjuster needs to make a record of the facts related to how the loss occurred. This will become a permanent part of their claim file. You will be asked to provide self-identifying information, such as your full name, date-of-birth, place of birth, Driver’s License # and Social Security #. With this information, the insurance company will probably order a C.L.U.E. (Claims Loss Underwriting Experience) Report and/or an Index Report. The C.L.U.E. Report will tell the insurance company of any claims you may have submitted to your own insurance company(s) in the past. The Index Report will reveal any prior claims you may have submitted for a Personal Injury Claim. The insurance company wants to know about your prior insurance claims experiences which could impugn your honesty.
2. By asking key questions about the circumstances of the loss, you may admit to something that would allow the insurance company to either deny your claim or substantially reduce the benefits you receive.
3. The insurance company will want you to be as detailed as possible in the recorded statement. Months later, when your memory may have faded, you may be called upon to once again answer the same set of questions. If you do not answer these questions exactly as you did in the recorded statement, the insurance company may try to make you look dishonest.

It is simply not practical to assume you will be able to avoid providing a statement to the insurance company. If you are dealing with your own insurance company, your cooperation is required by the policy. If you are dealing with the other party’s insurance company, the Rules of Civil Procedure give them the right to interview and Examine you.

Since you are probably not going to be able to avoid giving a statement, the next best thing is to be prepared for the statement. If you are dealing with the other party’s insurance company, as with a Personal Injury Claim, we strongly suggest to provide your statement in the company of (and with the guidance of) your own attorney. If you are providing your statement without counsel, we suggest you review the following guidelines:

1. Answer the questions asked as briefly as possible without going into extemporaneous detail.
2. Unless you are 100% sure of the exactness of your answer, qualify you answer(s) with terms like “about”, “approximately”, or “as best as I can recall”, etc. Or, if you do not know the answer to a questions . . . simply say so!
3. Avoid being specific as it relates to speed, time and distance. It is a simple matter of mathematics to take two of these factors and calculate the third. If you are specific in any of these two factors and you are wrong, then a wrong conclusion could be reached which could work against you. Believe me, insurance companies have “helped” other people shoot themselves in their own foot before. You would not be the first. Even honest people can become entrapped into a compromising position. If your insurance claim involves a “significant loss” – SEEK PROFESSIONAL COUNSEL BEFORE GIVING A STATEMENT !

The Wage and Medical Authorization:  If you have a Personal Injury Claim pending with either the other party’s insurance company or your own insurance company (Uninsured Motorist, Underinsured Motorist or Med-Pay Coverage), you will probably be asked to sign a “Wage and Medical Authorization” form. As nobody is supposed to be able to access your medical and/or employment records without your permission, it seems reasonable to sign this form. WARNING: By signing this form, you are usually allowing the insurance company to go on a “fishing expedition” in search of any reason to not pay all or any part of your claim. If your claim is with your own insurance company you have an “obligation to cooperate”, as specified in your Insurance Policy Contract. However, cooperation can be achieved without giving carte blanche to your insurance company. It is usually better to provide an authorization with limitations as to scope of access. A good Personal Injury Attorney will know how to limit this authorization, so as to protect your rights and limit what records your insurance company can access. If your claim is against the other party’s insurance company, you have no obligation to provide a wage and medical authorization to them. You will have to provide them with legitimate information upon which they can base their evaluation of your Personal Injury Claim. However, by having that information come through you or your Personal Injury Attorney, you are able to address any potential problems before they can be distorted and used against you. It is always best to be able to work with the insurance company. It is never prudent to surrender control of your claim to the insurance company.

At Maya Murphy, P.C., our personal injury attorneys are dedicated to achieving the best results for individuals and their family members and loved ones whose daily lives have been disrupted by injury, whether caused by a motor vehicle or pedestrian accident, a slip and fall, medical malpractice, a defective product, or otherwise. Our attorneys are not afraid to aggressively pursue and litigate cases and have extensive experience litigating personal injury matters in both state and federal courts, and always with regard to the unique circumstances of our client and the injury he or she has sustained.