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Posted On November 14, 2013 Personal Injury

Initial Contact with the Insurance Companies: The Basics

If you’re dreading the flood of phone calls and letters from insurance companies after your accident, you’re not alone. Dealing with insurance companies, even at this early stage, can be frustrating. If more than one company is involved – your own and another driver’s, or multiple companies representing multiple at-fault parties – you may not know who to contact first, or what information you are required to provide to which company. It can be hard enough even to remember which adjuster you talked to from which company, or which conversation you had with which adjuster. Then there are the demands that you make official statements and the influx of paperwork that you may or may not really have to fill out. Don’t worry – over the next few installments, we’ll break down the process of contacting all of the insurance companies involved, so you can focus on what really matters: getting better.

Your Obligations to Your Insurance Company

In the case of an auto accident, one of the first things you must do is notify the company through which you obtained your auto insurance policy. You chose to enter into a contract with your own insurance company when you purchased a policy from them. Because of this agreement, you do have some legal responsibilities to this insurance company. You must notify them of the accident promptly if you intend to make a claim for medical benefits under the personal injury protection (PIP) portion of your insurance.

You are required to tell your insurance company the basics regarding the accident, but you do not need to provide evidence of fault to access your medical coverage.

Since you are pursuing medical coverage from them, you will obviously have to tell your insurance company that you need medical coverage. However, you don’t have to give them the details of your injuries. After all, you’re not a medical professional. If you haven’t seen a doctor yet, you really have no idea what your injuries are. Even if you have seen a doctor, it is too soon to know how much medical care you will need, if all of your injuries are apparent this early on, or what your prognosis will be. Later on, the insurance company can access this information from the medical bills they receive. There is probably a provision in your insurance policy that allows the company to access your medical records, which will give them all of the information they need.

Your insurance company also can’t restrict which doctors you can to see. Be aware, though, that the insurance company may refuse to pay for treatments that they deem are medically unnecessary. In that case, you have three options:

  • You can continue trying to negotiate with the insurance company and attempt to persuade the adjuster that the treatment was necessary,
  • You can cut your losses and focus instead on other aspects of your claim, or
  • You can turn to an attorney for help.

While it’s important that you are aware of the possibilities, your primary concern should always be your health. Get the treatment you need, ask your doctor to note down the medical reason for prescribed treatments if necessary, and worry about how it factors into your claim later.

Your Obligations to the Other Driver’s Insurance Company

Since you don’t have a policy with the insurance company of the other driver, you have no contractual obligations to them. You will need to give them the information to process your claim eventually, but they can’t demand that information from you until you are ready to give it.

For now, all you have to do is notify the insurance company of any party who might be at least partially responsible that the accident occurred. Include your contact information, the date and location of the accident, and the policyholder involved. Whether you notify the insurance company in writing or over the phone, you only have to provide the basic details. You don’t have to provide any official statement about how the accident occurred, what injuries you sustained, or how those injuries are impacting your life. There will be plenty of time for that later, after the treatment phase of your claim is done.

Be Wise to Adjusters’ Tricks

Insurance adjusters don’t always play fair. If you’re handling a case on your own, the adjuster may be more likely to manipulate you because he or she knows you don’t have the knowledge and experience of an attorney. To protect yourself from any sneaky tactics that an insurance company could use to decrease your claim, be wary of some potential traps, and always document your conversations and correspondence.

Only discuss your injuries in detail with your doctors. The insurance adjuster is not a medical professional, and even giving them all of the specifics about your injuries wouldn’t aid your recovery in any way. However, if you’re not a member of the medical community yourself, you could make a mistake trying to give complex medical information to an insurance adjuster. Those mistakes could be used to downplay the severity of your injuries or your need for compensation, so that you never receive the settlement you deserve. If you’re in the early stages of recovery, you may not even know the full extent of your injuries yet, much less have a clear prognosis. Just as you shouldn’t talk about your injuries with the other party’s insurance adjuster, avoid authorizing medical records access for this insurance company.

When the time does come to make the other insurance company aware of your specific injuries, you should remain in control of what medical records they get to see. Your privacy rights as a patient don’t vanish just because you were in an accident.

Sometimes, even giving the basic information about your injuries, like which body parts are hurt, can be a risk. Insurance adjusters know how to ask questions that get you to answer in ways that could be used to minimize your claim. A common prompt is deceptively simple: “Name all of your injuries.” When you start talking about one injury, the adjuster may ask you further questions about that particular injury that may distract you from ever returning to the original point. Later on, the adjuster may refuse to pay for medical treatment for injuries that you failed to mention while answering such a question. This is no mistake – insurance adjusters are trained to help their company and hurt your claim by knowing when to interrupt you and when to let you keep talking. The conversation can go so smoothly that you have no idea you have been manipulated until much later.

Injuries aren’t the only subject on which insurance adjusters can trick you. They will often ask you for a recorded statement when you speak with them over the phone. They may preface their request with an assertion that the recorded statement is to protect you, or that it’s necessary for their files. No matter what an insurance adjuster says, don’t let them trick you. You are not required to – and shouldn’t – agree to give them a recorded statement.

Insurance adjusters are not your friends – but we’ll talk about that in greater detail in the next installment of How to Handle Your Own Personal Injury Claim.