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Posted On November 19, 2013 Personal Injury
Insurance adjusters may approach you as friends, but when it comes to getting your claim paid, the insurance company is your adversary. It may not be a personal feud – you want the most money for your claim, and they want to pay you the least amount of money to protect their employer’s bottom line – but the situation does put you on opposite ends of the bargaining table. Even if the insurance adjuster seems like the friendliest person in the world, don’t let your guard down. An insurance company is a big, powerful corporation whose success – and even survival – depends on profiting by paying out as little money in claims as possible. These massive companies don’t make the huge profits they do by putting their success in the hands of untrained personnel, which means the person on the other end of the phone is more than just an approachable voice. He or she is a well-trained professional at decreasing the cost of claims, including yours.
The business model of the insurance industry barely resembles that of other common industries, like manufacturing, retail, or food service, where serving the customer is in the company’s best interests. Instead, insurance companies charge hefty premiums for the promise of coverage – limited in both financial and situational scope – in the event of an accident that may or may not happen. They bank on bringing in much more money in the form of premiums than they will have to pay out in the form of coverage.
If an insurance company can’t deny or decrease your claim, it will at least try to delay paying you the settlement you really deserve. Every delay means more interest and money in their pockets, even as your family is waiting on that money to get by.
Yet central to that business model is the goal of keeping their financial obligations to a minimum by paying out as little as possible. If it doesn’t sound very nice, that’s because it’s not. Decreasing the value of legitimate claims hurts people like you, who upheld your end of the contract by paying your premiums and who need and deserve the money you’re entitled to recover.
Sometimes smaller claims are worth less money for good reasons. The injuries weren’t especially severe, or the medical expenses were relatively low, or there were no other damages like substantial amounts of wage loss. Other times, though, insurance companies try to get out of paying claims that deserve more compensation. To do this, they rely on a well-trained but often underestimated professional: an insurance adjuster. If you approach this interaction like a simple call to a help desk or a customer service center, you may find that anything and everything you say will be twisted and used against you. And unlike in a court of law, there’s no objective judge presiding over an insurance company claim to make sure your statements aren’t taken out of context and misinterpreted.
When the insurance adjuster comments on the noise of your children playing in the background or seems concerned about the effect of your injuries on your work, your first instinct may be to make conversation.
“Do I hear kids in the background?” the adjuster might ask you. “How many do you have? How old are they? I have two kids myself…” Just like that, the adjuster makes it seem that you two have something in common. You could be neighbors. If you got to know each other better, you could be friends. The adjuster is doing his or her best to gain your trust.
Establishing themselves as fellow parents is one way insurance adjusters get you to let your guard down, but they can use any (real or feigned) shared interest. A barking dog can spark a conversation about pets. When you give your address, an adjuster may mention that they know someone who lives in your town.
Similarly, an adjuster might seem exceptionally sympathetic to any difficulties you face at work as a result of your injuries. If during an early conversation you make the mistake of mentioning missing work, or of answering a direct question about missed work, the adjuster may ask what you do. This can be especially perilous if your job requires a lot of physical work, like moving heavy objects. “That must be tough on your back even without the injuries,” the adjuster might say of your job. While making conversation, you agree – “Yeah, I have a lot of aches and pains.” Without even realizing it, you have given the adjuster a reason to deny or at least decrease your claim. The insurance company can now argue that your job, not the accident, caused your injuries.
Determining which statements constitute innocent conversation and which could be used to manipulate you is no easy task. The best way to avoid this danger is by refusing to speak to the insurance adjuster at all regarding any matters not directly related to the subject about which he or she called. You don’t have to chat with your adjuster or reveal any information at this point about your family, your work, or your health. It’s natural to want to interact with another person, especially one who seems sympathetic, but you have no obligation to make small talk.
Knowing that you shouldn’t talk to the insurance adjuster about personal matters is one thing, but making sure the conversation goes as planned is another. You don’t want to be rude, especially if the adjuster comes across as a caring person. When you’re dealing with so much stress, it can be refreshing to talk to someone who seems concerned. Even though you know the keyword there is seems, you may still feel tempted to have the conversation an insurance adjuster wants to start. After all, what are you supposed to do? Interrupt them? Hang up the phone without a word?
Standing up for yourself doesn’t necessarily require aggressive behavior or a dramatic confrontation. You simply have to be unwilling to let an adjuster manipulate you, no matter how authoritative or well-intentioned they may seem.
You can tell the adjuster that you only have the time to talk about the basic facts of the accident right now. If he or she presses you about medical information, just let the adjuster know that your medical treatment is ongoing and that you won’t be able to discuss your injuries until your treatment is complete. You can field similar questions about missed time at work by saying that you are still undergoing treatment for your injuries and that the treatment may require you to miss more time. You are under no obligation to tell the insurance adjuster your specific injuries, your prognosis, your salary, or the number of workdays you have missed at this time. If the insurance adjuster insists that he or she will need the information for your claim, simply respond that you will provide all of the necessary information when you submit your demand for compensation.
By choosing to handle this claim on your own, you are taking on the responsibilities of being your own legal representative. Like it or not, you are acting as your own lawyer – and that means refusing to let anyone take advantage of you.
Setting up your medical claim can seem like an overwhelming task, especially if you aren’t sure how no-fault laws influence your claim or where the coverage is coming from. Check back for the next installment of How to Handle Your Own Personal Injury Claim for guidance on how to open your medical claim and start getting the treatment you need.