It is unfortunately true that many claims adjusters take advantage of
injured people before they have a chance to speak with an attorney.
Some adjusters will try to scare you by telling you that an attorney
will take a portion of your recovery for just a brief consultation. Some
claims adjusters will put unreasonable time pressure on your settle-
ment decision.
NOT ALL ARE BAD APPLES
Now, let me be clear that there are many honorable people in the
claims industry. For over sixteen years I worked almost exclusively as
an attorney for insurance companies, and I came to know many fine
claims reps who were totally honest, solid professionals.
THE CLAIMS ADJUSTER PUTS THE INSURANCE COMPANY’S INTEREST FIRST
Nevertheless, claims adjusters are not paid to be your friend. They are
paid to work for the insurance company’s interest, which may or may
not coincide with your best interests. Adjusters get promoted for closing files,
not for giving injured people personalized treatment. Here
are some tactics I have seen insurance companies use to push you to
prematurely settle a claim at less than full dollar value:
- Adjuster of the week program. Here, it seems
every time you call the insurance company you are directed to a
different person, who then asks you to repeat information given
to previous adjusters. [Related problem – the endless voice mail
menu.]
- Stalling. If you’re injured and out of work, the insurance
company knows that you may be desperate for a quick settlement,
even if below fair value.
- Playing doctor. Insurance adjusters will frequently tell
you that you’ve received too many treatments. Or, they may tell
you that the proof that you are not seriously injured is the fact that
you haven’t been going to the doctor for treatments often enough.
Heads they win, tails you lose.
- Bogus discounting. Years ago, a successful class action
was brought against one insurance company that deducted $50
every time they totaled out a car. The company’s theory was that the
value of most cars could be reduced $50 because the cars probably
needed a good washing. The court assessed a multi-million dollar
punitive damage award against the insurance company.
- Acting like your friend. Look, the insurance adjuster
may be a fine person, but he or she is not your friend. If he visits
you at your hospital or she comes to your home, these are not social
calls. If you hire an attorney, those visits will stop.
- Blaming it on the computer. Many insurance companies use computer programs to calculate how much medical
treatment you deserve and how much of a final settlement should
be paid for your case. Does this approach make sense? Just ask
yourself whether you would go to a doctor or a computer if you
needed surgery.
In 2010, the Idaho Supreme Court upheld a multimillion-dollar ver-
dict against Prudential Property and Casualty Insurance Company,
based on the way it treated one of its own policy holders. Testimony at
trial showed that the company refused to pay medical bills, under the
uninsured motorist portion of the insurance policy, until the entire
case was settled:
The adjuster who handled the claim in this case from its inception
until June 11, 2004, had worked for the company since May 1975. She
testified that the company had a standard practice for handling UM
claims, that it was the company’s practice not to pay undisputed med-
ical bills from UM coverage until the entire UM claim was settled, and
that to the best of her knowledge she handled this claim in the way the
company wanted it handled. Her supervisor, who had worked for the
company for about twenty-eight years, testified that it was the com-
pany practice not to pay undisputed medical bills under UM coverage
until it settled the total UM claim, even if the insured was incurring
medical bills for two or three years. A third witness had worked for
the company from 1978 until September 2005 and was a UM adjuster
during the time at issue in this case. She handled this claim beginning
in June 2004 and testified that she had reviewed the handling of the
UM claim in this case and it was handled in the way she was trained
to handle claims.
The jury found that Liberty Mutual had breached both the MedPay
and UM provisions of the insurance policy and that it had commit-
ted bad faith in its handling of the UM provision of the insurance
contract.
Weinstein v. Prudential Prop. & Cas. Ins. Co., 149 Idaho 299, 233 P.3d
1221 (2010), reh’g denied (July 1, 2010)