THE INSURANCE CLAIMS ADJUSTER IS NOT YOUR FRIEND

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:

  1. 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.]

  1. 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.

  1. 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.

  1. 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.

  1. 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.

  1. 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)