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 settlement 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
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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 verdict 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 medical 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 company 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 committed 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)


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