Personal injury cases can be long and excruciating, especially due to the involvement of insurance companies. In almost all personal injury claims, you’ll have to deal with the insurance provider of the at-fault party. For instance, if you get injured in a car crash, the settlement talks will involve the insurance policy provider of the driver. If you’re filing a premises liability claim against a homeowner, the insurance company of the owner will be involved.
Similarly, any other case of personal injury, including medical malpractice, negligence, accidents, etc., you are highly likely to face an insurance company. That’s why it’s important to learn how to deal with them so you can receive your rightful claim. Let’s explore this further!
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Let the negotiations begin
The negotiation process is the most crucial when it comes to claiming compensation for your injuries. The process begins when you send your demand letter to the company, stating the amount that you’re claiming for your injuries. The negotiations begin with an insurance adjuster right after that.
The insurance adjuster often contacts the claimant within two weeks to respond to the demand letter. But this time may vary depending on the schedule of the adjuster as well as the complexity of the claim. If it’s been more than two weeks, and the adjuster hasn’t contacted you, we would recommend calling the claims department. You should ask them to confirm if they’ve received your letter and how long it would take for them to respond.
When an insurance adjuster responds to the claimant, it often comes in the form of a letter called the “reservation of rights.” This letter is a way of communicating to the claimant that the adjuster has started investigating their claim, and the payment could be withheld if the policy doesn’t cover the accident.
It’s a form of legal protection for the insurance adjuster to prevent any future claims that the accident needs to be covered, as the company had started negotiations because they recognized that the policy covers the incident. The adjusted also uses it as a strategy to show to the client that they may not receive any compensation and thus, pressuring them to consider accepting a smaller settlement amount.
There are a few subjects that come under discussion during the negotiation process. The insurance adjuster usually asks the claimant a list of questions. They are a way to question the authenticity of the facts provided by the claimant to reduce the amount of compensation that is owed by the insurance company. The main points of conflict involve:
- Policy coverage: This point involves determining whether the insurance policy covers the incident or not. Most insurance companies may insist that your claim isn’t valid or try to discredit your evidence.
- Liability: Another point of focus is agreeing on who the at-fault party is. The insurance adjuster will also try to find the degree of comparative negligence by the complainant.
- The severity of injuries: The extent of the injuries of the claimant and whether they are temporary, permanent, or disabling.
- Cost of medical treatment: The adjuster will examine whether the type of treatment that the claimant received was necessary. They’ll also try to highlight your pre-existing conditions to weaken your claim.
Once the investigation is done, the insurance adjuster can raise objections concerning any of the points discussed above. This is their way of undermining the claim and making the claimant concede and agree to a lower compensation offer. If the points are valid, then the claimant may also agree to lower their demand. The adjuster then makes a new proposal with a revised settlement amount. If the claimant accepts it, the case is concluded.
Can the insurance company deny your personal injury claim?
Yes, it’s possible that the insurance company denies your claims based on the following points:
1. Misrepresentation of material information
One of the most common grounds for a claim denial is failing to provide material information. Regardless of the type of insurance claim, it’s considered misrepresentation if you don’t provide the updated and latest information. Material information affects the rate of an insurance policy. The material information includes things like changing address, purchasing a new car, switching back accounts, etc. If you fail to report it accurately, the insurance adjuster will conclude that you haven’t been paying the right rates. Thus, it can be considered committing fraud.
2. False claim
Insurance claims are often denied because the claimant provides false or fraudulent information and documents. This illegal tactic to receive more compensation can add a black mark on the record of the claimant’s history. This will also discredit the claimant for any future insurance claims for compensation.
3. Illegal actions
If the cause of your accident was an illegal action on the claimant’s part, then the insurance claim will be denied. For example, accidents that occur due to drunk, stunt, unlicensed, or distracted driving can all lead to the denial of a claim. If the action is proven, then the claimant could even lose all sorts of insurance coverage in the future.
4. Policy exceptions
The insurance adjusters often deny the claim based on the grounds that the particular accident isn’t covered under the policy. Most claimants assume that their policy covers everything and miss the underlying terms and conditions. That’s why it’s essential to be aware of what the policy covers and doesn’t cover.
Common mistakes to avoid during settlement negotiations
When you’re unfamiliar with the processing of insurance claims, you may commit a few mistakes. To help you prevent them, here’s a list of common mistakes to avoid during negotiations:
1. Do not provide irrelevant information
If your insurance adjuster is asking for irrelevant information, do not give it to them. The adjusters usually try to use this information against you and to lower the amount of recoverable compensation. That’s why it would be in your best interest to not entertain any request of unnecessary details such as records of your family, past and current employers, friends, etc. if they aren’t directly involved in the case. The information on medical history is also irrelevant, and thus you can refuse to provide it.
2. Do not provide a recorded statement
There’s a chance that your insurance adjuster asks you to record a statement. Since there’s no legal requirement to do so, you must refrain from obliging. The recorded statements are often used against you in reducing the amount of the offered settlement. It’s best to not record any statements without consulting with a personal injury lawyer. Otherwise, what you say can be used against you.
3. Do not sign any early medical release forms
Always avoid signing a medical release prematurely. You should only sign releases once your treatment is coming to its end. The release allows you to access your medical statements and other records. These required aren’t required to be submitted in the initial stages of the claim. So, you should only sign a release when your treatment is complete.
If you provide release early, the insurance adjuster can reduce the amount of compensation. Unless you’re entirely sure about your medical condition and treatment, it’s not the best idea to sign medical releases.
4. Do not agree to a settlement quickly
Most insurance adjusters entice claimants to settle for compensation right away. Although receiving imminent coverage for your medical costs may be your need, settling quickly can put you at a loss. In injury cases, the extent of damages can’t be determined right away. You can have complications later in the treatment process, or it can take time to diagnose the condition correctly. That can lead you to lose your employment or earning capability. If you sign a settlement quickly, you won’t be able to recover damages that surface after the settlement is concluded.
What do Insurance Adjusters not tell you?
1. They want to settle just as much as you
They may pretend that they don’t care about your agreement to settle, but insurance adjusters just as eager to settle as you. It’s essentially their job to settle your claim. If a claimant goes to court, it becomes a bigger expense for the insurance provider. To avoid the costs of the trial and the possibility of having to a larger settlement, makes insurance adjusters determined to settle with you.
2. They are supposed to act in good faith
The law requires insurance adjusters to act in good faith towards the claimant during settlement negotiations. Therefore, you must make sure that they are justifying their compensation offer. They are also legally liable for any tamper with evidence or withholding any information from you. If you feel like they are not working with you in good faith, you can press charges against them.
3. They could be recording what you say
Insurance adjusters have their cunning ways to gather the information that can be used against you. They do this to ensure a lower settlement. So, when you’re speaking with an adjuster, you must be careful not to give away too much information.
It would be best if you had a personal injury lawyer with you during the talks. A personal injury lawyer can help you make the right statements and keep you from giving any self-incriminating information.
4. They want to shift the blame on you
Different states have different laws for comparative negligence. That means that if your actions contributed to the incident, you could be denied compensation. Thus, the insurance adjuster would actively try to put the blame of your injuries on yourself. Most insurance companies will try to manipulate you into thinking that you caused the accident. Therefore, you don’t have a valid claim.
If you find yourself in any such situation, you must immediately contact a personal injury law firm to handle your case. An experienced personal injury lawyer will be able to counter the claims of the insurance company and gather evidence in your favor.
5. They will focus on your pre-existing medical conditions
Personal injury cases are rooted in the legal ground of negligence. Therefore, to claim a personal injury compensation, you’ll have to prove that your injuries were caused due to someone else’s action. Insurance claims often lead to disputes because insurance companies insist that your injuries were either your own fault or a result of pre-existing medical conditions.
That’s why an insurance adjuster may ask you for your medical history. However, you’re not legally required to provide them with this information. Any information that doesn’t directly concern the case is considered irrelevant. Therefore, you must not entertain any such requests because the insurance adjuster will use this information to undermine or deny your claim.
The bottom line
The process of dealing with an insurance company during a personal injury claim can be exhausting. And if you’re not acquainted with the process, you could end up making mistakes that can weaken your claim. That’s why it’s necessary to do your research and learn about your rights before getting into it.
Ideally, you should do this with the help of a personal injury lawyer. They are qualified and experienced in dealing with insurance companies. They understand the sly ways of insurance adjusters and the loopholes that they may try to exploit.
An experienced personal injury lawyer by your side could strengthen your claim by two-fold. That’s why you should hire an attorney. If you want to pursue the claim on your own, you can get a free consultation from a personal injury firm.
If you’re looking for a credible personal injury law firm with experienced attorneys, to represent your claim, contact us at Keith Zaid Law.