What You Need to Know About Insurance Adjusters (Part 1)

Our office has handled hundreds (if not thousands) of cases during this time. By representing hundreds and hundreds of work accident victims over the years, we began to see how the insurance industry deals with victims after they begin the claim process following the work accident.

• We have found that most insurance adjusters are highly trained adversaries. Most people do not realize this, at least not at the beginning of the workers compensation claims process. Most people understand that the insurance company’s job is to make money. One way it does this is by settling claims for less than the claim is worth. Yet, most people are unaware of how sophisticated, yet simple, the methods the carrier will utilize to help accomplish this goal.

Questions you MUST ask the insurance carrier:

Now, the carriers don’t like it when you ask these questions because they either cannot answer the question, or worse, they don’t want you to have the answer.

QUESTION 1: Isn’t it true that if I use an attorney, I’m likely to recover more benefits and more money in settlement than if I try to manage or settle the claim on my own?

Answer: Don’t be surprised if the adjustor lies to you and says “no” to this important question. How do I know the answer is false? Because a study by the Insurance Research Council (a nonprofit group funded by major insurance companies across the nation) found that the average total payout on claims that have an attorney involved is 4.8 times greater than those claims where the injured victim settled on his or her own. This same study showed that individuals who use an attorney receive 3.28 times more money after the attorney’s fee is paid. Most insurance claims adjusters are very aware of this study. So, if the insurance company wants to maximize profits it will train its claims representatives to go to great efforts to dissuade people from hiring an attorney. Simply put, the insurance companies know that if you hire counsel you will likely get more money in the settlement, even after deducting the lawyer’s fee. Second, since in Virginia workers’ compensation, the injured worker has the burden of proof, they are not obligated to tell you if there are any additional benefits you could be receiving. Rarely have I had someone come to me who knew all of the benefits for which they were entitled from their insurance adjustor.

QUESTION 2: How can the insurance company verify that the settlement amount (or the allowed calculation or impairment rating, etc) being offered to me is fair and reasonable?

Answer: It can’t and it won’t. Sure, the adjuster will tell you that the settlement offer is reasonable and fair but he can’t verify or prove to you that everyone with similar injuries never receives more. Unless you are in the business of negotiating and settling injury claims, there is little chance you will know whether the settlement amount that is being offered is fair. Therefore, by negotiating and settling the Virginia workers compensation claim yourself without using the assistance of a professional, (i.e., a Virginia workers compensation attorney), you run the risk of accepting a sum that may turn out to be much less than what is considered reasonable for your type of claim.

QUESTION 3: Why do I have to give you a recorded statement when you can get information about the accident from the 1st report of the accident?

Answer: Because the insurance company will try to use your own statements against you! In most Virginia work accidents, the 1st report of the accident will be filed and the insurance company has easy access to this report (it just takes a phone call to your employer). So why is a recorded statement necessary? Most companies have written policies in place which require the adjuster to get a recorded statement to see if there’s any information the accident victim might reveal which could be later used to either deny the claim or payout less money.

Check out Part 2 by clicking here for more tips to shed some light on the misinformation adjusters give to injured workers. It could mean the difference as to whether or not you are awarded benefits for your work injury!