In any personal injury claim, there is a high probability that you are dealing with an insurance company. For example, in car accidents, the insurance provider of the at-fault driver will be involved in the settlement talks. If a doctor is charged with medical malpractice, your medical malpractice insurance provider will handle the case. If a homeowner is charged with premises liability, their homeowner’s liability insurance will serve the plaintiff. Since most personal injury scenarios involve an insurance company, it is important to know what dealing with these companies entails.
The negotiation process
The negotiation process with an insurance adjuster begins once the claimant has submitted a demand letter stating the amount of money they are claiming for personal injury. The adjuster normally telephones the claimant within 14 days to offer his response to the letter. However, the time it will take for an adjuster to respond to the claims of the claimant will depend on their timing and the complexity of the case. If the insurance adjuster does not respond within 2 weeks, it is advisable to call the claims department and confirm if you received the demand letter and when you can receive a response.
The first thing an insurance adjuster will send to the claimant is a letter known as a “reservation of rights.” This letter seeks to inform the claimant that the adjuster is investigating their claim and will withhold payment if the incident is not covered by the policy. This letter protects the insurance provider against future claims that, because it began negotiations with the claimant, it recognized that the accident was covered by the policy. It is also a strategy aimed at hinting to the claimant that the insurance provider might not pay for their loss, forcing them to accept a small settlement.
During negotiations, insurance adjusters will ask a series of questions and challenge certain facts in an attempt to reduce the value of the claimant’s compensation . The main disputes involve:
- Coverage: if a claimant’s policy covers the accident
- Liability : the person responsible for the accident and the degree of comparative negligence of the plaintiff
- The severity of the claimant’s injuries – whether the injuries were disabling or permanent
- The type of medical treatment: whether certain procedures were necessary and whether the claimant had pre-existing medical problems
After conducting the investigations, the insurance adjuster will raise any of the above disputes to reduce the claimant’s offer. The claimant could agree to the adjuster’s arguments and propose a lower settlement amount. The adjuster will make another proposal and, if the claimant accepts it, a settlement contract will be established and the problem will be concluded.
How an insurance claim can be denied
Failure to indicate material information may be grounds for an insurance claim denial. Regardless of the type of insurance you are dealing with, it is considered that you do not provide the insurance with up-to-date information. These simple problems can affect your policy rates. Therefore, if you have not reported important information, such as buying a new vehicle, moving to a new residence, or changing bank to your insurance adjuster, this means that you are not paying the correct rates and therefore , you are committing fraud.
Fraudulent and false claims
Many claims are rejected due to falsification of information to get a claimant more than they deserve. Falsification of insurance information can also lead to a black mark on the claimant’s record. This means that it will be difficult for you to be compensated under a policy in the future.
For accidents that involve irresponsible behavior, such as drunk driving, distracted driving, stunt driving, or driving without a license, your claim is likely to be dissolved. Plus, you can lose your coverage and become unsafe in the future.
One of the main reasons insurance adjusters use to deny people their claims is to question that an accident is covered by a claimant’s policy. In many cases, claimants think they are insured under certain conditions, but later discover that they are not. It is important to study the provisions and exclusions of your policy.
Mistakes to avoid when negotiating a deal
Do not accept a recorded statement
Your adjuster may ask you to file your returns. You are not legally obligated to record statements. Insurers use registered returns to minimize your settlement. If your attorney is not present, refrain from recorded statements as anything you say will likely be used against you.
Do not give irrelevant information to your Adjuster
Insurance adjusters go to great lengths to secure irrelevant information that can be used to compromise your recovery. Therefore, refrain from disclosing information about your current and past family, friends, or employers to the adjuster, unless they are involved or important to your claim. The details of your previous medical condition are also irrelevant and can be used to quash your settlement claims.
Don’t sign medical releases prematurely
The ideal time to sign medical waivers is when your treatment is coming to an end. These versions help you get access to all of your medical statements. These records are not required by the adjuster during the initial stages of the claim, but are only required at the conclusion of your treatment. Giving your adjuster these records early in the settlement process will result in a low compensation award. It is advisable to keep these records until your doctor is certain of your medical condition and that future complications are not likely.
Establishment too fast
Many insurance adjusters leverage the claimant’s desire to resolve quickly. While ending the anguish of a personal injury claim is every claimant’s wish, too quick a settlement can work against them. In some cases, the extent of the injuries or damage doesn’t become apparent until later. For example, a crooked hand could be broken in the future. This complication means more medical expenses and can lead to loss of income, where a person depends on that hand to perform their employment functions. In such a situation, one is entitled to compensation higher than that of a crooked hand. So settling in early could cause you to miss out on more damage awards.
What insurance adjusters don’t want you to know
Insurance adjusters want to solve
While insurance adjusters will pretend that they care less whether it resolves or not, they are actually determined to resolve the claims. When a case goes to trial, it is a great loss to the insurance provider in terms of large settlement awards and court costs. Therefore, insurance companies choose to settle rather than pay litigation fees and high settlement amounts.
Insurance adjusters must act in good faith
Insurance adjusters are required by law to act in good faith during settlement negotiations. This means that they must justify their offers, they must not tamper with evidence or withhold information. An insurance adjuster is legally liable for actions that are performed in bad faith.
Insurance adjusters may be recording your returns
Insurance adjusters are shrewd when it comes to gathering information to help them pay a low settlement. This includes the recording of your statements. When you speak to an insurance adjuster, make sure their statements are not self-incriminating. It is best to have an attorney by your side to intimidate the adjuster and prevent you from increasing.
The settlement process with an insurance company can be tedious. However, becoming familiar with what it entails, and the basic difficulties, can prove valuable in the end. If you have any further questions, contact your Las Vegas personal injury attorney for a free consultation as soon as possible.
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