Methods Used By Adjusters To Lower Size of Payout

Every insurance company hopes to stay in the black. In other words, it wants to make a profit. The company’s adjusters do their best to aid achievement of that goal.

An adjuster often indicates that the size of a payout is dependent on the claimant’s ability to produce certain materials.

• Any documents relevant to the reported accident
• Any evidence, such as photographs
• Notes taken from medical records
• Any receipts from doctors or other medical facilities

Other tactics used by adjusters

Calling the physician that is treating a particular claimant, and asking questions with closed endings. By using such a tactic, an adjuster would obtain only limited information on the claimant’s injury. In other words, the adjuster’s file would not contain any information about the possible need for extended treatment in the future. Speaking with witnesses and using the same types of questions.

Having a given claimant scheduled for an independent medical exam (IME): Although referred to as an “independent” exam, the insurance company has chosen the examining doctor. Pay investigators to follow the claimant, using a hidden camera.

Study what has been posted on Facebook and Instagram: This represents an effort to find any photographs that were posted by a specific claimant. Adjusters hope to discover a photograph that shows someone with a reported injury performing a task that he or she had claimed could not be carried out successfully, due to the injury’s existence.

Asking for a recorded statement: Typically, such a request gets made soon after submission of the personal injury claim.

Disputing any claim that the treating physician has suggested the need for an extra level of treatment.

Suggesting legal support for a denial of coverage, or for an allegation that that the claimant’s own actions were partly responsible for the accident’s occurrence, or the severity of a particular injury. No personal injury lawyer in Richmond Hill has the right to declare that the terms of a claimant’s insurance policy free the insurance company from covering the damages that were linked to a submitted claim.

Delays responding to a message from someone that has submitted a personal injury claim. Might say that the delay had been caused by the adjuster’s need to contact his or her supervisor.

How to respond to some of the tactics listed above?

Ask for date when a reply from the adjuster’s supervisor could be expected. If planning to attempt a given task, obtain permission from the treating physician, and have that same doctor mention the granted permission in the patient’s medical report.

Never agree to give an adjuster a recorded statement, unless recording can be made at a time when the claimant’s lawyer can be present. Never grant the insurance agency the right to all medical records.

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