In my former life I was an insurance coverage attorney and spent (too) many years dealing with insurance adjusters as clients! Knowing some very talented adjusters, as well as many less talented ones, I can agree with John McKiggan and Mike Bryant that even the best of the best adjusters work FOR the insurance companies and, therefore, are inclined to serve their interests before those of an injured victim, especially if they are calling from the insurance company representing the negligent party who caused those injuries.
Even if we are to put aside the legalities of an insurance adjuster giving advice to an unrepresented claimant, it is simply smart practice to take anything said by a potentially biased individual with a grain of salt. Unfortunately, the only way to help level the playing field is for claimants to get legal representation before speaking to claims adjusters which, unfortunately, will only occur if the public is made more aware of the potentially predisposed and prejudicial actions of the insurance representative “friend”.
Here is what I now see as the reality, having shed my rose-colored insurance glasses and replaced them with Lasik vision:
1. You are in an accident.
2. You hear from your friends and relatives to see if you are ok.
3. Then, out of nowhere, you get a friendly call from someone at some insurance company who you don’t know but seems to know about your accident.
4. They ask how you are and sympathize with your circumstance. They want to help.
5. You are asked (very nicely) if it is ok for them to record your conversation because it will help them to help you get money for your claim.
6. They want to know whether you have been to a hospital or seen a doctor and the extent of your injuries. They are very concerned about your well-being.
7. They might share a personal quip and express their hope that you have insurance and that your medical bills are being covered so that you have no out-of-pocket expenses.
8. They want you to know that they can help you, which is their job.
9. They advise that they have a vast amount of experience with claims like yours and even though there might not be liability they can probably work with you to resolve your claim because they like you.
10. You spill your guts to your new friend, exchange thanks, and after being told someone should be getting back to you, you hang up the phone.
11. Maybe you hear back and maybe you don’t. If you do, you might be offered some money for all of your pain and suffering, even though it is a difficult case, because the claims person really feels for you.
12. You are advised that you need to sign a release in exchange for the money. You are not advised that you have waived all claims against the negligent party, even if in the future you discover that your injuries are far worse than they are now.
Unfortunately, what you might not realize is that the claims representative is NOT your friend. Claims adjusters are professional negotiators, whose job it is to try to settle a matter in the most favorable way for their employer, the insurance company for the other party involved in the accident in which you were injured. They are excellent at getting you to say something which could be considered an admission of some fault on your part or – with respect to the degree of trauma incurred in the accident – something which would limit the value of your claim.
In addition, you cannot – at such an early stage – have a complete understanding of all of your injuries. If you have been involved in substantial trauma, your injuries may develop or simply become more apparent over time. The insurance adjuster wants you to give incomplete or inaccurate information as early on as possible because it helps reduce their exposure if it appears that you are changing or amplifying your claim down the road.
So, here is what you should do rather than fall prey to a sweet-talking insurance person:
1. Be direct in asking from what company the person is calling and whose interests the person represents.
2. During any such conversation, make notes and document everything, including the name of the person, the company they are with and the reason for their call.
3. Be polite but NEVER give any statement, oral or written, to the other person’s insurance company.
4. No matter how tempted you may be to get into a discussion with the person representing the other side, you should resist the impulse.
5. Instead, take the phone call as a clue that the other party or his/her insurance company may be worried about the accident.
6. If an insurance adjuster offers a settlement to you, although it may seem reasonable, it will invariably be less than it should be, so do NOT accept a settlement offer on the telephone.
What I tell our potential clients (and anyone else who will listen) is that it is bad enough that you were the victim of an accident that caused you injuries in the first instance. Do not be a victim for a second time by talking to your adversary’s representative and risking a substantial reduction in the value of your claim. Instead, get a legal professional on your side in order to balance the playing field. Then, you can let the games begin… which they undoubtedly will if insurance is involved!