An insurance adjuster’s job is to investigate, manage, and value insurance claims. They will either settle or dispute an insurance claim. Insurance adjusters are the first line of defense for insurance companies, and they are trained to protect the company’s bottom line at all costs. They usually have the authority to settle claims only up to a specific monetary amount. These front-line or field adjusters often work in very specific case areas, which is to say an auto insurance adjuster does not work on homeowner’s claims and vice versa. Adjusters control the purse strings, and if you are seeking an amount of money that is greater than what they think the case is worth, they can make your life difficult and hold your settlement hostage.
Dealing with insurance adjusters is an art, not a science. Too often, adjusters are overworked and underpaid. They are dealing with hundreds of similar claims at once, and their understanding of your case is only as good as the notes in their file. It should come as no surprise, then, that there is often a disconnect between an adjuster’s assessment of a case's worth and your opinion about what you are owed.
For simplicity’s sake, we’ll say that your damages are estimated at $50,000. This includes medical expenses, the cost of repair or replacement of your car, and lost wages. After making your claim with the at-fault driver’s insurance company, you wait several weeks and don’t hear anything. You call the adjuster and are stunned when he tells you that according to his calculations, the estimated damages are more in the range of $10,000. Now what? Why are the numbers so far apart? There are many possible reasons.
Lack of information is often the main reason adjusters lowball the value of a claim. Perhaps they don’t have the appropriate medical records or receipts. Perhaps they were given the wrong police report or weren’t informed that their insured client was cited as being at-fault for the accident. Adjusters are human, and they deal with an enormous amount of information all day, every day. Mistakes are made and things slip through the crack. That’s where you come in.
The first line of defense against an rejected insurance claim is to document every dollar spent or lost as a result of your accident. Medical bills, prescription receipts, mileage to and from the doctor, old paystubs that can verify your pay rate, car payment records, and repair estimates, will serve as proof of your damages. Insurance adjusters will never, ever, just “take your word for it.” If the adjuster disputes your claim, provide him or her with the basis for your number. It is entirely possible that the adjuster’s file is incomplete or contains errors. Often, submission of supporting documents accompanied with a detailed letter outlining why the documents support the claim can be enough to get the adjuster to raise their settlement number.
It is also possible that the adjuster paid little or no attention to the effect of injuries you sustained. Say, for example, that you tore a muscle in your shoulder and you’ll require months of physical therapy, but otherwise you’re mobile. In your case, however, the shoulder injury prevents you from working your job as a baggage handler at the airport. You’re restricted from lifting more than five pounds. Unfortunately, the documentation you provided to the insurance adjuster simply states that you work for XYZ Airline and doesn’t specify your actual job. The adjuster did not include any wage loss in his calculation, so based on his file, you can still work. In this situation, you need to explain to the adjuster that your job requires constant heavy lifting. You must also make it clear that your doctors have restricted you from performing any heavy lifting, so with this restriction, it's impossible for you to work until you make a full recovery. Make sure the insurance adjuster’s file not only has all the information, but that the information is relevant. Essentially, you’ll have to do the insurance adjuster's job for him if you want to win your claim.
If, despite your best efforts, the adjuster still disagrees with the basis for your estimated damages, get a lawyer involved. You don’t necessarily need to file a lawsuit (although this may happen later), but once you have a lawyer representing your interests, your claim is generally transferred to an insurance company lawyer for analysis and negotiation. Insurance company lawyers pay more attention to claim files. They look at medical records, work histories, medical restrictions, vehicle repair estimates, and more. They put the time in where adjusters do not.
Often, the two lawyers can work out any alleged deficiencies in your claim through submission of evidence, conducting interviews or further investigation. While the adjuster still controls the purse strings, the insurance company lawyer has the power to make recommendations as to the appropriate settlement amount. When presented with proper support, adjusters will settle the case. As adjusters often say, the best file is a closed file.
It's entirely possible that you’ll have to file a lawsuit to recover your damages. Insurance companies often dispute certain injuries, such as closed-head injuries or alleged aggravations of prior medical conditions. Once you file a lawsuit against an insurance company, the claim can either settle after an investigation or proceed to trial. Ninety percent of cases settle, but be prepared for a long, arduous investigation before the case is resolved.
Injured parties and insurance companies have opposing interests. Injured parties want to be made whole. Insurance companies want to hold onto every penny. If an adjuster disputes your claim, do all you can to provide him or her with the necessary documentation and supporting details. If all else fails, again, consult a local personal injury attorney to ensure that your rights are protected.