What the Insurance Claim Rep Won't Tell You About Your Personal Injury Claim

 Author: David Williams, Stafford, VA Personal Injury Attorney

Claim representatives for the insurance carriers are professionals who are experts at what they do. The claims representative[1] for the liability insurance company is a trained professional whose job is to have your claim cost the insurance company as little as possible. That means your compensation may be a small percentage of what is considered a "fair and reasonable" settlement amount.

If you are hurt and unrepresented, and not familiar with personal injury claims, the hardball tactics used by some claims representatives can leave you feeling dazed and confused. You are likely to feel that you are being taken advantage of in the process. Often the claims representative will pressure you to settle right away. However, settling quickly may not be in your best interest, depending on the type of injury you sustained and the type of treatment needed to recover from your injuries. What you don't know really can hurt you.

The claim rep may tell you that you can save money by not hiring an attorney because you won't have to pay one-third contingency fee that personal injury attorneys usually charge. The claim rep may tell you the insurance company will be flexible and work with you and that you won’t need an attorney.

What the Insurance Company Won't Tell You

They Are Looking For Contributory Negligence

In Virginia if you are found to be even 1% at fault in a way that significantly contributed to cause the accident, then you are not entitled to recover any compensation for your bodily injury or property damage. 

If you give a recorded statement right after the accident while you are still anxious or upset about the crash, are under the influence of pain medication, or before you have had an opportunity to gather yourself, you may say things that are not be in your best interest. You may not know the significance of what you are saying and you might agree with a question the claims adjuster asks you, but that may mean something very different from what you intend.

Remember, the adjuster is a professional trained in getting just those kinds of statements from you. They are counting on you to say something that will expose any contributory negligence or fault on your part and give them any reason to deny your claim.

You Can Refuse A Recorded Statement

When the claim representative requests a recorded statement, they don't tell you that you have a right to refuse or that you are entitled to a copy of your recorded statement whether they transcribe it or not.[2]

The claim rep will tell you that all they need to get things started is your recorded statement to determine liability (that is, who is at fault), or that their insured has not reported the accident so they need your version of what happened. Then the claim rep will ask not only a number of questions about how the accident occurred, but also about the property damage, your injuries, your prior health condition, and other personal information.

If you give a recorded statement, you are simply giving the insurance company ammunition they will use against you later in settlement negotiations and at trial. What you say can and will be used against you by the insurance company.

They Know About Prior Injuries/Prior Claims

Claim reps won’t tell you about the Claim Index Database System maintained and used by most insurance companies to track and secure the claims history of every claimant. The claim rep will likely request your full name, address, date of birth, and social security number. To relieve your apprehension about providing personal information, they may simply tell you that this information is essential to their investigation and processing of your claim.

What they don't tell you is that this information is being used to search a national data base maintained by a company paid for by insurance companies with a list of your prior Bodily Injury, Auto, Workers' Compensation and Homeowner claims. This information also includes the coverage for which you filed the claim, the date of the incident, the type of injury, and the settlement for you and anyone else in your household. This information is provided to any insurance company that pays a fee to subscribe to this service, and almost all of them do. The database service also sends an alert to every insurance company that has an open claim for you when there is a new search conducted.

During the recorded statement, when a claim rep inquires about your injuries from the crash and asks about any prior injuries and prior claims, they probably already know the answer. If you have been involved in an automobile accident or worker's compensation claim, they will know because they will have already run your name through the Claims Index Database or received an alert. If you were not in the Claims Index Database before the crash, you will be after.

You Could Be Under Surveillance

An insurance company won't tell you that the claim rep may request video surveillance of your activities, especially if you have a pre-existing condition or prior injuries.  If the claim rep thinks any of the surveillance collected contradicts anything you told the claim rep about your injuries and pre-existing conditions, they will use then it as an excuse to delay your claim, to pay you less, or to refuse to compensate you at all. They are seeking to cast doubt on your injury or blame it on a pre-existing condition, or just to have an excuse to portray you as a dishonest person.

They May Use Medical Authorizations Against You

After a recorded statement, the claim rep may request authorization to obtain your medical records. What they won't tell you is that the insurance company can use your medical authorization to not just obtain your treating records, but also to obtain your prior, unrelated medical records.

The claim rep or adjuster will ask you to sign a medical authorization form so that the insurance company can obtain your bills and medical records from the collision. In addition, the authorization will normally also allow them to talk directly to your doctor about your injuries, your condition, your progress, and your treatment. By the time you are finished treatment, the insurance company will know more about your injuries and health conditions than you do thanks to your recorded statement, the Claims Index Database, and your medical records and information obtained through your medical authorization.

They Want To Rush Your Settlement

A claims rep won’t tell you to hold off on settling your case until you are released from medical treatment.

You don't know how you will be feeling weeks or months after the crash, and you shouldn’t rush to settlement. If you have not recovered from your injuries and are continuing medical treatment, you should not settle your case. Your doctor is better at determining your course of treatment, including how long to treat you, what type of treatment you should receive, and the likely recovery period from your injuries. A claim representative cannot make that medical determination. If you settle too quickly, you take the risk that you are settling before the true extent of your injuries and losses are known. 

Claim representatives are aggressive in their methods to contact you, to get a recorded statement, to have you sign a medical authorization, to obtain your medical records, and to get you to settle and sign a release to save them money and prevent you from getting a consultation with an attorney. Insurance companies even have a name for this process—it’s called "controlling the case."  They know that if you see an attorney, they will pay out exponentially more for your claim.

Insurance claims representatives are trained professionals who know how to handle claims in the best interest of the insurance company. You need someone who is knowledgeable and experienced on your side, and who will fight for you.

An initial consultation at Allen & Allen is always free. You should speak with a personal injury attorney because you are at a huge disadvantage if you deal with an insurance company yourself. 


[1] The terms "claims representative," "claims rep," and "insurance adjuster" and "adjuster" are used interchangeably in this article.

[2] See Va. Code §8.01-417 at http://law.lis.virginia.gov/vacode/title8.01/chapter14/section8.01-417/.

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