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

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 for you to get as little as possible, as opposed to 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 will 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 will tell you the insurance company will work with you and that you do not need an attorney.

More than likely after an accident the claim representative will contact you the same day after the crash occurred. The first thing they will want from you is a recorded statement. They will tell you that they just want to get your version of the events and then they will need time to contact their insured if they haven't already spoken to their insured about what their insured says happened.

What the Insurance Company Won't Tell You

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. None. No recovery.

If you give a recorded statement right after the accident, while you are still anxious or upset about the crash or 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. "But if I'm honest, why does that matter?", you might ask. The problem is that you may not know the significance of what you are saying, so that you might agree with a statement the claims adjuster asks you, but that may mean something very different from what you intend.  And remember, the adjuster is a professional trained in getting just those kinds of statements form 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 out right.

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, whose fault it is), 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.

Prior Injuries/Prior Claims

They don'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 (that means YOU).  The claim rep requests your full name, address, date of birth and social security number. To relieve your apprehension about providing personal information they 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 the 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 who resides in your household. This information is provided to any insurance company that pays money 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.

During the recorded statement, when they are inquiring about your injuries from the crash and asking 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 already 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.

Surveillance

What they won't tell you is 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 this information is different or contradicts anything you told the claim rep about your injuries and pre-existing conditions, they will use it as an excuse to delay your claim, to pay you less, or to refuse to compensate you at all. They are trying 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.

Medical Authorizations

After the recorded statement, the claim rep will send you medical authorizations and maybe even a release. What they won't tell you is that the claim rep will often 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 so 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 treating, 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 you're your medical records and information obtained through your medical authorization.

Settlement

What the adjuster also won't tell you is 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 should not 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 - how long to treat, what type of treatment and the likely recovery period from your injuries. Not a claim representative. You take the risk that you are settling before the true extent of your injuries and losses are known.  You may be settling too soon and too cheap, which may please the insurance company but is certainly not in your best interest.

Claim representatives are aggressive in their methods to contact you, get a recorded statement, get your authorization signed, get your medical records, get you to settle and sign a release to save them money and prevent you from getting a free 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'll end up paying more money.

Insurance claims representatives are trained professionals who know claims and know how to handle them 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 the insurance company yourself.  There are quite a few things that the claims rep will not tell you that are pertinent to your case.


[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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