What Happened to Fair and Reasonable?

Author: Egena T. Younger

I worked on the defense side for insurance companies for over 17 years. I experienced many years of investigating, evaluating, and negotiating automobile and commercial claims. From the first day of work, I was told to settle cases for a fair and reasonable amount. I was proud to represent the insurance company and its investors by checking every bill and report, to ensure that only what was necessary, related and reasonable, would be considered in evaluating an appropriate settlement offer. I gave a lot of consideration to the amount of property damage, the amount of the bills, the duration of the treatment, and how credible a witness our insured would make in defending his/her actions. I was never told to be unreasonable, but when I could negotiate a settlement for less than my evaluation, I felt proud of my accomplishment.

However, I was not really considering the injured claimant, and that the claimant was a real person with a life who had endured a lot after being injured in an accident. I failed to see that this was a person who was in pain, who often couldn’t work, who had to find some form of transportation, who had to go to doctors or therapists, sometimes over many months, in hope of finding someone to help them get better. I only considered what was on paper. My goal was to settle the case, timely and efficiently, with as little cost to the insurance company as I could. No, my paycheck did not change if I settled a case for a lower amount, but there was a sense of accomplishment, a sense that somehow, I won the battle. Why, I don’t know, but I’m sure many claims adjusters can relate to my experience.

I have since turned the page in my career and I now work to assist injured claimants. I am amazed at the different perception I’ve gotten from looking an individual in the eyes and hearing the sincerity in their voice. There are very few who are not struggling to handle this ordeal, and even fewer that are trying to get more than what is fair and reasonable. I meet with people every day who are going through the chaos of trying to deal with the consequences of an accident. I listen to people who have lost their jobs, because they were unable to work due to injuries resulting from an accident. I listen to people who are concerned because their doctor does not allow them to return to work because their injuries won’t heal properly if they do, but their employer won’t guarantee their position will be available when they are able to return. I listen to people who are trying to find a doctor that will treat them when they don’t have health insurance. I listen to people who are struggling to see the doctor or therapist while trying to maintain their household and raise their children. I meet with people who find themselves in financial debt, sometimes with bills sent to collection agencies, because the liability insurance company doesn’t pay until their treatment is complete and there is a final settlement.

I work hard to try and get cases to settlement as soon as I can, but changes with insurance companies have made this more difficult. In these difficult financial times, many insurance companies are downsizing, and each adjuster often has an overwhelming case load. As a result, insurance adjusters are taking much longer to settle cases, because often they are unable to review the file for two to four months, or even longer. Many insurance companies use computer systems to determine the value of a claim based on the CPT and Diagnosis Codes for medical treatment, which totally removes the compassion and understanding of individual circumstances and hardships a claimant might face.

Thinking back to when I first began working for an insurance company handling claims, I have to wonder if the insurance company considers that the injured person has been wronged and should be compensated fairly, and if there is still a goal to settle cases for what is fair and reasonable. Unfortunately, I think I know the answer.

Sobre el Autor: Egena Younger works in the Chesterfield, Virginia branch of the personal injury law firm of Allen & Allen. She is a former insurance adjuster and works with supervising Attorney Trent S. Kerns to assist clients in settling their personal injury claims.