Hand holding mini car with car insurance paperwork on deskWhy The Auto Insurance Company Is Not On Your Side

Insurance companies are businesses and, like any profit-seeking business, they have no incentives to pay out full value on an injury claim unless it is absolutely necessary. They hire claims adjusters to persuade the injured to agree to a low settlement so the insurance companies can maximize profits.

They also train their claims adjusters very well. Insurance claims adjusters are trained to call you as soon as possible after an accident to make you give a recorded statement. You must be careful because your statements can be taken out of context by the adjuster. This could hurt your injury case later.

For example, you may be asked a general or ambiguous question like, “How are you feeling?” to which you answer, “I am feeling fine.” You could mistake the question for just a generic greeting and not really about how you actually felt at the exact second it was asked. As a result, your answer may be seen by the adjuster as a contradiction to the medical findings. This can be dangerous to your case, which is why you should never give a recorded statement without legal counsel present.

Claims Adjusters and Settlement Value

Sometimes, claims adjusters say or hint that you should not use a car accident attorney in your injury case. They will also mention that you have to pay attorneys’ fees, which will deplete your settlement value. Claims adjusters have been known to threaten to deny or “lowball” your claim if you seek legal counsel. They get paid for making low settlements and are sometimes rewarded by incentives and promotions.

Statistically, injured parties receive settlements of 3.5 times more when represented by competent legal counsel. The insurance claims adjusters know this and believe legal counsel will interfere in their efforts to reduce the settlement offer. I sometimes meet clients who have spoken to the at-fault insurance company before retaining my law office. They explain the great efforts the claims adjuster made to dissuade them from using an attorney and the low settlement offers they make before seeing any piece of medical evidence.

Medical Authorizations

The insurance claims adjuster may ask you to sign medical authorizations to obtain all of your private medical records. The problem here is that if you are without legal counsel, the forms are sometimes drafted to allow the insurance company to:

  • Obtain all of your medical records and not just the ones about the accident. I routinely see forms asking for information pertaining to private issues such as HIV, psychiatric treatment, or alcohol-related problems. These forms ask you to voluntarily disclose private health information that goes beyond the scope of what the insurance company is entitled to review in terms of your injuries from an accident.
  • Obtain medical records with no limits on how far back they can go to seek private information on you.

Independent Medical Exams

Under California law, the insurance company has the right to call you for what is called an “Independent Medical Exam” (IME) in order to further evaluate your injury claim. This is true for the at-fault party’s carrier as well as your own insurance carrier.

Make no mistake, the IME is far from independent because it allows the insurance company to hire its own medical expert whose goal is to minimize your injury claim whenever possible. This relates back to the insurance company’s bottom line. If they can minimize claim value, they will. Please view my legal video called “Your Rights When It Comes to Independent Medical Exams (IMEs) in California” for more information on this subject.

By using an IME, the insurance company can cut off necessary medical care prematurely. Some of these defense doctors are known to be “hired guns” for the insurance company. We sometimes see the same defense doctors being used by different insurance companies in the San Diego courts. I am confident this happens in every court in the United States.

Tactics Insurance Companies Use to Lower Your Settlement Value

The insurance company will use tactics collectively known as “delay and deny.” They either sometimes delay claim review by taking too long to obtain medical records or they sometimes deny the liability of a claim in whole or part through an apportionment of liability arguments based on the facts of the accident and your medical conditions prior to the accident.

They also know that if you are in need of money; the longer they delay your claim, the more willing you will become to accept a lower settlement offer. Denying all or part of your claim also helps the insurance company save money.

You may be placed under video surveillance to try and catch you in a moment during your daily activities when you look “normal” rather than injured. The insurance company will pretend to be your friend and, at first, tell you to get medical care. Then, in the middle of your care, they may dissuade you from further care, even though your treating doctors say otherwise. Worse, they may refuse to pay for any further medical care without reviewing the medical evidence of the injuries. All of the above reasons should indicate why and how the insurance company is not on your side.

Mark Blane
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San Diego Personal Injury Lawyer | California Car Accident Attorney
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karen 07/22/2011 10:10 AM
This is an excellent post that anyone who drives a vehicle in California or anywhere else should read. It should also be a warning to those who opt for minimum state requirements when buying their motor car insurance - these are rarely enough to cover medical or other costs that are incurred after a serious accident. When purchasing car insurance it is always a good idea to check how a chosen carrier treats its policyholders after accidents, even companies with high ratings can have a lousy track record of paying claims.
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