Insurance is a Business
Insurance companies are in the insurance business. They derive profit from selling insurance policies. The law requires that they honor their contractual policies when legitimate claims are made against them. However, in order to maximize corporate profits for the company and their shareholders, the insurance corporations have figured out an exhaustive array of methods to dispute and mitigate losses to their bottom lines. Some of the main methods they employ may directly affect you; the insurance casualty. (aka the accident victim.)
Independent “Analysis” of Factual Situations – (i.e.) Negotiations
Insurance Companies will not just pay you what you are owed. If they did, there would be no need for lawyers or court systems to enforce contracts. Instead, the Insurance Company will analyze the facts of your accident from a defensive perspective, attempting to find any and all weaknesses in your claim in order to devalue it. They call this process “evaluation.” The problem is, they aren’t evaluating the actual fair value of your claim. They are evaluating the minimum amount they can comfortably get away with paying.
Insurance Companies will often delay claims or outright ignore your phone calls. I can’t tell you how many clients come to us telling us they have reached an impasse in settlement negotiations with an insurance adjuster who refuses to call them back or even acknowledge the claim. It is our experience that some adjusters will stall claimants for months or even years, hoping that the clients will just go away, drop the claim, or miss the statute of limitations which results in their claim being barred as a matter of law.
Unnecessary Information Requests, Examinations Under Oath and ‘As Often as We Require’ Requests
Modern insurance companies write their own policy language and as a result, many of the insurance carriers now insert clauses into their contracts requiring that in order for them to honor your claim, you must comply with their information requests. These clauses are often worded broadly and vaguely so that the insurance company can continue to request information from you, including unnecessary information, “as often as they require.” Further, they will deny your claim or keeps your claim on hold indefinitely, pending your compliance with these impossible information requests. Further, insurance companies may require you to submit to multiple examinations under oath, “as often as they reasonably require.” In many cases, compliance with these requirements, gives the insurance company numerous opportunities to unearth information, which will devalue your claim or destroy it entirely. In fact, we advise clients to NEVER give recorded statements to insurance companies without the assistance of legal counsel.
Disputing Reasonableness of Medical Treatment
Insurance Companies will routinely dispute your medical treatment. Not only will they evaluate the reasonableness of your medical records and bills, but they will often submit your records to their own hired medical experts to “peer review,” your treatment and render opinions as to why your treatment was excessive, unnecessary, over-expensive and completely unwarranted. Don’t get caught in this trap. Get a lawyer involved.
‘Independent’ Medical Examinations
This is one step above peer review. Can’t come to an agreement with the insurance adjuster as to the reasonableness of your medical treatment? Don’t agree with their peer review report? If your case enters litigation, you may be required to submit to what plaintiff lawyers refer to as a Defense Medical Exam. The insurance company will use the word, “independent,” to obfuscate their true intentions. But the exam is anything but. Experts which are hired by insurance carriers and who routinely examine patients for insurance carriers conduct these examinations and the results are very rarely in your favor.
Misrepresentation as to Insurance Benefits
We have on several occasions dealt with adjusters who have misrepresented the amount and/or kind of insurance benefits available to our clients. Whether these misrepresentations are negligent, or intentional, you can rest assured the insurance company is not going out of their way to get you what you deserve. An aggressive attorney on your side however, will do everything possible to maximize your compensation.
Collecting Recorded Statements to Use As Impeachment Evidence
This is a big one. Any statements you provide to the insurance company are admissible in subsequent civil hearings as a hearsay exception as a “Statement of a party opponent.” Unfortunately, their statements to you are not admissible.
Requiring You to Sign Overbroad Releases to Obtain Your Entire Medical History
The insurance carriers will often dig into your medical history, criminal record, accident history, workers compensation claim history, employment history and so forth; looking for any and all details they can use to devalue your claim or pay you less.
Offering to Settle Your Case Quickly Before You Can Call a Lawyer
They don’t want you to have an attorney. They know in the hands of competent legal counsel, your claim will most likely command a higher value. If they can settle your claim before your lawyer gets involved, they typically settle it for less, which increases their profits.