Every so often, I get a call from a client who caused a car accident. They are worried about a claim possibly being made against them, and worse, having to defend themselves in a potential lawsuit. They ask, "Do I have to hire a lawyer to defend me?" It's often surprising to me how many folks don't realize that a benefit of having automobile insurance is the insurance company will handle the claim for you. That's why you are paying premiums. Report the accident to your insurance company and let them deal with the claim. If the incident was very minor, you might be able to handle things yourself, but in most cases, you are are better off tendering the matter to your insurance company. If you are sued, they will provide you with an attorney to defend you in most cases...however you should take comfort in knowing that most cases are settled without going to court.
Keep in mind, you should make sure you have adequate insurance. If you have a good job and income, and/or some assets, don't get the minimal insurance policy required by law. If you cause significant injury to someone, their attorney is not going to be happy with your tiny car insurance policy. They are going to take that policy and go after you for the rest. Therefore, if you have adequate insurance, your insurance company will handle the claim for you and provide you with an attorney to defend you just in case. The reason you want adequate liability insurance is to encourage a claimant to take your insurance policy without coming after you for the rest. If you want to learn more about this subject, feel free to call my office to discuss.
Today I spoke with a potential personal injury client. She told me she was in an accident several days ago. The insurance adjuster for the party at fault had contacted her and kept wanting to meet (no doubt to offer a paltry sum of money to quickly settle the case). After several calls, the client lost her cool and screamed and yelled at the insurance adjuster. I told her that wasn't a very wise thing to do. She seemed perplexed until I explained the adjuster is the very same person who may end up writing her a settlement check one day. I asked her, "Do you think your yelling and screaming made it more or LESS likely the adjuster will ever write you a check?"
An adversarial relationship with the insurance adjuster is rarely in your best interests. You can certainly disagree about many things (and you probably will), but it's generally better to maintain a civil and friendly relationship with the claims adjuster. Sometimes, a good relationship with an adjuster can make or break your chances of settling your personal injury case. In most cases, it leads to a more amicable settlement for all involved.
When I was a defense lawyer for a major insurance company, one of the first things we looked for when defending personal injury claims was "gaps" in treatment. That means, we would look at every single date of treatment and try to find "gaps" of 10 days or more. Sometimes, we'd see gaps of 2 weeks or much more. We would use those against the person making the claim. Also, we would look to see when treatment commenced after an accident. We would sink our teeth into delays of over 10 or more days. Why do insurance companies use gaps in treatment and delay in commencement in treatment against you? Because they want to minimize your case. They will argue, "Well, if you were REALLY hurt, you wouldn't have waited 2 weeks to get treatment." Or they might say, "Well, if you were in any REAL pain, you would have treated more regularly without missing appointments etc."
The insurance companies will do anything they can to minimize your claim. My clients are often surprised by this tactic. My clients will say, "Well, I couldn't get in to see the doctor for a long time" or "I couldn't get a physical therapy appointment for a month..." The excuses are legitimate and understandable, but that doesn't mean insurance companies will be easy on you or "understanding." They simply don't care. They will use it against you because at the end of the day, they aren't really interested in compensating you. They are interested in minimizing their losses. Therefore, the lesson here is to commence treatment as soon as possible after an accident, even if you only suspect an injury. You don't want to take chances. Also, once you start treatment, be diligent about your health care and follow up visits. In all fairness, there are some insurance adjusters who do understand there are sometimes legitimate reasons for delays in treatment, but most of them won't see the big picture.
Insurance companies don't make money by paying out settlements on insurance claims. When you put it that way, it's easy to understand why the insurance companies are low-balling their settlement claims, whether the claim is brought by a third party or by their own insured.
Insurance companies make money by collecting premiums and holding onto their money. They invest it and make even more money. While insurance adjusters handle your claim, they utilize industry tips and tricks to lowball your settlement. I'm not saying all adjusters and insurance companies engage in such practices. However, when was the last time you ever heard someone say, "The insurance company offered me a really fair deal!" or better yet, "The insurance company was very generous with me." These are statements you will rarely ever hear.
About half of U.S. insurance companies are using software products (one actually called "Collosus") to evaluate claims. They basically plug in your information to get a sense of your case value. These software products utilize tons of historical data to evaluate claims of all kinds using parameters like age, injury claimed, region of the country, type of accident, jury verdicts, etc. However, critics of these software products argue they take the "human" element out of the equation, reducing your personal injury case to a commodity. Truth be told, sometimes I wonder why I'm dealing with an adjuster (a human being) when all they are doing is punching data into a computer. However it is a sad reality nevertheless. No matter how hard you try to explain to them some unique circumstances of your case, your case will simply be lumped in with every other case their computer has analyzed. Many insurance companies will publicly deny they use such software to evaluate cases. After all, why would they?
These software companies compete for insurance company business. They want their software product to be chosen, touting more "accurate" results and more importantly, bigger "savings" for the insurance company. These claims of "savings" by the software companies lead some to conclude that insurance companies are "fine tuning" the software products to produce certain more "favorable" results. Critics note these "adjustments" and "fine tuning" are nothing more than tactics designed to cheat the consumer. My personal feeling is that using historical data, regional differences, age, etc are fine, but if the companies are tweaking their software parameters to produce more conservative and "lowball" settlements, then consumers have even less hope in this "David versus Goliath" scenario.
For more information about Collosus software and similar products, click here for more information.
The insurance adjuster may ask you for your social security number at some point during your claim. The primary reason they want your social security number is because they want to “index” you. That means they want to run your social security number through their computer system to see whether or not you have a previous claims.
In some cases, they can learn about previous accidents, injuries, attorneys you’ve worked with, doctors you’ve seen, and much more. If you have a rich history of claims, you can expect that could backfire when it comes time to settle your case. Pre-existing conditions and claims to the same body parts in the past will be used against you.
Insurance companies look for any evidence of a similar injury from the past. For example if you’re claiming a back injury from an automobile accident, any mention of previous back injury will likely backfire and work against you. Of course, there is the notion of “aggravation of pre-existing condition,” but the difficulty comes in trying to assess how much is attributable to the new accident versus how much is attributable to the old accident or pre-existing condition.
Therefore, providing the other insurance company with your social security number essentially gives them permission to go fishing for your history. By the same token, the lack of any previous claims can benefit you in some cases. Insurance companies have grown tired of “professional plaintiffs,” people who make claims every couple of years for one reason or another. However, if your record is very clean and you have no pre-existing claims or very few, that can actually help your case to some extent.
If you're involved in a hit and run accident, the best thing to do is try to obtain as much evidence of the incident as you can. Talk to witnesses who may have seen the accident and get their information. Call the police and make a police report. If they won't come to the scene, have a police report prepared on a subsequent date. It is important to document the fact that this hit-and-run accident occurred. Since it was a hit-and-run accident, you can't go after that party's insurance company. Therefore, your only option will be to pursue your own "uninsured motorist" policy (aka UM Coverage). Of course, that assumes you have UM coverage available.
If you want to pursue your own insurance company's uninsured motorist policy, you will have to prove that something actually happened. Sometimes, your insurance company might be suspicious of your claim if you cannot prove that someone else caused the accident and fled the scene. A hit and run accident is often treated as though it were an uninsured motorist case - even though the other driver may have actually had insurance. After all, you were injured by someone else who for all intents and purposes doesn't have insurance available for your claim. As a result, you will have to pursue your own insurance company's policy.
You want to make sure you gather as much evidence as you can about the hit and run because the insurance companies are trained to be suspicious when comes to hit and run accidents. Believe it or not, there are some people who fake claims against insurance companies in order to collect. You don't want to be lumped in with these people!
Not only is NOT wearing a seatbelt dangerous, but it can also backfire on you if you bring a claim against the responsible party in a car accident. In California, the other party will point to your "comparative negligence" for not having worn a seatbelt. Their argument will be that your lack of seatbelt contributed to your injury. In other words, had you been wearing your seatbelt, your injuries would have been far less serious. Of course that isn't always true, but truth doesn't really matter when it comes to defending a case in the personal injury world. The insurance company for the responsible party will do anything to poke holes in your case. Also, a jury might look unfavorably upon someone who was injured if they were not wearing a seatbelt, even if one can demonstrate the lack of a seatbelt had nothing to do with the injury. The moral of this story is you should wear your seatbelt when driving or anytime you're in a vehicle. Wearing your seatbelt is arguably the safest thing to do and is required by law. If you get hurt in an accident and you weren't wearing your belt, that fact will certainly be used against you. Simply put, be safe - personal injury case or not.
In most cases, talking to the insurance adjuster for the responsible party is not in your best interests. No matter how nice the insurance adjuster seems to be, they are not your advocate.
Remember, insurance companies make money by collecting and investing insurance premiums, not by paying out settlements! Therefore, it is generally in their best interests to reduce the amounts paid to injured people like you.
Of course, you can talk to your own insurance adjuster from your own insurance company. They are generally there to help you, and they owe you a fiduciary duty and a measure of loyalty because you are their customer. Your premiums pay their salaries. You can usually talk to your own company without much concern.
However, be careful what you say to any insurance company. For example, if you tell your insurance company that you are "fine" and later find out the other party did not have insurance, you might need to approach your own company pursuant to potential Uninsured Motorist (UM) coverage. However, if you told your company you were not hurt, your UM claims won't go very far. The best thing to do is to contact an experienced lawyer who can really explain to you what to expect. It certainly can't hurt since most personal injury lawyers offer a free consultation.
In my opinion, the most important aspect of any auto insurance policy is Uninsured Motorist Coverage (better to exceed $15K - get as much as you can). The number of people driving without insurance is staggering. I've seen too many cases involving clients that have been seriously hurt, but the responsible party has NO insurance, and my clients have nowhere else to turn! Uninsured motorist coverage usually covers "underinsured" motorist claims as well - situations when the other party did not have enough insurance to cover your losses.
Check your automobile coverage to see if you have Uninsured Motorist Coverage. Sometimes, it shows up as "UM Coverage" on your declarations page (the page your insurance company sends you which outlines the car insurance you have). It is important to get as much as you can afford. Check with your insurance professional and discuss your options. Sometimes, insurance companies fail to tell you about available UM coverage.
Also, if you make a claim pursuant to your UM coverage, your insurance company should treat you fairly and in very good faith since you are their direct client. That doesn't mean they have to buy every claim you present, and they may be skeptical at times. Remember, you are making a claim that needs to be proven as if you were bringing a claim against another insurance carrier.
You can’t just settle your personal injury case without making sure all the doctors and other service providers have been paid. Any doctor or medical service provider is not usually providing their service out of the goodness of their heart. They expect to get paid. In some cases, the health care professional is working on a lien, expecting to get paid out of any settlement you might receive. In other cases, the health care professional may have been paid by your health insurance company but they have a balance that must be paid because they were not a “preferred” provider. This is known as “balance billing.”
Other times, the doctor has already been paid by your health insurance, but what most folks don’t realize is their health insurance provider expects to be reimbursed from any settlement proceeds. They could technically come after you for reimbursement in many cases. That is an unpleasant surprise if you’ve already spent the proceeds or settled for less than you should have. Also, if your own insurance company paid any of your medical bills, they might also be expecting reimbursement. If you have Medi-Cal or MediCare, you can bet they want their money back from your settlement! You should always make sure all involved parties have been addressed.
by Robert Mansour
Robert Mansour is a personal injury lawyer serving Santa Clarita, Valencia, Saugus, Canyon Country, Newhall, Stevenson Ranch, Castaic and surrounding communities.