When you submit a bill to an insurance company for payment, don't expect the insurance adjuster to simply accept whatever you send them. Whether it's a property damage claim or an injury claim, most adjusters will not accept the bills you send them. They will look for every conceivable reason to reduce the bill you sent them.
Many insurance adjusters will do everything they can to minimize payment on your claim. Some look for reasons not to pay your claim. Insurance companies do not make money by giving you money, they make money by holding onto their money. That means they will look for reasons not to pay or to pay you less than what you expect. Sometimes, you just get unlucky and get assigned an insurance adjuster who thinks everyone who makes a claim is trying to "game the system." Others are working for insurance companies that have company wide policies/culture and software programs designed to reduce claims and payouts. Here are some common arguments:
1) The property damage estimate is too high.
2) The property damage estimate includes items not involved in the accident. (Most adjusters don't actually go to the body shop - they send "estimators" who are arguably beholden to the insurance companies)
3) You treated with the doctor too long (most insurance adjusters don't have medical degrees last time I checked).
4) The charges from the doctor are too high. (This is usually based on software programs arguably designed to favor the insurance companies).
5) The frequency of your treatment was too frequent.
6) The frequency of your treatment was not frequent enough.
7) You waited too long to seek treatment.
8) You sought treatment too soon. You should have waited.
9) You did not have any diagnostic testing like an MRI or CT scan.
10) You should NOT have had diagnostic testing because it was "unnecessary." (and too expensive).
11) Some of the medical records don't specifically mention the accident, so the treatment was obviously unrelated (these are adjusters who can't see the forest from the trees).
12) Your injuries are pre-existing.
If you think about it, the insurance adjuster's job is to "adjust" your claim. That means they have to legitimize their existence by "adjusting" the claim you present to them. If they don't adjust your claim, then it is reasonable to question why they are even employed by the insurance company. Therefore, in an effort to legitimize their position, they MUST adjust the numbers you send them. This is true whether it is a property damage claim or a medical claim. So if the adjuster's job is to "adjust" the numbers, which direction do you think they will adjust? To "increase" the claim or to "decrease" the claim?
While there are rare exceptions, they will typically adjust the numbers downward. It is rare that I see an insurance adjuster simply accept the numbers as given to them. They also rarely "adjust" the number upward. For example, I've never had an adjuster say, "I know you sent me the bill for $5000, but I think the bill should be $10,000!" Can you imagine if an insurance adjuster did that? Therefore, by design, an insurance adjuster will "adjust" your figures downward. I have never seen it the other way around. Be prepared to be disappointed. It's just the way the game is played.
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by Robert Mansour
Robert Mansour is a personal injury lawyer serving Santa Clarita, Valencia,