When you file a claim for personal injury against the responsible party's insurance carrier, you will usually be assigned an "adjuster" to help you with your claim. If your claim is for property damage, you will be assigned a "property damage" adjuster. If your claim is for injury, you will be assigned a "bodily injury" adjuster. In some cases, the assigned adjuster will handle both the property damage claim and the bodily injury claim.
Keep in mind that while the adjuster is "helping" you with your claim, their unspoken job is to save money for the insurance company. After all, you are not employing the adjuster. They are employed by the insurance company and that's really where their allegiance is. While many adjusters will certainly do their best to help you, it will be within their company's guidelines and parameters. If push comes to shove, don't bet on the adjuster siding with you. Once again, their allegiance and loyalty belongs to their employer...not you.
If you are dealing directly with any insurance company, most of the time the claims adjuster will try to get you to settle for a very small amount. Usually, it's far less than what you deserve. Oftentimes, these "lowball" offers are made shortly after your accident because they know you are probably upset, distraught, and generally confused. Sometimes you're simply not in a position to make a reasonable decision. They figure you will take whatever they offer you because you might be afraid you won't get anything at all. Also, insurance companies know claims can take a long time, sometimes years to bring a lawsuit against their client and win a judgment in court. They are betting you are more apt to take the money presented to at the beginning rather than wait years for something better. Whatever happens, do not make a decision on impulse. In most cases, there is no "emergency" and no reason to rush to settlement. Make sure you discuss your matter with an experience lawyer first.
Some adjusters will employ specific tactics to their advantage. Some will even try to convince you to call another insurance company - sending you on a wilde goose chase. Sometimes they won't return your calls or your emails. In some cases, they will argue that you "waited too long" to file a claim. If you are bringing a claim against your own company, there might indeed be time limits, but generally speaking, you don't have to bring a claim immediately. Keep in mind there is a difference between making a claim and filing a lawsuit. You must be mindful of the "statute of limitations." Technically you currently have two years in California to file a lawsuit for personal injury against the responsible party from the date the accident occurs, unless your claim involves a municipality or other public entity in which case other time limts may apply. Of course, this is the current law and may change.
The insurance adjuster may also tell you they can only pay for your "out-of-pocket" expenses. That is not true. Your out-of-pocket expenses are only part of your overall claim. If your bills were paid by a health insurance company, they may be entitled to reimbursement, but that is another issue. The insurance adjuster will also try to get copies of all your past medical records. To some extent, they are seeking to learn more about your injury. However, in most cases, they are simplly looking through your medical history for things to use against you. For example, if you injured your back in the car accident, they will find any mention of previous back pain from years ago and may make an issue of it. They will make mountains out of mole hills.
Talking with an experienced attorney will help you make an informed decision. Being represented by an attorney is not always recommended. However, it's always good to learn about your options.
I cannot emphasize this enough - the insurance adjuster's job is to "adjust" your personal injury claim. Their job description is in their title - "adjuster". After over 20 years of practicing law, working both sides of the fence (plaintiff and defense), I can safely say that insurance adjusters almost always adjust your claim DOWN. I don't remember the last time an adjuster told me the value of the case should be more than I'm asking. They've never said, "You know what, Rob....I know your client wants $10,000 to settle this case, but I'm going to offer you $25,000 instead." Never happens.
So here are some common arguments that will be used against you in an effort to minimize your claim or deny it altogether.
These are just some of the arguments insurance adjusters will use against you. Remember, they do so because that's their job. That is their reason to go to work every day. They are not on your side. They are not there to help you. There allegiance is to their employer - the insurance company. There is nothing wrong with that. After all, there are many exaggerated and false claims out there. I just want you to be aware of these realities. Don't take them personally. These arguments are not just being used against you - they are being used against virtually every person who brings a claim.
Please call (661) 414-7100 to see if we can help you with your personal injury case.
Here is the complete segment from SCV Today featuring Dave Caldwell and Tami Edwards. Santa Clarita lawyer Robert Mansour discusses some insurance company strategies and tactics commonly used against people claiming injury. It's not that the insurance companies are "evil" but their interests usually don't align with yours.
Some of the issues discussed during this segment include:
1) Why insurance companies don't really want you to get a police report.
2) When should you file a police report?
3) Why filing a report days later doesn't really help you.
4) How insurance companies use the absence of a police report against you.
5) Why insurance companies don't want you to involve emergency personnel like an ambulance.
6) Insurance companies want you to delay or forego medical care.
7) Be wary of insurance adjusters who are too friendly with you.
8) Some insurance adjusters will give you wrong information.
9) When should you call an attorney after an accident?
10) Are insurance companies evil?
Robert use to work for the insurance companies as a defense attorney, and now he represents victims of serious car accidents. If you need guidance on your personal injury claim, feel free to call (661) 414-7100.
In this brief video, Attorney Robert Mansour explains how some insurance adjusters give accident victims patently false information. Now, whether or not this false information is given purposefully or by innocent error is not terribly relevant. What is important to learn is you should run the advice by a seasoned professional who can tell you whether the information you received is misleading, not entirely true, or an outright lie. Again, having worked for an insurance company I can confidently say that most adjusters are just trying to do an honest job. They aren't out to trick anyone. However, that doesn't prevent some people from giving false or incomplete information to victims of car accidents. Just be careful and make sure you consult with a lawyer to figure out whether the information you've been given is accurate or perhaps not quite so.
Here is the brief transcript for the above video:
Dave: And then you have here, on one of the things, they will patently give you false information.
Robert: Yes. And unfortunately, there are always bad eggs in every industry. So one of the false things that they'll tell you is, they'll say, "Well if you had a back injury before, you can't make a claim for a back injury from this case." Or, "It seems that you had shoulder surgery in the past. If your shoulder is hurting you, you're not allowed to make another claim for that." Or they will tell you something like, "Don't hire a lawyer because you're not going to recover enough money if you hire a lawyer." And the biggest one is, "We'll pay for your medical bills."
They will always tell my clients, "Oh, we'll pay for everything. Don't worry. You just send us the bills." And I always tell my clients, "They're not going to pay your bills. They're not." Because insurance adjustors "adjust." That's their job. They have to "adjust." So what do they do? They take your bills and they offer a fraction of them. They tell you they're going to pay the bills, but they don't. They just pay a fraction of those bills because they adjust them and they say, "Oh, this was too expensive. This was unnecessary." And now you're stuck with all these bills that you can't pay.
VIDEO TRANSCRIPT: Hi, this is Robert Mansour. I'm a lawyer in the Los Angeles area. One of my areas of practice is personal injury. I wanted to spend a few minutes with you on this brief video to talk to you about things you need to keep in mind when treating with doctors and physical therapists after your personal injury case.
What you want to make sure you understand is that the insurance companies are going to be evaluating your case partly on what's called the diagnostic codes, which means that what the doctor writes down as your diagnosis is going to be considered by the insurance adjuster.
That's why when you go to the doctor you have to tell the doctor everything that's bothering you and with great specificity. So you can't just go in there and say, “Oh, my neck hurts.” Well, what is it exactly? “Oh, I have radiating pain into my shoulder and between my shoulder blades or my middle back, my upper back and my lower back hurt me” rather than oh, my back hurts me. What is it exactly that you're feeling? What are your symptoms? The doctor has to write all this stuff down. It's transferred into a diagnostic code that is written in your medical records.
The reason this is important is because if something is not in your medical records it's like it never happened. So, if there's a diagnostic code that is missing or some complaints that you have that are not documented in those medical records, then it's like it never happened. The insurance company will not consider it. You see, the insurance companies are using software more than ever to analyze their cases. So a lot of major insurance companies now are using software products in order to evaluate these cases.
What they do is they'll type in your age, where you live. They'll type in all the diagnostic codes. They'll type in all the treatment codes, any treatment that you received from any place. Also, they look in the medical records to see what kind of complaints you had. This is why it's very important to indicate in your intake forms when you go to the doctor. When you talk to the doctor, every time you see the doctor, you've got to mention what you're going through, what you're feeling.
I had a client. She called me and she said, “I'm having a really hard time at work. I'm having concentration issues and also my back is killing me when I drive for more than half an hour.” I told her, “You need to tell the doctors about this. It needs to be written in your records.” The reason once again, if it's not in your records it's like it never happened.
So, once again, please keep in mind that you're got to tell the doctor everything that's going on. Those diagnostic codes are very important. The way the accident has affected your daily life you want to make sure you tell the doctors and the physical therapists about that. You know, every time you go to the doctor they ask you. They say, “How you feeling?” You go to the physical therapist, “What's going on? How are you feeling? What's been going on since the last time we saw you?”
That's where you tell them with great specificity what's going on so they can document it. Of course, if it's not documented then it's not going to end up in the software and the software will not analyze your case and the insurance adjuster will just treat it like it never occurred.
I hope you found this video helpful. My name is Robert Mansour, and thank you very much for visiting today. If you want to learn more about my practice, you can visit www.valencialawyer.com, or you can call my office at 661-414-7100. Thank you very much for watching this video.
VIDEO TRANSCRIPT: Hi, this is Robert Mansour, and I'm a lawyer in the Los Angeles area. One of my areas of practice is Personal Injury Law, and I'm broadcasting today from my office in Santa Clarita, California which is in northern Los Angeles County. I want to spend a couple of minutes with you talking about this letter that I got from Mercury Insurance. The reason I like this letter and I think it's a terrific letter and I want to share it with you is because it is very demonstrative of how insurance companies deny claims.
This is an accident case. It was not a big accident. My client knew that going in. Here's the letter. I think this letter just sums it all up really well. I'll show you exactly what I'm talking about. So here's the letter that I'm going to read to you. This is from Mercury Insurance.
It says, dear Mr. Mansour, we have evaluated the specials. Now, the term specials means the damages, the economic bills, et cetera. It says, this loss involves a minor impact to the driver side rear of your client's vehicle. They're using the fact that it was a minor impact to try to minimize the case. So the severity of the impact is very important. That's something that you should keep in mind. It says here, there was no police report filed. So here they're using the absence of the police report as an indication that this was not a major accident which, of course, is silly, but here's how insurance companies work.
If the police are not called to the scene, then obviously it was a minor accident, but if they are called to the scene they generally presume well, maybe there was an injury. So again, very interesting. No police report filed, it says. Your client did not receive emergency treatment on the date of the loss or subsequently. So the fact that my client never went to the emergency room or wasn't taken away by ambulance or anything like that, the lack of emergency treatment is being used against my client.
Now, maybe my client is stoic. Maybe my client wasn't hurt all that badly, but what they are doing is they are using the absence of emergency treatment against her. Also it says here, your client sustained soft tissue injury. That means pulls, muscle strain, sprain, that kind of thing. She was treated by a chiropractor which is interesting. That is the reason that they are using to minimize this claim, the fact that she was treated by a chiropractor.
Now, in some minds of some insurance adjusters, the chiropractic treatment is not as valued as an orthopedist treatment which is very interesting because many chiropractors provide terrific relief for their clients, here it is being used against my client. The fact that she went to a chiropractor. It says here, the treatment charges are excessive in relation to the injuries and the impact sustained.
Basically, they are using the size of the impact to dictate how much treatment she should have gotten. So if it was a low impact she should not have gotten this kind of treatment. Again, they don't take any individuality into consideration. They just look at the amount of the impact and determine, gee, does that make sense? Did they go treat for too long or not too long?
You'll notice in this letter it doesn't say anything about my client's medical condition, what the actual doctor had to say, what my client's reported injuries were, whether she is a frail person, whether she has any pre-existing problems, nothing like that. This denial, well actually it's not a denial. They offered her $2,000, but we suspected that in the very beginning.
Here's the thing. This letter is full of all the classic arguments. No police report, no emergency room treatment, minor impact, chiropractor. All of this being used against my client. I just wanted to share this letter with you as a demonstration of how some insurance companies, especially Mercury, just my opinion, use to deny and minimize these kinds of personal injury claims.
Thanks again. My name is Robert Mansour. You can learn more about me by visiting my website valencialawyer.com or calling my office at 661-414-7100. Thanks a lot for watching.
I admit this is a bit of a rant. I recently took on a case where the impact was relatively minor at first glance. It's not my favorite kind of case to handle because the damage is not very visible and in most cases, it's hard to convince an insurance adjuster of injury in low-impact cases. However, in some cases I might take such a case if the client is compelling, believable, and truly injured.
Although there are plenty of scientific studies supporting the fact that folks can get injured in lower speed accidents, some insurance adjusters still employ the knee-jerk reaction that little property damage necessarily means little to no injury. There is an adjuster I'm dealing with right now who keeps sending me letters on this particular case. From "Day One," his letters basically read as follows, "We consider this a low impact case and expect your client's injuries to be minor. Please send us your client's medical records when she's finished treating." Then another letter came last week that stated, "This is a minor accident. Both cars did not have much damage. Your client should be done with her treatment by now...."
As you can see, this adjuster has already made up his mind and by "implying" it in his letters, he basically wants me to adopt his framework for the case. While I agree that low impact car accidents present some challenges when convincing others of injury, I have been a bit surprised about how presumptive this adjuster has been. He has already concluded my client should have no injury without talking to her, without seeing her records, without knowing anything about her. He took one part of the puzzle (the low property damage), and he extrapolated a complete "analysis" that precludes the notion someone could be injured.
Truth is I'm not terribly surprised because insurance adjusters are bombarded with bogus and inflated claims. As a former defense lawyer, I understand it's hard to persuade adjusters with lower speed impact cases. However, what some insurance adjusters fail to realize is that every so often, a claim is legitimate. Some folks injure more easily than others. Some may have a pre-existing problem. Sometimes, age is a factor.
What troubles me the most is how myopic and conclusory some adjusters can be. Sometimes I just want to ask them, "Well, if low property damage ALWAYS means little or no injury, then why are you involved at all? Why don't you just resign and stay home? Why don't they just use robots to do your job?" Of course, there are also true insurance professionals out there who take into account all the facts before they jump to conclusions. That's the kind of adjuster I usually hope to get on my cases, but I don't always get so lucky.
I truly feel I can make these assertions after working for a major insurance company as a defense lawyer for over 10 years. I've seen both kinds of adjusters, and whether I'm working for plaintiff or defense, I appreciate adjusters who soak in ALL the information before making a decision. Thank you for allowing me to rant today. However, these are not only MY realities but also my client's realities. My job is to educate them that there are adjusters who won't see matters any other way. They will always analyze a case from within their paradigm.
If you need help with a personal injury case, please call (661) 414-7100 for a consultation. If an adjuster is giving you a hard time and refuses to see things any other way, take comfort in knowing you are not alone.
by Robert Mansour
Robert Mansour is a personal injury lawyer serving Santa Clarita, Valencia,