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Law Office of Robert Mansour

Library Articles

Reasons used by insurance companies to minimize or deny your claim for injury

10/26/2014

 
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.  

  1. The impact was too minor to cause injury - If the impact is minor, the insurance company will argue that injury was unlikely or impossible.  Remember, the fact you were injured is not relevant - the insurance company is banking on the fact that most juries won't award anything unless the impact was major.  Whether you were hurt isn't important.  
  2. Your injuries were only "soft tissue" - that means you had no broken bones, surgery, or anything else that was serious.  If all you had was sprains and strains, they will argue your case is simply a "MIST" case (Minor Impact, Soft Tissue).  
  3. There isn't much visible damage to your car - Again, insurance companies know that most juries won't award you anything unless there is visible damage.  It needs to be notable damage.  If a jury has to "work" to see the damage, the insurance companies know they will statistically prevail.  If you have to explain the damage, you should think twice about the viability of your personal injury claim.
  4. There was no frame damage to your vehicle - purely cosmetic damage - Even when there is notable damage, some insurance adjusters will analyze the property damage estimate. If there is no frame damage, some adjusters will still insist the impact wasn't that big of a deal.
  5. You were not taken by ambulance from the scene of the accident - People who decline an ambulance or who simply don't need an ambulance are obviously not hurt in the insurance adjuster's world.  There may have been a perfectly good reason you declined an ambulance  Nevertheless, some adjusters will use it against you.
  6. The police were not called to the scene - a sign that no one was injured - Officers will typically come to the scene and take a report ONLY if there is injury reported.  If there is no injury reported, the parties are usually simply encouraged to exchange information.  Some insurance adjusters will use the lack of a police report as evidence that no one was injured.
  7. You were not taken to the emergency room after the accident - This is the same argument used in conjunction with the ambulance argument above.
  8. You waited more than a few days to seek medical care - If you wait more than a few days to seek medical treatment/attention for your injuries, the adjuster will assume your aren't hurt that badly.  If you were "really" hurt, you would have sought medical treatment more quickly.  
  9. You did not seek any medical care - Some clients call me weeks/months after an accident.  They were injured but never sought any care or treatment for whatever reason.  In the absence of treatment, medical care, or any other documentation, an adjuster will probably decline such a delayed claim without any affirmative or proactive care.  If you don't act like an injured person (i.e., seek care), then they won't even entertain the idea you were injured.
  10. You have a pre-existing injury - if your injury/condition pre-dates the accident, they will argue your injury is not from the accident but existed before the accident.  You can argue the accident aggravated the pre-existing problem, but they will use it against you as much as possible.  They will dig through your medical records to try to find any evidence of similar pre-accident complaints.  That's one of the reasons they want you to sign releases for your medical records - so they can go fishing for reasons to deny your claim.  Trust me, they are not interested in "learning more" about your injuries.
  11. You saw a lawyer first before you sought medical care.  While I do encourage clients to talk with a lawyer, they shouldn't delay medical care if they need it just so they can talk to a lawyer.  Some insurance adjusters will make the inference that you went for medical care at the direction of a lawyer and that you really aren't actually hurt.   
  12. You gave a recorded statement to the insurance company during which you denied being injured, didn't articulate the extent of the injury, or deliberately downplayed the injury because you thought you would feel better over time.  Again, giving a statement to the insurance company is usually not the best thing to do.  Of course, you want to cooperate if you are dealing with your own company, but even then, be careful what you say because it can haunt you later.
  13. You treated for too long - Absent any significant injury (positive finding on an MRI, CAT scan, X-ray, etc.), insurance companies come down hard on people who treat too long.  How long is too long?  Most insurance adjusters will give you a very hard time if you treat for longer than 6 to 8 weeks.  Clients who treat for longer than that are in for a big shock when they may be saddled with more bills and expenses than they can pay.  Do not assume the other party will pay your bills.  In fact, assume the opposite.
  14. You missed or canceled health care appointments - Insurance adjusters will use cancellations, missed appointments, etc. against you.  They will argue that you couldn't be in that much pain if you were willing to cancel and/or miss doctor's appointments.
  15. You continued to work - If your job is unaffected by the accident, an adjuster will argue the injury was minor insofar as it didn't affect your daily work activities.  I'm not suggesting you miss work to prove something to an adjuster.  I just want you to be aware of the argument.
  16. Your actions are otherwise inconsistent with your injury claim - If your medical records mention that you went on vacation, worked out at the gym, went for a run, took a bike ride, etc., those things will be used against you as evidence that your injuries weren't all that bad. After all, how bad can things be if you take a vacation during your treatment? Also, if you (or someone else) post photos of yourself doing something on Facebook or other social media site that is inconsistent with your injury claim, you may have just sunk your claim.  Insurance companies are looking for you online to find anything they can use against you.  I had a client who claimed injury and then went to a party the next day.  While she didn't post any photos, her friends posted photos on Facebook and tagged her having a great time, dancing, laughing etc.  Needless to say, she didn't look like an injured person!

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.

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    by Robert Mansour

    Robert Mansour is a personal injury lawyer serving Santa Clarita, Valencia,
    Saugus, Canyon Country, Newhall, Stevenson Ranch, Castaic and surrounding
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