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Law Office of Robert Mansour
Santa Clarita Personal Injury Blog

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Speaking to adjusters through medical records

2/16/2018

 
Today I had the pleasure of meeting with a wonderful new client. A vehicle had crossed the center median and smashed into her car. She wanted to learn more about the personal injury process and what her options were.

I was explaining the personal injury process to her and stressing the importance of excellent documentation in her medical records. We spent a good part of our conversation talking about documenting the actual injuries from the accident.

FIRST YOU MUST MAKE AN EXHAUSTIVE AND DETAILED LIST OF YOUR INJURIES.

I asked her to start from the top of her head and move her way down her body. She mentioned the fact that she was having severe headaches, she had a nosebleed at the accident scene (along with nasal pain), pain in the right shoulder radiating into the right arm, pain in her upper back, pain in the right side of her mid back, and a bruise to her right knee.  She had been to a doctor since the accident.  I asked her if she had told any of these things to her doctor. She said she only told the doctor about the neck pain!  I explained she would not be getting any points for anything that she failed to mention. You see, insurance adjusters are going to read your medical records with a magnifying glass, and they will only consider what’s in there. If you forget to mention something, that injury does not exist as far as the insurance company is concerned.

I encouraged her to make a list of all her injuries (no matter how minor) on a sheet of paper and the next time she went to the doctor, she was to make sure that those injuries were mentioned in her records. She wasn't lying or fabricating injuries. Clients need to recount ALL their injuries, not just the "main" ones.  Wouldn't you want the insurance adjuster to know about ALL the injuries you had and not just some of them?  Remember, the insurance adjuster's job is to minimize your case.  If you fail to mention all injuries, then you are basically doing their job for them!

SECOND YOU MUST KEEP A LIST OF HOW THE ACCIDENT IS AFFECTING YOUR LIFE

Another exercise we did during our meeting was make a list of all the "effects" of the injury on her life.
To some extent, the value of your injury claim will be based on the following formula:

Severity of Injuries + Effects of Injuries = Value of Claim

She told me she had trouble bathing, trouble putting on her clothes, trouble concentrating at school, She literally was avoiding driving anywhere near the scene of the accident because it brought back so many bad memories.  Of course, she had not mentioned any of these things to her doctor. Again, I stressed the importance of mentioning those things and making sure they are part of her medical record. Every time you get medical care after an accident, at every appointment, imagine the insurance adjuster standing in the room with you.  I always tell clients to ask themselves the following, “What would I want the insurance adjuster to know about my accident?“ Whatever your answer is, you need to make sure that you articulate those things to your treating providers, physical therapists, etc. 

Don't keep your injuries a secret!  Don't keep the effects of the injuries a secret.  This is not the time to be stoic.  This is not the time to "tough it out."  This is the time for documentation!  Always ask yourself, "What would I want the insurance adjuster to know?"  Then TELL YOUR DOCTOR about it so it actually ends up documented in your records.

Be careful when speaking with insurance adjusters

7/3/2016

 
VIDEO TRANSCRIPT:

Hello, everyone. This is Robert Mansour, and I want to make a brief video about an issue that comes up all the time - "Should I give a recorded statement to the other party's insurance company?" The answer is generally "no."  You have no legal obligation to speak to the adjuster from the other party.

As a matter of fact, it is very curious - they generally call you the day of the accident or even the next day to get a recorded statement from you, and here's why: Generally speaking, they are trying to box you into a story.  How do I know that?  I used to work for an insurance company as a lawyer for them. They generally want to call you right away because they want to box you into that story.  They might say, "Were you hurt in the accident?" You'll say, "Well, I'm kind of sore, but not too bad."  Then a few days later, you are really sore. You can hardly move.  Your muscles have really tightened up, or you've discovered an injury that you didn't even realize you had on day one.

See, the problem now is you've given the other party a recorded statement, and they have you saying, "I wasn't hurt. I'm fine. Not a big deal." That's why you don't want to give a statement so early on in the process. There's very little, if anything, to be gained by it.  In fact, it's usually used against you in the future.

Also, giving a statement to your company, your own company, you want to be careful with that too. You have generally a legal obligation, a contractual obligation, to cooperate with your own insurance company, because otherwise they might pull the coverage from you and say, "Well, you didn't cooperate with us, and therefore we're not going to extend coverage to you."  However, there's nothing wrong with telling the adjuster, "Listen, I'm not feeling very well right now. Can I get your name and number and I'll contact you in about a week's time to talk to you at that time?" Nothing unreasonable about that.

Even better, go talk to an experienced personal injury lawyer and say, "Here's what's going on. What do you think I should do? Should I give a statement? Should I not give a statement?"

Then, you also might have the issue of liability. By talking about what happened at the accident so early on, first you might want to see what that police report has to say about everything first.  Remember, you don't have a legal obligation to speak to the adjuster from the other party.  You may have an obligation to speak to your own adjuster, but either way, be very careful what you say and when you decide to give that statement. You may choose not to give a statement at all. There's nothing wrong with that. Again, you may have to cooperate with your own insurance company, but at the very least, talk to an experienced lawyer first to see what your options are. Thank you very much for watching this brief video.

If you've been injured in a serious car accident, call (661) 414-7100 to see if we might be able to help you.  

What insurance companies say and what they actually mean!

9/14/2014

 
Over the past 21 years, I've worked for both sides - the insurance companies and now for the victims of serious car accidents.  Here is a "somewhat" tongue-in-cheek translation of statements made by insurance companies and what the statements ACTUALLY mean in the real world.  Hope this helps:

WHAT THEY SAY: 

"Just send us all your medical records and bills and we will evaluate your claim."

WHAT THEY ACTUALLY MEAN:

"Just send us all your medical records and bills.  We will then slash your bills by 50% if you're lucky!"

WHAT THEY SAY:

"Just go ahead and rent a car.  Then send us your rental bill and we will take care of everything."

WHAT THEY ACTUALLY MEAN:

"Go ahead a rent a car.  When you submit your bill, we might entertain paying a fraction of it. You either paid too much or rented for too long.  Perhaps both!"

WHAT THEY SAY:

"Go to whatever doctors you want.  Have them submit their bills to us.  We will take care of it."

WHAT THEY ACTUALLY MEAN:

"Go to whatever doctors you want.  Good luck getting us to pay those bills.  We will either argue you treated too much, were charged too much, or both."

WHAT THEY SAY:

"We would like to take your recorded statement to learn more about the accident, your version of the events, and your injuries."

WHAT THEY ACTUALLY MEAN:

"We would like to record you in an effort to box you into a story and use your words against you at a later date.  Just FYI, a recorded statement has rarely benefited the person giving the statement."

WHAT THEY SAY:

"We would like to meet with you to discuss the accident and learn more about your injuries and damages."

WHAT THEY ACTUALLY MEAN:

"We would like to meet with you to feign interest in your matter.  After we do so, we will dangle a check in front of you for $500 along with a general release so you can never bother us again."

WHAT THEY SAY:

"We need to investigate this matter before we can assist you with your claim."

WHAT THEY ACTUALLY MEAN:

"Although liability is clear, we want to "investigate" for weeks while we delay your claim and try to avoid responsibility.  Then we will argue we are not responsible for any damages you incurred while we were investigating/stalling."

WHAT THEY SAY:

"We are very sorry to hear about your accident. Our client was definitely at fault.  We will guide you every step of the way."

WHAT THEY ACTUALLY MEAN:

"We are employees of the opposing insurance company.  We don't work for you, so be prepared to be disappointed."

WHAT THEY SAY:

"We are going to use an independent third party company to evaluate the value of your vehicle."

WHAT THEY ACTUALLY MEAN:

"We are going to offer you about 85% of the value of your vehicle because an independent company (who we hire over and over again....REALLY they are independent) said your car is worth less than every other resource you found."

Again, this was a tongue-in-cheek look at what insurance companies say and what they actually mean.  While there are always adjusters who are exceptional at what they do, there are unfortunately others who continue to make the list above less fictional.

Beware of the friendly insurance adjuster!

6/29/2014

 
VIDEO TRANSCRIPT:

Dave:              Now, another thing, we were talking about this during the break, that the insurance adjustors are trying to befriend you. They're trying to be open, "Let's meet for coffee."

Robert:            Oh yeah, that's a new strategy. What they do is they call you within 24 hours and they're very friendly. "We'll take care of this. We're going to pay for everything. Don't you worry." They send you flowers! I'm being silly. 

     But here's the new thing. Some insurance companies are having adjustors put lids on cases very fast, so what they'll do is, they'll say, "Let me meet you at Starbucks because I want to learn more about the accident. I want to learn more about your injuries." They don't want to learn anything. They want to dangle a check in front of you at Starbucks. "Here's $500. Why don't we call this a day? Would you sign here?" And the next thing you know you're signing away all your rights because you were presented with a $500 check, and at the time it seemed reasonable. But the next day it doesn't seem so reasonable when you're still hurt, or you find out that you have a disc injury and you weren't aware that it was a disc injury. So yeah, "Let's meet for coffee," the "friendly" insurance adjustor approach.

If you need assistance or guidance with your personal injury case, give my office at call at (661) 414-7100.  We will let you know if there is anything we can do to help or otherwise bring value to your case.  We serve Santa Clarita and its communities of Valencia, Newhall, Castaic, Canyon Country, Stevenson Ranch and beyond.

Another stall tactic used by more and more insurance companies

10/26/2013

 
There is a new tactic be employed by some insurance companies that I thought I would share with you. Basically, even when liability is perfectly clear, they will stall the process by insisting that they need to "speak with their insured." 

That simply means that they are trying to delay the settlement process. They will say things like they can't accept liability unless they speak with their client, even when liability is clearly against their client.  They do this even when the police report is clearly against their client. 

They simply state, "Well it's our policy to speak to our insured first before deciding whether or not to accept fault for this accident." In the meantime, there's damage clearly to the front of their clients car, damage clearly to the back of my clients car, and a police report that puts the blame squarely on their client. In truth, there really is no "need" to speak to their insured. What they're trying to do is delay the settlement of the case and defer the acceptance of liability. In the meantime, my clients are incurring bills, may be unable to rent a car, or other problem simply because the responsible party's insurance company won't accept liability until they "speak with their client." 

I can understand the need to speak with their client when liability is disputed or there are serious questions about the case. However, interviewing their own client when liability is obviously clear is nothing more than a stall tactic.  It is very sad to see how low some insurance companies will stoop an effort to avoid paying out what is owed.

Please call my office if you want to discuss your personal injury case.  The phone number is (661) 414-7100.  

Insurance adjusters are offering to meet victims of accidents

6/28/2013

 
Many insurance companies are encouraging their insurance claims adjusters to meet with victims of accidents shortly after the accident occurs. Basically, you get a call from the from the insurance adjuster who seems to have your best interests in mind. He will explain that he wants to "learn more" about your accident. He will say that he's concerned about your medical bills.  You'll be reassured, "Don't worry...we'll take care of everything."  The next thing you know, he's offering to meet for coffee at the local Starbucks. 

Be very careful because in most cases, the insurance adjuster does not have your best interest in mind. Surprise!  What they're really trying to do is put a quick settlement before you in an effort to close their case.   I used to work for the insurance companies, and the mantra we heard over and over again was, "A 'closed file' is a 'happy' file!"

They will often offer you $250 or $500 in an effort to put a quick end to the matter. They will dangle the check in front of you and hope you take it. There is no pressing reason to meet with the adjuster so early in the case.  You are certainly not obliged to do so.  You might not even sure what the extent of your injuries are.  Actually, that is why they offer to meet you so quickly. If they wait much longer, you might become more fully aware of your injuries and less likely to accept their paltry offer. 

While there are some very conscientious insurance adjusters out there, there are many who have no interest in justice or doing what's right.  They just want to close their file quickly.  Remember, a closed file is a happy file!

If you've been involved in a serious car accident, seek legal assistance before talking with the insurance company.  Call our office at (661) 414-7100 for a free consultation.  Read some of the other information on this website and make sure to check out the video page. 

Adjusters who make life easier.

5/10/2013

 
In a recent post on my "Library" page, I ranted about insurance adjusters who view cases myopically.  They refuse to see things from any other paradigm except their own. 

Well, today I wrapped up a case with State Farm, and I must say, the adjuster (Chris) was a joy to deal with.  He was always responsive and occasionally viewed the case from different points of view but stuck to his guns on other issues.  However, when he stuck to his guns, he always explained his reasoning in a polite and reasoned manner. 

I could tell Chris had reviewed the case carefully, looked at all the medical records, learned more about my client, and sought explanations when needed.  I had to respect his decision because I could tell he was actually evaluating the case after digesting all the information - not based on a short-sighted or knee-jerk analysis - or blind allegiance to an insurance company.  He worked very hard to try and resolve this case.  I appreciated his dedication and hard work. 

As you may know, I'm a former attorney for State Farm Insurance.  I was a defense lawyer, defending the company and their insureds against personal injury cases.  Chris and others like him restore my faith in insurance adjusters who understand their job is to evaluate cases fairly, without predisposition. 

    Attorney Robert Mansour

    Robert Mansour is an attorney in Santa Clarita, California who has been practicing law since 1993.  After working for 13 years for the insurance companies, he now counsels victims of personal injury. Click here to learn more about Robert Mansour.

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* This site does not create an attorney/client relationship and is not legal advice. Always consult with an attorney. Robert is an injury attorney serving Santa Clarita, Valencia, Saugus, Canyon Country, Newhall, Stevenson Ranch, Castaic, Frazier Park, Acton, Val Verde, Palmdale, Lancaster, the Antelope Valley, and surrounding areas.

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