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It's an eye-opening experience to walk around an unfamiliar house with a trained building inspector. It's eye-opening because a seemingly perfect house to the untrained eye might really be a mess below the surface if you know what to look for. Wood shavings, cloudy windows, or a stain on the basement wall may seem harmless, but to a building inspector, these are signs of poor insulation or a history of flood damage. In fact, a building inspector's job is to spot red flags (areas of concern that cause one to consider further inquiry) like this when going through a house.
Although their motivations are different, insurance adjusters, much like building inspectors, look for red flags when evaluating car accident injury claims. When insurance adjusters evaluate a personal injury claim, they look for red flags that can call into question what otherwise might be a legitimate claim. The more red flags they find, the less money they will offer to settle a claim. Consequently, evaluating your auto accident injury claim like an insurance adjuster is financially valuable if you can eliminate or minimize red flags. In this article, I will identify and explain the red flags that insurance adjusters look for when evaluating a claim.
So, for purposes of illustration, assume the following facts:
John Victim is stopped at a red light. Suddenly, his vehicle is struck from behind by Betty Dangerous. Mr. Victim, not thinking that he is too hurt, refuses an ambulance ride to the hospital, finishes his police report, and drives his moderately damaged vehicle home. Two hours later, Mr. Victim goes to the local urgent care facility to complain about back and neck pain.
Two days later, Mr. Victim goes to his regular chiropractor's office. While there, he exaggerates the severity of the car accident and claims that he knew that he was hurt immediately after the accident. Mr. Victim describes the pain in his neck and back, but also states that he now has pain in his right knee and left shoulder. Furthermore, he claims that he thinks he lost consciousness at the scene of the accident for a brief period of time.
After listening to Mr. Victim's complaints, the chiropractor is concerned enough to send Mr. Victim to an orthopedic surgeon. After an MRI of Mr. Victim's right knee, Mr. Victim undergoes surgery on his knee to repair a partial tear to his ACL.
A few months later, Mr. Victim, through his very capable legal counsel, submits a claim to Betty Dangerous' insurance company, Scoundrel Mutual. The claim gets assigned to an adjuster named Jimmy Diligent. Mr. Diligent, who is well trained in spotting red flags, goes through Mr. Victim's file to identify facts that will lower the settlement value of the claim.
A) BEFORE THE CRASH OCCURRED:
In evaluating personal injury claims, good adjusters will want to get their hands on every prior medical record. In Mr. Victim's case, a red flag will be noted if he ever complained to a doctor in the past of neck, back, knee, or shoulder pain.
Also, Mr. Diligent will automatically red flag the fact that Mr. Victim, prior to the crash, had a "regular" chiropractor. Mr. Diligent will assume that Mr. Victim regularly went to a chiropractor before the crash because he had preexisting back and neck pain. Accordingly, Mr. Diligent can claim that the crash did not injure Mr. Victim's back and neck pain because he was already suffering from back and neck pain before the crash.
B) AT THE SCENE OF THE CRASH:
Mr. Diligent will note the following red flags from the scene of the crash:
1) Lower Impact Car Damage:
The fact that Mr. Victim's car was only moderately damaged in the crash will bolster an argument that Mr. Victim's injuries were not caused by the crash because his car was not too badly damaged. Mr. Diligent will assert that there is no way that Mr. Victim became so injured in such a minor car crash.
2) Not Claiming Injuries at the Scene:
Mr. Diligent will red flag the fact that at the scene of the accident, Mr. Victim told the police that he was not hurt, refused an ambulance, and did not immediately go to the hospital.
C) REPORTING OF INJURIES:
Mr. Diligent isn't finished yet. Next, he will review Mr. Victim's medical records and compare the injuries that Mr. Victim complained of to the urgent care facility and the details he gave of the car accident with what he told his doctors later. People notoriously tell "fish stories" where events become more grandiose and extravagant than what they actually were.
Mr. Diligent will notice that Mr. Victim did not complain of any injuries at the scene of the accident and only complained of back and neck pain several hours after the crash. Even worse, Mr. Victim did not complain of his shoulder pain, knee pain, and loss of consciousness until several days after the accident to his chiropractor.
More specifically, the fact that Mr. Victim exaggerated the severity of the moderate car crash to his chiropractor is a huge red flag. The ultimate red flag for an insurance adjuster is to find a way to call into question the truthfulness of the claimant. After all, the best way to defeat a personal injury claim is to prove that the claimant is a liar.
At Anderson Hemmat, we know that there is no such thing as a perfect personal injury claim. When examined under an insurance adjuster's trained eye, every claim will have a number of red flags. Nevertheless, it is important for injured victims to hire an experienced attorney who knows what insurance adjusters look for and can help eliminate or minimize those red flags.
By reporting their injuries accurately and not telling fish stories, crash victims can avoid red flags and increase the settlement value of their personal injury claims. If you have been injured in a car crash and are concerned about potential red flags in your case, please call to speak with one of our attorneys today.
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