I have a confession to make. More than any other single topic I have covered in any of these blogs I have the least amount of "first-hand" experience with this topic. This is simply because I have never worked for or represented any insurance companies. However, this being said, I have spent more than 18 years battling the efforts and perceptions of these corporate giants. As an experienced tactician, I realize that knowing your opponent and what they are thinking is critical to success. It is from this perspective that I would like to share with you how these insurance companies operate and what they think about you as a claimant.
How They Operate
First it is important to understand that insurance companies are large corporate profit centers complete with regional offices, corporate policies, and competing branch managers. The average claims office is an entire floor, or many floors, of an often dreary office building with very little character or personality, which frankly matches the employees who work there. In these floors you will usually find small metal and plastic furniture offices around the periphery of hundreds of cubicles. This dreary work environment makes it easy to forget that injured people are more than just number.
Large Corporations love to systematize their stock and trade because of their basic belief that in so doing it will increase efficiency and ultimately their bottom lines. Insurance companies are no different. They themselves will usually admit that resolving property damage claims lends itself to systematization far more easily than personal injuries. People and their injuries are unique. Even if the employees of the insurance company know this fact in their personal lives, they seem to think nothing of driving to work each day and treating unique injuries as some sort of equal and tangible commodity.
When you make a claim to the at fault driver's insurance company, almost immediately, the company will assign your claim to a department. In turn, the department head, called a claim supervisor, assigns a specific overseer [known as a claim representative or adjuster] to your claim.
Though the adjuster's job description is not overtly described in any manual, saying they are to make sure you receive as little as possible, rest assured that this is their main concern. If you have ever seen Disney's animated movie, The Incredibles, you'll know exactly what I'm talking about.
As part of an adjuster's overall efficiency they are rewarded based on how well they resolve matters consistent with the policies, and criteria created by the company. To better systematize, insurance companies use something called "valuation software." These are computer programs which make it possible for adjusters to drain every possible drop of life out of a claim and turn it all into pure numbers. One of the most popular programs is called "Colossus" (a self prophetic indication of the enormity of these insurance companies).
The way these programs work is that adjusters take the factual and injury scenarios and input the information into the computer and the settlement range pops out. The criticisms of this approach are plentiful. However, for purposes of this blog, I will side-step the issue and spare you the pages of commentary I could write on the flaws of such a system.
It is with all of the above in mind that I want to provide you with two steps to utilize when you proceed with your claim and the insurance company handling your claim.
To begin with, there are certain red-flags that the insurance adjuster will note and these are often the basis of low or at least lower settlement offers. You too should be able to spot these red flags to help you understand where the insurance adjuster is coming from. Those red-flags include, but are not limited to the following:
Red-Flag #1: Small or no damage to the car.
I have seen insurance companies completely disregard major injuries (even surgeries) that have no other earthly cause but the car accident, because the adjuster gets stuck on the fact that the vehicle damage was under a $1,000. The fact is emergency room doctors never go out to look at your car to decide how to treat you. Furthermore, to my knowledge, no auto mechanic has ever been consulted in lieu of an x-ray. So, I am constantly amazed that an adjuster will believe that a metal bumper can be contacted and significantly distorted, but the occupant could not in turn have muscle, ligament or cervical disc injury caused by the same collision.
Red-Flag # 2: No immediate emergency room care.
The vast majority of clients I have represented drove away from the accident scene and did not go by ambulance to the hospital on the day of the crash. Studies show that often very injured people do not express that injury at the scene. Despite the well recognized literature on the subject, insurance companies regularly discount cases for this omission.
Red-Flag #3: Delays in seeking treatment for more than a couple days.
Insurance adjusters hold a bias and firmly held belief that people who are really injured get to the doctor quickly. In this day and age, without automatic medical coverage and the economy being what it is, often people try to grit out their injuries and avoid incurring a bill. Even though insurance companies are aware of this, they continue to maintain this as a red-flag issue. I once had a nurse client who waited 18 days before he sought care with his general practitioner. Despite the delay he ultimately required a 4 level lumbar fusion surgery.
Red-Flag #4: Pre-existing injuries.
This one is huge. If an adjuster learns that a person with a neck injury has suffered and treated for a similar malady in the past, often that adjuster will feel there is nothing else they need to know. This analysis is so very flawed.
A person who had an injury in their past, received care and ultimately a complete release from her primary doctor generally has really great documentation that she recovered from her prior condition. If some years later the patient has another accident that results in the need for additional care, in my mind that should not serve as a discounted claim. In fact, that claim should be worth every bit as much as any other injury claim. However, adjusters refuse to see it this way on their own.
Red-Flag #5: Prior claims.
People who have formerly brought claims, even very minor ones are often treated worse by the insurance companies than first-timers.
Red-Flag #6: Medical treatment with one or more of the "Usual Suspects."
There are doctors in the State of Colorado that the insurance companies know as being "players." Whether it is true or not, certain doctors get the reputation for being overly enthusiastic for their patients. As a consequence, patients who see these doctors are viewed by adjusters as likely not being as injured as these doctors are suggesting.
Red-Flag #7: Medical care being orchestrated by attorneys.
This is probably a sound red-flag in that attorneys who orchestrate the doctors that their clients see really do a disservice to their clients. It is so easy for the patient, his doctor and the lawyer to all be completely discredited by this completely avoidable mistake.
In a perfect world, if you know you are injured in an accident, doctors and emergency staff should be consulted at the scene and immediately thereafter. Go to doctors you would regularly see. If you are still in pain from the accident, do not allow large gaps in treatment. Do not be pushed into seeking medical care or any other care because that is what your attorney wants. In that circumstance, stick to medical providers you have seen before and replace the pushy lawyer. Always be honest with your doctors about the severity of damage to the vehicles involved (don't call a fender-bender a high velocity head-on collision, for example). In fact, at all times be honest about everything. Honesty is the best policy and if you are perceived as honest and trustworthy, by and large you will be treated as such.
At Anderson Hemmat, we can, in one complete and free consultation, evaluate your claim and identify any red-flags that an insurance adjuster may be getting hung up on. We can also tell you how we will address those red-flags and make sure that they are not insurmountable obstacles to you receiving fair compensation for your injuries.
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