Getting Your Due

Getting Your Due: You and Your Insurance Claim

By Daniel G. Baldyga

(From Motorcycle Tour & Cruiser, May 2000. Reproduced without permission for purposes of discussion on the VRCC message boards)

You were cruising along on your motorcycle and a four wheeler hit you. You were injured, and your bike was damaged.

A week later, along comes an insurance adjuster from the insurance company of the driver who hit you. The adjuster will undoubtedly be courteous. He (or she) is likely to be a nice guy (or gal). You should in turn be cordial. But you need to know what you are dealing with.

I’m retired, but I was a claims adjuster, supervisor, and manager for most of my working life. I know what makes the insurance business tick. So here are some tips from an insider to help you get your due when making an insurance claim.

Be careful what you say and don’t sign anything If an insurance company adjuster suggests you give him your statement over the telephone, ask to meet in person. Do not dictate a statement into a tape recorder over the phone. When you first meet with the adjuster, do not agree to allow him to record your statement and do not sign any written statement. Make it clear that you will be more than willing to provide a statement after your claim has been paid.

Be pleasant, but firm. No matter how wrong the person was who hit you and how he or she acted at the scene of the accident, do not take it out on the adjuster. Never underestimate the importance of the adjuster’s impressions and conclusions about you. If he finds you to be a reasonable, rational person, that data will go into your file. And that information is part of your case until you are paid your settlement.

Understand the adjuster’s motivation. Never forget that the insurance adjuster’s goal is to save money for the company that signs his paycheck. That’s his job. He also wants to look good to his company, which means settling your claim out of court if at all possible. Be patient and remain steady in your determination to get what’s due to you. At the end of the day, it’s more likely than not that your claim will be treated fairly.

Know that time is on your side. Most adjusters carry a caseload of 50-plus new claims each month and must “close” an equal number every month just to stay even. So, you have an advantage. The adjuster is under pressure to settle your claim and move on. It’s in his best interest to work with you to resolve the claim as efficiently as possible.

Choose your own doctor. My experience is that doctors assigned by the insurance company often report “no objective basis” for the injured party’s complaints. You are entitled to see the doctor of your choice and do not have to agree to be examined by the insurance company’s doctor. The exception is if your claim goes to court. Then, the insurance company has the legal right to require you to be examined by its own doctor. The good news is that so much time will have passed since your accident that this examination may have little value in refuting your doctor’s diagnosis or his estimate of the length of your disability.

Check your own insurance coverage. You may find that you have coverage to pay for your medical bills. If you have health insurance, check your policy. It may or may not require you to pay back the amount of medical bills paid to you by the insurance adjuster’s company for that expense. (If in doubt, err on the side of caution. Insurance fraud is a serious offense.) Whatever you find out, do not share this information with the adjuster. The medical coverage you have has nothing to do with the value of your claim.

Arrange the negotiation meetings to your advantage When the time comes to settle your claim, call the adjuster to schedule the appointment. Try to avoid admitting or creating the impression that you are fully recovered. If you are normally a cheerful person, tone it down. You are engaged in serious business — securing the value of your loss.

Schedule the meetings during normal business hours. Do this even if weekends are more convenient. If the adjuster asks you your reason for the timing, tell him you may want to contact certain “consultants” during business hours for guidance during the negotiations. If asked whom you’re referring to, suggest the state insurance commissioner’s office.

When you and the adjuster meet, have a witness present. This can be an adult friend or relative, but preferably someone other than your spouse. Simply introduce that person as someone you want to sit in on your discussions. This will help keep the adjuster honest — and give you more confidence in the negotiations.

Tape-record or take notes about the conversation. Detailed notes or a tape recording will send a message to the adjuster that you are not going to be taken advantage of. It’s also helpful to review the conversation later.

Present detailed documentation of your losses. This should include all medical bills, damages, and out-of-pocket expenses — such as damaged personal items and alternate transportation or family arrangements — that are a result of the accident. Wherever possible, provide receipts for services rendered and original receipts for damaged items. If the original receipts for damaged property are not available, replacement value receipts may be accepted. Keep copies of everything. If you missed work due to the accident, include the amount of your lost gross wages, and do not allow the adjuster to make deductions for sick-leave benefits provided by your company. In many states, if you are self-employed your “lost earning capacity” can be claimed.

Be prepared to question and act. If the adjuster claims you are not eligible for reimbursement of your gross wages, ask him to cite his “legal authority” for that position. Ask him to back up the claims with court decisions, legal precedents, or statutory texts in the state where the accident took place. Have in your pocket the telephone number of your state insurance commissioner or the local office. If necessary, ask that the negotiation session be temporarily stopped so that you can call the commissioner’s office with questions. It’s unlikely that you’ll have to make that call.

It’s just a matter of what’s fair. If you’ve been wronged, insisting on getting every dime owed to you is your absolute right. Some insurance adjusters may accuse you of being greedy or trying to make a profit from an accident. Let’s face it, in this litigious day and age that might be true in some cases. And you can’t blame adjusters for being cynical, considering what they’re dealing with on a daily basis.

I’m not telling you to try and gouge anyone. I’m just encouraging you to go after what’s due to you. You should know what you are up against, figure out what’s a fair settlement, and do what’s within your means to get it. I certainly hope you never need this information — but if you do, good luck.

MT&C

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