How to avoid becoming a victim of unfair insurance company tactics
Many accident victims do not understand that the insurance adjusters are not appointed to help them — and are not even required to tell the truth. In our 70 plus years of experience dealing with liability insurers we have often seen detrimental strategies in action.
When you have been in an accident, don’t forget that the adjuster’s role is to save the insurance company money and that the adjuster cannot be trusted to protect your interests.
Here are some real examples of unfair insurance company tactics and how to avoid becoming a victim.
Lesson: The third-party liability adjuster has no duty to tell you the deadlines applicable to your case. Consult with an attorney about your deadlines so your claim will not be barred.
Tactic 2: Concealing Payout Amounts
Lesson: Ask the adjuster specifically how much money YOU will be receiving, and how much money is being paid to the hospital and health insurance company. You have the right to negotiate with the hospital and health insurance company, but you have to ask. The adjuster will not tell you this.
Lesson: If you retain an attorney and advise the adjuster that you have done so, the adjuster must stop contacting you and your family members.
Tactic 5: Concealing Liens
A woman settled a personal injury case with the adjuster. After the settlement, the woman’s health insurance contacted her and told her she was required to pay all of the settlement funds to the health insurance company. The adjuster failed to disclose to the woman that she would have to repay her health insurance company from the settlement funds. Had the woman known this, she would not have accepted the settlement amount from the adjuster and would have attempted to negotiate a higher recovery.
Lesson: Most health insurance companies have a lien on your personal injury settlement. Adjusters will not volunteer this information to you. If you negotiate a settlement yourself, you need to find out about all liens on your recovery, so you know the exact amount you will receive in settlement. Health insurance liens can be negotiated before the settlement is reached.
Tactic 6: Swoop and Settle
A gentleman was injured in an accident. The liability adjuster told him the insurance company would pay up to $20,000 in medical bills and $2,500 for pain and suffering. The gentleman accepted this offer. He received his $2,500 check and then submitted $15,000 in medical bills to the liability adjuster. The liability adjuster paid only $7,500 of the $15,000 in medical bills. When asked, the adjuster advised that she did not agree he needed 36 sessions of physical therapy nor that he needed an MRI, so she would not pay for those charges. The adjuster further pointed out that the settlement agreement obligated the liability insurance company to pay up to $20,000 in medical expenses reasonably and necessarily incurred due to the accident. The agreement left it up to the adjuster to decide which bills to pay. The gentleman was then on the hook to pay $7,500 in medical bills, with no recourse.
Lesson: This tactic is called swoop and settle. The insurance company wants to trick you into settling before you know the extent of your damages. This leaves the insurance company with the discretion to decide which bills to pay, and you with no remedy for the wrongful denial of medical charges. DO NOT fall prey to this scheme. There is no requirement that you settle your case immediately. Adjusters often threaten that they will “close their file” and the like. This is a hollow threat. You can wait until you have completed treatment to attempt to settle the case. You have two years after the accident to file a lawsuit.
Conclusion
When you have been in an accident, don’t forget that the adjuster’s role is to save the insurance company money and that the adjuster cannot be trusted to protect your interests.
Here are some real examples of unfair insurance company tactics and how to avoid becoming a victim.
Tactic 1: Letting the Statute of Limitations Expire
An accident victim supplied medical bills and records to the adjuster as requested. The injuries were severe, and treatment took a long time. The adjuster advised that the medical bills would be paid, lulling the accident victim into a sense of security. At no time did the adjuster advise that the year two statute of limitations was approaching or that the claim would be denied after the statute ran. Once the two-year mark passed, the adjuster denied the claim.
An accident victim supplied medical bills and records to the adjuster as requested. The injuries were severe, and treatment took a long time. The adjuster advised that the medical bills would be paid, lulling the accident victim into a sense of security. At no time did the adjuster advise that the year two statute of limitations was approaching or that the claim would be denied after the statute ran. Once the two-year mark passed, the adjuster denied the claim.
Lesson: The third-party liability adjuster has no duty to tell you the deadlines applicable to your case. Consult with an attorney about your deadlines so your claim will not be barred.
Tactic 2: Concealing Payout Amounts
An adjuster offered an individual injured in an auto accident $10,000 in settlement, which she accepted. The individual received a check for $1,000. When she asked why she only received $1,000 when she had settled for $10,000, the adjuster told her, for the first time, that $9,000 was paid to the hospital. Had the adjuster been upfront with the individual, she could have negotiated the hospital bill herself, saving thousands of dollars. Because she had already settled with the insurance company, she had no recourse.
Lesson: Ask the adjuster specifically how much money YOU will be receiving, and how much money is being paid to the hospital and health insurance company. You have the right to negotiate with the hospital and health insurance company, but you have to ask. The adjuster will not tell you this.
Tactic 3: Insurer-led Investigations
A family tragically lost their son in a collision. The insurance adjuster contacted the son’s friends, misrepresented the details of the accident, and took recorded statements, recording only part of the interviews, creating a misleading record. This misleading record was then used against the family.
Lesson:
Contact an attorney right away if a family member has been killed or has suffered catastrophic injuries. The adjusters immediately begin to build their defense, using unfair tactics. You do not want to be put at a disadvantage. An attorney can contact friends and family to alert them to be on guard and combat these unfair tactics.
Tactic 4: Adjuster Harassment of Victims’ Families
Tactic 4: Adjuster Harassment of Victims’ Families
After a family tragically lost their child, the adjuster began hounding the family and relatives—going so far as to send messages to family members on social media. The actions of the adjuster caused additional stress for the grieving family.
Lesson: If you retain an attorney and advise the adjuster that you have done so, the adjuster must stop contacting you and your family members.
Tactic 5: Concealing Liens
A woman settled a personal injury case with the adjuster. After the settlement, the woman’s health insurance contacted her and told her she was required to pay all of the settlement funds to the health insurance company. The adjuster failed to disclose to the woman that she would have to repay her health insurance company from the settlement funds. Had the woman known this, she would not have accepted the settlement amount from the adjuster and would have attempted to negotiate a higher recovery.
Lesson: Most health insurance companies have a lien on your personal injury settlement. Adjusters will not volunteer this information to you. If you negotiate a settlement yourself, you need to find out about all liens on your recovery, so you know the exact amount you will receive in settlement. Health insurance liens can be negotiated before the settlement is reached.
Tactic 6: Swoop and Settle
A gentleman was injured in an accident. The liability adjuster told him the insurance company would pay up to $20,000 in medical bills and $2,500 for pain and suffering. The gentleman accepted this offer. He received his $2,500 check and then submitted $15,000 in medical bills to the liability adjuster. The liability adjuster paid only $7,500 of the $15,000 in medical bills. When asked, the adjuster advised that she did not agree he needed 36 sessions of physical therapy nor that he needed an MRI, so she would not pay for those charges. The adjuster further pointed out that the settlement agreement obligated the liability insurance company to pay up to $20,000 in medical expenses reasonably and necessarily incurred due to the accident. The agreement left it up to the adjuster to decide which bills to pay. The gentleman was then on the hook to pay $7,500 in medical bills, with no recourse.
Lesson: This tactic is called swoop and settle. The insurance company wants to trick you into settling before you know the extent of your damages. This leaves the insurance company with the discretion to decide which bills to pay, and you with no remedy for the wrongful denial of medical charges. DO NOT fall prey to this scheme. There is no requirement that you settle your case immediately. Adjusters often threaten that they will “close their file” and the like. This is a hollow threat. You can wait until you have completed treatment to attempt to settle the case. You have two years after the accident to file a lawsuit.
Conclusion
Liability insurance companies and their adjusters have a whole playbook of dirty tricks. If you or a loved one has been seriously injured, you need experienced Texas personal injury attorneys who have seen it all and know how to win. Please contact Wham & Rogers for your free consultation, by phone, Zoom or in person.
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