Some adjusters, like some personal injury lawyers, give the business a bad name, but on the whole, most adjusters try to be reasonable within the parameters set by theie respective insurance carriers. Any discussion of the mind-set of insurance adjusters must differentiate between adjusters associated with huge conservative national carriers and adjusters who work for companies that are less likely to be in litigation all the time.
Very large conservative carriers do not mind lawsuits. Even a multimillion dollar verdict will run off their backs like water, and they are extremely successful in small to medium cases in which jurors often return verdicts for the medical bills or less. If your case is in the $25,000 to $30,000 range, your accident attorney’s job is to resolve it without spending several years and several thousand dollars.
The mind-set of adjusters who work for large conservative insurers is based primarily on the philosophy of their employers. The job of these adjusters is to resolve as many cases as possible for a figure that is substantially less than the settlement authority given to them by their insurer. Bonuses are given for exemplary performance, especially when cases are resolved for amounts approximating the medical bills only with little or nothing for pain and suffering.
These major carriers try to resolve cases without the intervention of personal injury attorneys. One of these carriers was cited in several states for engaging in the unauthorized practice of law because of letters that discouraged injured claimants from employing an attorney.
Principles and philosophy of adjusters at conservative insurers
Insurance adjusters at conservative companies believe in and follow these principles:
- It is not unfair to settle cases cheaply because the adjuster’s duty is to the policyholder/potential defendant just as the defense attorney’s duty is to the defendant, not the plaintiff.
- Many claims filed each year are phony, exaggerated, or based on pre-existing injuries that were not caused in the incident that is the subject of the claim.
- Personal injury attorneys who are employed by claimants often exaggerate small to medium claims and therefore cannot be trusted to give accurate information.
Every claim processed by an insurance adjuster requires close scrutiny with strict attention to details such as medical bills, causation, and other factors including:
- Liability: Is there any chance at all that liability can be questioned?
- Coverage: Is there any possible coverage defense such as non-payment of a premium, failure to cooperate, or other possibility that the claim can be denied on the basis of coverage?
- Contributory negligence on the part of the claimant, especially in those states where any contributory negligence whatsoever precludes recovery as opposed to those “comparison states” where comparative negligence only reduces the amount of the award.
- Pre-existing or prior injuries that in any way relate to the present claim.
- Exaggerated loss of income claims or inflated self-employment losses.
- The social status of the claimant that may result in a reduction of the value of the claim such as being a welfare recipient, a person with a criminal background, or other factor which reduces the value.
- Prior claims of any kind on the part of the claimant including workers’ compensation, bodily injury claims in other auto accidents, claims against stores for slip-and-falls, or any other claim that may appear in the insurance claim index.
- Reputation and credibility of the attorney filing the claim including experience, success in law suits, and reputation among defense attorneys.
- A strict chain of command in settling cases with authority being given in small increments and close scrutiny of settlement policies.
Insurance adjusters who work for large conservative companies are usually very loyal and are often long term employees. These adjusters are also very moral people. They attend church regularly, are attentive to their families, and are usually quite conservative in their beliefs. Having dealt with many cases involving catastrophic injuries or death, small to medium cases involving soft tissue injuries or sprains are not very important to them. Also they are very knowledgeable about medical testimony and medical issues.
Relationship between adjuster and defense counsel
Another significant part of the philosophy of insurance adjusters is based upon the relationship between the insurance adjuster and defense counsel. This is one of the most overlooked aspects in evaluation of claims by inexperienced plaintiffs’ personal injury attorneys. Many inexperienced attorneys believe that the threat of a lawsuit sends the insurance adjuster into a fearful frenzy. In fact, the opposite is usually true. The most common element between large and small conservative carriers is the fact that they have excellent defense counsel.
Once a file hits the desk of defense counsel, a plaintiff’s case can suddenly be in deep trouble. Often the value will be reduced or defense counsel will find some weakness in the case to focus on. Once this occurs, the case may need to go all the way to trial and a verdict. So experienced personal injury attorneys know not be so quick to threaten a suit in small to medium cases. The adjuster will not be worried. The file simply goes to the litigation claims manager and defense counsel will begin tightening the screws.
Negotiating with the adjuster
A skilled personal injury lawyer will take note of the clues that the adjuster gives during settlement negotiations or even preliminary discussions. If the adjuster suggests the case has weaknesses such as questionable liability, medical causation, pre-existing injuries, or other limiting factors, the chances are pretty good that the offer will be low. When the first offer is very low and the second offer is only increased by a small amount, the case is likely headed to litigation.
Experienced injury attorneys will not waste time arguing with the conservative adjuster or trying to convince the adjuster of their position. They will consider all of the weaknesses in a case and try to see the case from the adjuster’s point of view. Questions to consider are:
- Is the adjuster correct in her assessment or way off?
- If the case proceeds to trial, how would a jury likely see it?
- Who is defense counsel going to be in this case?
- How much will it cost to take this case all the way to trial?
- Will the attorney have the support of the trial judge if a low offer comes from the defendant?
After consideration of all factors [see 18 factors that affect case value and The 9 most common personal injury case weaknesses link to articles], the experienced injury attorney will determine whether he and the adjuster are actually miles apart or just a few feet apart. If it’s miles, then mediation is a possible alternative. But if the carrier refuses to mediate, a lawsuit will be necessary.
Skilled personal injury attorneys will try to work with adjusters for large conservative national carriers to resolve cases, but when that isn’t possible, they will let the judge or jury decide.