After You've Been Injured in an Accident is the Insurance Adjuster Your Friend or a Foe?

Video Transcription:

Jim Dodson: So, is the claims adjuster your friend or a foe? I wanna talk to you about some horror stories and help you decide for yourself what you think.

I can tell you some anecdotal information from experiences we've had. Of course, we deal with claims adjusters every day. But I think most people who have had a crash, or been involved in some type of an injury claim, their first contact is gonna be from a claims adjuster calling them. Many times, it's before they've hired a lawyer. And you have to bear in mind that claims adjusters are trained to get your confidence, they're trained to make you feel comfortable telling them information that you wouldn't tell anyone else. And they're trained to help you make a decision, or to lead you to a decision that you don't need a lawyer, that you're better entrusting your case to them and a lawyer's just gonna take a third of your settlement anyway.

So let's look at some of the things that we've experienced in terms of dealing with claims adjusters to really kinda get behind whether this is someone who really has your best interests at heart. And I think you'll quickly see where we're headed with this.

You know, we had a situation even earlier this year where a claims adjuster continued to call a person who later became our client. And the adjuster would just call, pick up the phone, he would call and say, "Hey, Bill, this is Tom. "So how you feeling, and where are you going "for your treatment these days?" He'd never identified that he was the claims insurance representative for the party that caused the crash. He just engaged in conversation. This is really not the right thing to do. And when someone does that, they're only doing it because they are concerned that they're gonna get more information by not being truthful, than being honest with you and say, "Hey, listen. "I'm the insurance claims representative "from XYZ Insurance Company. "I'm calling here because of the crash last week." 'Cause I think a lot of people would get a little bit more tentative in what they're going to say in that situation.

One thing to bear in mind is, if you have any concerns that you've been contacted by an insurance representative, or someone that you know has, a letter of representation from a lawyer stops all of that. As soon as a claims representative gets a letter of representation, or a call from our office, they no longer are permitted under their rules and their ethical obligations to reach out and try to reach the injured party behind the back of their lawyer. That is a definite, big time no-no. They don't do that. So, stop all these issues by simply retaining a lawyer. We'll send our letter of representation and you won't have any further contact with the claims adjuster.

You know, another situation we had with, we were dealing with a bike crash. Claims adjuster called me because we were dealing with trying to negotiate the claim, and said to me, "You know, we're not sure "if our insured hit your client, "or whether your client hit our car." And I said, "Are you serious about making this argument? "Because your car has an obligation "to remain at least three feet away from the bike, "regardless of whether we made contact with you, "or you made contact with the cyclist. "It doesn't matter "because you've violated their right of way." So, what would the average person have said in response to that kind of inquiry from a claims adjuster? It's one of those things where, I don't know whether the claims adjuster understood the law, or whether was just fishing around to see if I understood the law. 'Cause when I pointed out that when an automobile passes someone on a bicycle, they have to maintain a safe passing distance. The minimum is three feet. Safe passing distance may be much further than three feet, depending on the circumstances of the case. So that argument was quickly shut down when I pointed out to her how, actually how the law works and what the law said.

We had another situation is kind of what insurance adjusters do from time to time. We had a conversation with an adjuster and another one saying, "I don't know "that we can accept liability "because your client "rode their bicycle into "the side of our car." I'm like, "Yeah, I think that's true "because your car made a right-hook turn right in front "of this person, they couldn't avoid hitting them! "They violated our right of way." But yet, this is an argument that was made by a claims adjuster with a straight face to me as a lawyer, as a cycling lawyer, for that matter. What would the response have been for someone who wasn't trained in the law, didn't understand that it didn't matter whether we rode into the car or not? They violated the right of way and the liability is clearly on the driver.

So, I think some of these situations arise because these adjusters don't know the answer themselves. Remember this, a claims adjuster is just a person who is hired by an insurance company. They've got experience and training in adjusting cases. They probably have more cases on their desk than they can handle, many of them have 200 files or more. They're under a great deal of pressure to try to get cases settled. They don't have any expertise in cycling cases. They see far fewer of these cases than they do regular automobile collisions. They don't understand the cycling law, necessarily. They can't conceive of why the average cyclist would want to even ride their bike 50 or 60 or a hundred miles a week. It's another world to them. And so when they are assigned a cycling case, they start out with a lack of understanding of how the whole process works and why we're involved in the sport that we're involved in. And some of what we do is an education process for them, leading them to make the right decision because they sometimes take off on the wrong track. I mention that because the average person trying to deal with a claims adjuster on their own, really doesn't understand that and take the time and the effort, or have the credibility quite frankly, to educate the adjuster the way we can do.

We've had situations in the past. One of the things that we always obtain, any lawyer obtains from a claims adjuster when we are dealing with a bike crash, or an auto crash, or any type of injury is what is the insurance information on the person who caused the injury? Whether it's a driver or someone owns a piece of property, or homeowner. And we rely on the claims adjuster and the insurance company making an accurate disclosure of their insurance information. They're actually required to give that to us as a sworn declaration sheet under oath. But many times they want miss that step and just send us information, or tell us something over the phone. And we've had situations where that information was inaccurate. I can't ever tell whether that was done intentionally, but I think most of the time it's done through a little bit of sloppiness, maybe off the top of their head, remembering. But that can make a difference in the evaluation of a case. Now, it's something that, when you're dealing with a lawyer, they might tell us something in a casual conversation about coverage early on, but we're going to get a sworn dec sheet, so we're going to know the real answer before we ever make a decision about the value of the case, or the value of the settlement. But for the untrained person, that kind of misinformation could be pretty devastating and could really get you kind of off the mark.

How many people have told us that the first thing they receive when they get a call from a claims adjuster is, "Hey, we'd really like "to help you understand your case more. "It would help us understand "what happened if you just give us "a recorded statement about what happened." Claims adjusters are really just, are trained to want to get a recorded statement. Bear in mind that when you're dealing with the other driver's insurance company, you, as the injured party, have no responsibility to give them a written statement or a recorded statement, or a non-recorded statement. They want the information because they know, in a large number of cases, something will be said that will help them down the line. Particularly if they can get the injured person to give them a statement early on after a crash happens, or after a motor vehicle accident, or after a fall. So many times, inaccurate statements are made, people generalize about what happened. They're not particularly careful in making descriptions of what they say. And those are the types of errors that can come back and cause big problems later, even after you get a lawyer because they now have the insured, the person who was injured, giving the agent, either a sworn statement or a non-sworn statement that takes a position contrary to what they're later taking.

Give you a perfect example. Insurance adjuster calls and catches someone on the phone, and says, "Hey, listen. "Just want to follow up with your crash. "Sorry our client caused you to get hurt. "How are you feeling, "and what kind of medical care are you having?" Now, at the time they call, the person's maybe having back or neck pain and they say, "Well, I'm having back or neck pain, "but it's not too bad. "I think I can get by and I'll see a doctor." That's one scenario. Or they have back and neck pain, they also have knee pain, but they're not mentioning that to the claims adjuster. After their treatment begins, over the next course of the next several days or weeks, their knee, which is a minor issue initially, becomes a major issue. Their neck, which was a major issue, becomes more minor because it starts resolving. And a month down the road, they're told they need knee surgery. Well, when you have that discussion when you're injured and you have that discussion with a claims adjuster for the other party, and you tell them, or you don't mention to them that you have a knee issue, when that becomes a major problem later and we're revealing it as, well, this person saw a knee doctor and they need knee surgery, and it's like, well, they never told us that when we first talked to them two days after the crash. So now, it puts the victim, the injured person in a posture of looking like they're changing the story. And that's exactly why claims adjusters want statements from people soon after a crash. They want to catch your information that may or may not be accurate as the course of events unfolds.

So, this is why, I mean, in many situations, I'll tell clients that there's really very little you're gonna say to a claims adjuster that's gonna hurt your case, but the problem is, you, as the insured, don't really know if that's the case or not. I mean, you don't know if your situation is one of those or not. I, as a lawyer, can look at it and tell you it might be okay to make a statement, but in the long run, generally my advice is always let me handle that situation. Talk to us, we'll make the decision. If we think it'll help your case, we'll give a statement. If we don't think it's necessary, we won't. It's pretty simple.

So, I hope you're enjoying our program. You know, we're committed to representing cyclists. I'm a cyclist, I ride multiple times a week myself. I've ridden for many years. I think that you may know somebody, or you may have been contacted by an insurance adjuster. You may have something going on in your life right now, whether it's a fall, a crash, a motor vehicle accident, or cycling crash. And you're wondering, what do I do? What do I say to these people? Should I do some of the things you're talking about in this video? Sometimes people have been involved in a crash, many times we get calls from people, they really have been pretty seriously injured, but in their mind, they're not sure if their case, either is one that's big enough for a lawyer to handle, or whether they need a lawyer. Even though, in my view, it looks like a pretty significant case. And many people just have a question about is this something that a lawyer should handle? Or that would benefit me from having a lawyer handle? You know, I'm committed to representing cyclists, I'm committed to helping cyclists any way I can, whether you've been involved in a bike crash, or any other type of injury, anywhere in Florida, quite frankly. So, if I can help you understand the issues, and I can give you information that will help your situation. If you don't need a lawyer, I will tell you. If you can settle your case on your own, for what a lawyer could end up netting you at the end of the day, I will tell you. And frankly, our experiences, you can pay a lawyer fee and still come out ahead in the vast majority of cases. So, if you need help from me, I'm only a phone call away. So just don't hesitate to call.

Renae, I appreciate you signing in and I appreciate your, really, encouraging us with the information we're giving out. Jerry, how are you? Glad you joined us today.

So, let's look at a couple of other situations involving claims adjusters when we're sort of exploring this avenue of whether they're your friend or your foe. We had a situation, we've had a situation in more than one case where there is, some insurance companies will actually assign one claims adjuster to represent the interests of the driver who caused the crash, and your own uninsured motorist coverage. So, it's pretty common in Florida where you have the driver's insured by an insurance company and that same insurance company may be your auto insurance company as well. Most companies in that situation would assign a separate adjuster to represent the driver who caused the crash, and a separate adjuster to represent your interests under the uninsured motorists portion of your auto policy. Which, of course, covers you in a bike crash. But we have had situations where there are companies that, they'd assigned the same adjuster to both sides. Personally, I think that's a huge conflict and shouldn't be done. And we've had the situation where the net claims adjuster calls and wants a recorded statement from their insured, the person they insured under the UN policy, who also would be giving the reported statement to the insurance company for the other driver, same company. But because you have an obligation under the UM portion of your policy to cooperate with your own company, they're leveraging that to try to get a statement as the bodily injury adjuster for the driver who caused the crash. And our position is you can't do that. You can't get a recorded statement in that situation. So, we've been successful in resisting that, but I think it's another trap for the unwary. If you don't know. Lee, I appreciate you signing in and appreciate your comments. If people don't know, they just don't know how to respond.

One of the things, one of my standard pieces of advice to clients when you have been called by an insurance company. We have a lot of people who have been called before we were ever called. People don't call a lawyer necessarily the day of the crash. And they've already been called by an insurance adjuster. I have a simple advice. When you pick up the phone and it's an insurance company on the other end, just say, "Hey, listen, I appreciate you calling. "Give me your contact information, give me the claim number, "and I'll call you back when it's a convenient time. "And you caught me at a bad time." That way that shifts control from them to you. You can make a decision then that is as to whether you do call them, or you can just simply pass that information over to me as your lawyer, if I were representing you. And we will initiate the contact.

I think one of the greatest common denominators of what people say to us when we take over the representation of their case is, "I'm so relieved of the burden of not knowing what to say "to these people who are calling me, "asking questions about this case." People simply don't know what to say and they're concerned they're going to say the wrong thing, which they certainly can do. I think people are just relieved enormously by just saying, "I'm gonna turn this over to Jim and his team. "I don't have to worry about this anymore." My position is, I'll handle the insurance company, you focus on getting better and getting back on the bike, or getting back into the life that you enjoy.

One thing to keep in mind, insurance adjusters, insurance companies, are always trained to look at any evidence in a case which paints the case in a light different than how our injured client sees it. They're looking for evidence to show that our client could have been partially at fault in the crash. Or in the fall, or in whatever the circumstance might be. It's a universal principal. So, if they can divert some of the responsibility from their driver, their property owner, their dog owner, to the cyclist, to the driver, whomever, it reduces what they will have to pay. It's called comparative fault. And Florida does have comparative fault. We'd look at the conduct of the person who caused the crash, we'd look at the conduct of the victim. Is there any plausible argument that there is some negligence, some fault, something that the victim, the cyclist in our situation we're using, may have done something that contributed to the accident? They're looking for that information, they're gonna seize on any piece of evidence they can to help bolster their argument that there is some comparative fault. Statements made by the injured person to an insurance company early on in one of these recorded or non-recorded statements, is exactly how they do that. You know, maybe I was going too fast, maybe I should've stopped, maybe I wasn't watching where I was going, or I just didn't see them. Any statement like that that they can use, you can guarantee it's gonna raise its head and become a big issue in trying to cast fault on the victim rather than the person who actually caused the crash.

There's also this issue of prior complaints of pain or treatment to the same part of the body. It's when you have a situation where there is a pre-existing condition. So one of the things that claims adjusters are trained to do. Two ways. They want to do it in that initial statement they tried to get from the injured party. Have you ever been injured in your back or neck before? If that's what you're complaining of today. Well, yeah, well, I had this auto accident back in 2004, and you know, I was treated with a chiropractor, whatever. That information, I mean, we will not play hide the ball when we get your case, ever. We're always gonna tell the truth. But we're gonna know exactly what the truth is before we start revealing it to the other side. And we're gonna be able to put that truth in the right context. So many times what people do is they make intemperate statements about how they felt before the crash, or the kind of treatment they had had in the past, which may not line up with the medical records at all. It may paint it in a much more worse shape for the victim than the medical records actually show. And that will be used against you. Claims adjusters, when we present a case to an insurance company, they want every prior medical record that is evidenced in any medical record we have. So if it's any evidence you've been treated in the past, they're gonna want that record. And we give it to them. We request those records, we give it to them, but we know exactly what it is before we give it to them, and we know how to spin the information in a light most favorable to us, okay? So it's really exercising some control over how that information is revealed, not whether it's going to be revealed. But it shouldn't be revealed in the statement by the insured or the injured person right away, okay?

The other thing we've had experience with is insured, injured people, rather, making a comment that, well, they told me I need surgery, but I'm never gonna have the surgery. Or they told me that I might need injections on my knee, but I would never do that. You know, don't make those statements. That may be true, but we don't need to volunteer that information at an early stage in the proceedings, you know? When before you've hired a lawyer, and before you've really made a full evaluation of what you're gonna do to treat your case. That kinda stuff comes back to haunt you because what medical treatment the injured party will need in the future, is a big part of the evaluation of the case. When you take that off the table at an early stage, really before you've had an opportunity to live with the injury, understand the consequences of the injury, and maybe realize yeah, well, maybe that injection would help me, or maybe that knee surgery would help me. Maybe I will consider doing that. Makes a huge difference, so these are the reasons why you really want to limit what you say and how to avoid kind of hurting your case by revealing these things to a claims adjuster in the early stage.

I think that claims adjusters are like anybody else. We have really good people, trying to do their best. We have ignorant people, who don't care. And we have lazy people who are hostile to our position. I mean, they come in all shapes and sizes. The issue for an injured party if you've been hurt in a crash, you don't have any idea who is this person I'm dealing with. Many times we've dealt with them, many times in the past. We've got a track history with them. We know exactly what their motivations are, we know exactly who we can trust and who we can't trust. It's possible in many situations, under the right circumstances, to have a claims adjuster actually help your case. We've had a situations where that has occurred. And it's because we've been able to create some type of a bond, a connection, an emotional connection between our client, the injured party, and this claims adjuster on a level that's unrelated to the injury itself. Maybe it's something about the family, it's something about the claims adjuster's family, that we are able to make a connection. And when that connection is made and the person then actually wants to try to help solve your case, it's a huge difference. Sometimes this occurs when you've got multiple insurance people involved. You've got one over here, and one on the other side, and they can really be instrumental sometimes in helping forces that get the case resolved. But the problem for someone who's not involved in this system, you just don't know who they are and what buttons we need to push. You know, in our office, we have Mark who's a retired claims adjuster, works for us. Mark's got over 30 years of handling claims experience and he knows how it all works in the backside over there and what buttons to push on our side to leverage our strengths and how to minimize our weaknesses.

So, I hope you enjoyed the program. I think you'll find that claims adjusters are someone you need to be wary of. It's pretty much like walking up to a dog you don't know. They may be friendly, but you don't know right away and they can do surprising things to you that are hurtful. So, I'm Jim Dodson, the Florida Bike Guy. We've got a resource for you for three tactics that the insurance adjusters use after a bike crash. Just follow that link, I appreciate all of you joining us. Hope the information's useful. Be safe out there, I'll see you on the road. Take care, bye.

Jim Dodson
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A Florida injury lawyer, family man and avid cyclist who clients have trusted for over 25 years.