How Insurance Adjusters Try to Keep Your Money!

Video Transcription:

Jim Dodson: What are the tactics you need to be concerned about when you talk to a claims adjuster? You know, I've been dealing with claims adjusters throughout my entire career. And, I have a claims adjuster, retired claims adjuster that works for us two days a week, been an enormous help. And, what I've learned are some things that I need to pass on to you because nothing that they do is by accident. No call you receive from a claims adjuster, nothing they send to you in the mail, it is there by design. And, the design is for them to better understand the case so that they can pay as little as possible in the end of the day to settle someone's claim. That's the entire name of the game.

One of the things that I've learned is that it's very common for a claims adjuster to wanna put you at ease, after a bike crash, or after a car crash, they wanna put you at ease. They would like to reassure you that they will take care of you. They want you to feel that you can place your trust in them and that your case will be fairly evaluated and fairly settled, by leaving it in their hands. And, sometimes they're successful in doing this! I've had some very sophisticated people, over the course of my career, call me and just basically tell me, "I'm gonna leave it with the claims adjuster. "I trust the person. "I think they'll be fair with me." At the end of the day, that type of person will get a settlement. They'll receive a settlement but the problem is, it won't be anywhere near the full value of the case. It just won't! I've learned in my career that if I don't feel in my heart of hearts that I can get my client more money than they would get dealing with a claims adjuster on their own, I will tell you right away that's the case. And, then I'll tell you how to do it on your own. But there's some things that you need to be aware of before anyone would ever make a decision to address their case, or hold their case, on their own and deal with the claims adjuster without the help of a lawyer.

I think that my assistant, my claims adjuster here, Mark, has told many stories over the years of people he's dealt with and I think Mark is a fair-minded guy. I mean, he's proved that in his work with me. The problem is when you talk to a claims adjuster from an insurance company, whether it's yours or whether it's the other company, they have one motivation in mind, is to. They have a case. They wanna get it off their desk and they wanna get it off their desk at the least possible cost to their company. If they offer you $5, the case is worth $10. It's just the way it works. And, the problem, when you and I, if you're not in this environment, not working in this arena, like I am everyday, you have no idea, you have no point of reference, no idea what your case may or may not be worth. It may be worth a lot more than you think it's worth or it may be worth a lot less than you think it's worth. And, the role of your lawyer is to be honest with you and tell you exactly where you are in this process.

Hey, Jennifer, thanks for your comments. I know, Jennifer's pointing out that there's a lot of people out there and maybe you're on the line today that have had an unfortunate experience with a claims adjuster, or a situation that kind of left a bad taste in your mouth. If you have, let us know. Yeah, Jennifer's again telling me that, you know, she's got a claims background and knows exactly how they're trained behind the scenes to do exactly what I'm talking about right now.

You know, insurance adjusters look at claims differently than I do, than any lawyer does. They are, by nature, they're very suspicious. They don't believe any story. They don't believe any set of facts. They don't believe any injury is as bad, or exactly as it's being portrayed. They always feel like they're being worked to some extent. So they're always looking at the case through a lens, which is totally different than the lens you see, as the injured party, reaching out to someone, at a moment of need, relying on this person to be fair, honest and open with you and give you the benefit of the doubt. That rarely happens. That rarely happens. Can it happen? Sure it can happen but it's a rare occurrence in the claims business.

Another thing that they do frequently is to try to talk to you about why you shouldn't even get a lawyer. They want you to leave the case with them and not get a lawyer. I've had people come talk to me, after they've been involved in even a serious accident, whether it's a bike crash, or a car accident, about how the claims adjuster tried to convince them they don't need to get a lawyer. That's why these companies are trained to intervene, right away, to try to establish some type of repertoire, relationship with the claimant, to try to convince them they don't need a lawyer. And, what they will tell the person is, "By the way, don't hire a lawyer. "They're gonna take a percentage of your recovery. "Save that percentage. "I'll deal with you directly and you'll come out ahead." There've been many studies. There's a famous one that, it's floating around, that's been around for a long time, actually, probligated by one of the big auto insurance companies, that actually proved, internally for them, which later become public, that people who are represented by a lawyer, receive multiple times the value of a case compared to the person who tries to handle the case on their own. So the reason they want to convince you not to get a lawyer is because they know, at the end of the day, it's gonna cost them more money. And, the lawyer's gonna take the time to build the case, to be what it actually should be.

I've got a, kind of a case in point, we had a case we settled just recently at mediation. Mark and I, my adjuster and I, were talking about it. And, you know, Mark works with hundreds of lawyers across the state and across the country and he said, "Jim, you know, this case, in the hands of most lawyers, "would've settled a long time ago for 10% of the value "that you just settled this thing for "because they wouldn't have waited and understood "how to work it up, what needed to be done, "who the person needed to see, "how it needed to be expressed, "and how to negotiate and express that "to an insurance company and put it in the range "where the actual case value was." And, that's what, you know, a trained lawyer, it's what we do in our practices. Try to work the case to the point where we're gonna receive the maximum value, in terms of trying to get the case settled for you. And, many times, that's multiples of what insurance company views it at, particularly early on. Sometimes cases need to be worked up properly and that's one of the values of a lawyer.

Another something that they will never tell you is, for instance, if you're on Medicare or health insurance, you're gonna get that lien reduced if you're working with a lawyer. Let's say you have a $30,000 Medicare lien that has to be resolved at the end of the case. Number one, without a lawyer, you have no idea how to even do that and you can get in serious jeopardy with Medicare if that's not handled properly. But if a lawyer's representing you that's gonna be reduced by the, really, the percentage of the lawyer's fee. So if the lawyer's charging you a third, your Medicare lien is gonna be reduced by roughly a third. If you're handling this on your own, there's gonna be no reduction, okay? And, the same thing applies, although there's no structured formula, with trying to get healthcare liens resolved with health insurance, or Workmen's compensation, or the VA. There's a process and a way that a lawyer understands how to do that. So when you factor in, for instance, the amount of money your lawyer saves you on the liens that they get reduced, offset against the fees that they charge, the percentage that you're paying becomes much, much less and virtually no case we handle doesn't have a significant lien that we work to get significantly reduced, to increase the net to our clients. So an insurance adjuster would never discuss with you, you know, the backend problems of trying to handle the case on your own and the problems that you can have, not understanding how to resolve lien, what percentage you can expect to get it reduced by, or the complications in your life if you have to deal with it with them. One simple thing would be, you know, in the Medicare, most insurance companies are gonna want you to send the check to Medicare. They're gonna put Medicare on the check. Can you imagine sending your settlement check off to Medicare and hoping that sometime they send you the proceeds back? We don't do that. We put the check in our trust account. We negotiate with Medicare and we send 'em a check directly from our trust account. So it just streamlines the process.

So again, this is just a process, a tactic, that a insurance adjuster wants to do, to gain your confidence and try to keep you so that you don't wanna walk outside and get a lawyer 'cause they know at the end of the day that's gonna cost them a lot of money. Let me just look at this note by Jennifer.

So Jennifer's pointing out, you know, Jennifer has a claims background and she was pointing out in her comment, and I appreciate you calling, sending that in, Jennifer. Even the simple fact of calling you and saying, "How are you?" And, engaging you in that simple conversation is all part of a programmed attempt, a way, a device that they use, just simply to be nice and appear to be nice, and do those things. It's just a process to gain your confidence. So you have to understand that every conversation you have with them, you're being worked to an extent. It's a process. It's designed. It's a plan. And, you have to just be careful not to allow it to, you know. It's the easiest thing to do. Just leave it with the insurance company but at the end of the day, it would be a very, very costly mistake.

So another thing that they do right away, many times, is to send you a signed medical authorization. This would be just a blank medical release form so that they could send that to, they're gonna tell you they're gonna send it to your medical providers to get the medical records from your injury. But the reality is, when you send what it is, blank, signed, medical authorization to an insurance company, your own, or the other person's, you've given them a blank, carte blanche to your medical history, whether it's related to this or not. Theoretically every name they can find, linking from one record to the next, they'll pour over it. You're referred by a primary care doctor. He's not treating you. They'll get those primary care records. Primary care referred you to an OB/GYN, they'll get their records. I mean, it's a chain that they follow. And, the problem is, you don't know what records they have when you follow their template. So you're not even aware what records they have. And, the reason they're trying to build that record history is to understand every argument that anything you have today, you complained of some time in the past. You know, you saw your OB/GYN one day when you were complaining of neck pain and they mentioned it. That becomes a preexisting condition if you have a neck issue now. So in our practice, we certainly don't hide the ball, in terms of what we provide medical doctors, but we always know exactly who they're getting records from and we have a copy as well. So if we send, if we provide a medical authorization, we generally will just get the records and send the records directly to them ourselves. If we provide them the medical authorization, it's to a specific doctor, for a specific period of time. It's not just, go out and find whatever doctors you want. Your personal medical history, that is unrelated to this crash, or the injury that you have received, is no business of an insurance company and they have no right to be pouring through your medical history and having that float around, wherever they have it float around. And, it's just another thing which is, just a trick of the trade, and something that you need to avoid.

One final thing that I wanna talk about today is, they will call you, every insurance company, whether it's your own company or the other person's company, will always wanna get a recorded statement, okay? They're trained to take recorded statements. And, on one hand you look at it and say, "Well, I'm just gonna tell the truth. "What difference does it make?" I've seen this bite a client so badly, so many times, that it's hard to believe. Many times, when you have, even a bike crash, you may have a fractured collar bone that needs surgery but you may have a hip issue, or a knee issue, or concussion, at the first 24/48 hours. Get an insurance company calling you right away. They ask for a recorded statement. You talk about the fractured collar bone. You say, "Well, I hit my head "but I'm not having any symptoms." Or, "I've got a little scrape on my knee "but I don't have any issues with that." And then, two months from now, you're needing knee surgery or you've got a concussion issue but it wasn't mentioned in your recorded statement. Now, it appears, when it materializes in the medical records, a month, two months down the line, it appears that it's a new condition and they're gonna argue that it's unrelated to the crash. Why? Because they had an opportunity to talk to you immediately after the crash, had a recorded statement, and you played it down. Or, you didn't think about it. Or, you didn't mention it to them. So it's an opportunity for them to deal with it now, in the picture that it's not related to the injury but it's perhaps a something that happened to you after the fact. It wasn't told to us at the time. Why have they changed their story? You know, you can see the way this gets turned and twisted against you. We are selective in giving recorded statements. Many times, we won't give a recorded statement but I will simply call the adjuster and say, "I'm not giving you access to my client "but here's exactly what happened "and these are exactly their injuries." In certain situations, if I'm convinced it's gonna help us, we'll give a recorded statement. Sometimes, if it's your own insurance company, you may have a responsibility, under the terms of your own policy, to give a statement and you need to understand that. But those are relatively few and far between in the big scheme of things. Most of the time, we're dealing with this on the other driver's insurance company, trying to get information from you, right out of the chute.

So those are some of the most common things that I think clients deal with, right away, after a bike crash or a car injury. I want you to avoid them. I want you to understand the process. I want you to do those things that are best for you. I always tell clients, "Listen, you have a life to live "and you have an injury. "Your injury is part of that process. "Gonna make decisions that are best for your life "but the injury claim is an important part of that as well." And, let's make decisions that while, in helping your life, "are gonna help your claim." And, that's the role that we play, as a lawyer, in trying to help you through this process.

I've got a free report I wanna give to you. The, "Beware of the Tactics Used By Claims Adjusters," and we talk about these very things I've talked about today and several others. I think you'd find this helpful. Just go to the bit.ly link that Katie's gonna put on there. The biy.ly/TacticsToWatchFor.

I wanna thank you for listening to us today. I'm Jim Dodson, the Florida Bike Guy. You know, friends don't let friends call a 1-800 mystery lawyer after a bike crash or after car injury. We appreciate your referrals. All your referrals will be handled by me and by my team. And, I look forward to hearing from you if I can help you. I'll see you next time.

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