If you’ve been involved in a motor vehicle accident and filed a claim with an insurance carrier, you have probably already spoken with an insurance adjuster. For those of you unfamiliar, an insurance adjuster is a representative of an insurance carrier assigned to your claim. The adjuster gathers information about your claim to determine if the carrier is responsible for payments pursuant to your policy and if so, the adjuster calculates the payment and then issues said payment. This process is known as “adjusting a claim.” There are several types of adjusters you will likely have to deal with during the pendency of your motor vehicle accident claim.
A property damage adjuster adjusts your property damage claim. Property damage refers to your vehicle and any property that was damaged in the vehicle at the time of the accident. The property adjuster can be employed by either your insurance carrier or the offending vehicle’s insurance carrier depending on which carrier you are making a claim against. Once a property damage claim is started the carrier will assign a claim number along with a property damage adjuster. You should always have your claim number handy when communicating with your adjuster for them to easily access your claim.
Once the property damage adjuster is assigned you must coordinate an inspection of your vehicle and all damaged property. You should not discard the vehicle or any damaged property prior to having the insurance carrier inspect the property. Also, gather any receipts for items that were damaged or receipts for any prior vehicle upgrades that may have increased the value of your vehicle, such as new tires. The inspection is usually done by a qualified expert for the insurance carrier. Once an inspection has been completed the expert will make a list of all damaged items and calculate the price of repairs. This report will be forwarded to your adjuster. You are entitled to the property damage report and I recommend that you obtain a copy. Discuss the report with your auto body shop prior to accepting payment as they may have a different opinion on the damage to the car. If so, you will need to ask for a re-inspection to address those items.
If the damage is too excessive, the adjuster will deem the vehicle a total loss and offer to pay for the current fair market value of the car. This is often called the “book” value as it is usually determined from publications such as Kelley’s Blue Book. The insurance carrier is only responsible to pay for the current fair market value of the car. If you have a car loan and that loan exceeds the value of the car, you will be responsible for the difference. Often, people purchase gap insurance. If you have that type of insurance coverage in your insurance policy, it will cover the difference between the book value of your vehicle and the loan amount.
If there is a disagreement about what the insurance carrier values your vehicle as opposed to you, you do not have to accept the offer. The way this dispute is resolved depends upon which carrier you made a claim with. If the claim was put through your own collision coverage, you can request arbitration. If the claim was put through the offending vehicle’s insurance policy, you can pursue recovery through the court system.
A no-fault adjuster is assigned to handle your no-fault claim issues such as medical bills, lost wages and other out of pocket expenses. To recover no-fault medical payments, your healthcare provider must bill the no-fault carrier. You should make sure your health care providers are made aware that your treatment is because of a motor vehicle accident and are provided with the no-fault claim information. Failing to do so may cause your healthcare provider to miss important deadlines to submit medical bills to your carrier, which could cause them to seek payment from you. Also, don’t just assume your carrier will make payments just because you provided your doctors with the proper claim information. If you receive medical bills, contact your adjuster and submit those bills for payment.
No-fault does not preapprove medical treatment. If you seek treatment and that doctor accepts no-fault coverage and your adjuster denies payment stating that the treatment was not medically necessary, your healthcare provider is not allowed to pursue payment from you directly except in very limited situations. It is incumbent on the doctor to resolve that issue with the carrier and not you. Therefore, should you receive collection letters from your doctor’s office for medical bills from your car accident, refer them directly to your carrier to seek payment. Should your doctor refuse and continue pursuing you for payment, hire an attorney to protect your interests.
If your treatment lasts for several months, your no-fault adjuster may request you attend an independent medical exam (IME) to determine if treatment is still necessary. There are generally three outcomes of an IME.
If treatment is terminated you can use your private health insurance to pay for future treatments.
Your no-fault adjuster will also issue no-fault lost wages up to 80% of your salary up to $2,000 a month provided that you can supply a lost wage verification form from your employer, and a medical note stating you cannot work from a qualified healthcare provider. Once these documents are received by your adjuster, the carrier has 30 days to issue payment. Again, this is something that you must continually follow up on with your doctor, employer, and adjuster to make sure the paperwork is being completed and processed. Don’t assume because you’ve done your part that everyone else will do the same. I’ve seen many employers and doctor’s offices fail to return the forms and many carriers loose paperwork. Further, your adjuster will require updated medical notes every thirty days.
Finally, try to develop a good relationship with your adjuster. The better your relationship, the more likely your payments will be processed quickly.
Your bodily injury adjuster may be the most important adjuster you will deal with. This adjuster is employed by the offending vehicle’s insurance carrier to adjust your bodily injury claim. Not all motor vehicle accidents will have a bodily injury claim. But if you do, this will be the person that evaluates the claim and decides how much money to offer to settle the case. I advise people that if you have suffered bodily injuries, it is usually best to hire a personal injury attorney to handle the claim. There are rare instances where you may be better off handling this claim on your own.
The bodily injury adjuster will gather the police accident report, witness statements, medical records, lost wages and out of pocket expenses. Once the adjuster has compiled all that information they will evaluate the case. I always advise asking the adjuster to not evaluate a case until all treatment is complete. Once a case has been evaluated an adjuster will decide whether the carrier wants to settle. If so, the adjuster will make an offer to settle. If not, the adjuster will decline to make a settlement offer.
If the adjuster makes a settlement offer, you have a few options. First, you can accept the offer. Second, you can negotiate for more money. Finally, you can skip negotiations and pursue your claim in court by starting a lawsuit. Obviously, I would suggest to never accept an adjuster’s first settlement offer. It’s been my experience in the vast majority of cases I have handled that an adjuster always leaves room to negotiate a claim. There are limits to their ability to offer money to settle a case. The adjuster is usually given a range of money in which to try and settle a case by a supervisor. Once that limit is reached the adjuster will offer no more money.
If an offer was conveyed to you that you feel is insultingly low, it may be best to not even negotiate and just proceed to court. Negotiating an unfair offer never results in reaching an amicable resolution and just delays the inevitable need to go to court.
As a practicing personal injury attorney, I’ve been consulted by prospective clients at all stages of the claim process. Often, when a person receives a low offer they will come to me seeking help. It’s rarely too late to consult with an attorney except in cases where a person has executed a release. Then it’s likely too late.
I’m never surprised at the difference between what an adjuster will offer to settle a case with an inexperienced layperson as opposed to an attorney. I was once consulted by a client that was offered $15,000. After several months of litigation, we were able to obtain 20 times that amount of money. Consulting with an attorney is never a bad idea. Even if you decide to pursue that matter on your own, at least you will receive some valuable pointers.
Finally, no matter what type of adjuster you are dealing with, remember that person is employed by an insurance carrier. No matter how nice they are, ultimately it is their job to minimize the money that you receive for your claim. So, always be wary and do your research before executing any releases.