If you’ve suffered an injury as a result of someone else’s negligence, there is a good chance an insurance company may be financially liable to you. For example, if you are injured in a car accident the automobile insurance company of the responsible party will be liable for your bodily injuries, or if you fall at someone’s house there will be a homeowner’s insurance company that will be responsible for your injuries.
Knowing this, insurance companies like to be proactive. This means they work to protect their assets even before a claim is filed. They often hire investigators, gather witness statements, and take photographs as soon as they find out there has been an accident. But their efforts don’t stop there, especially if you file a claim. I’ve often been asked by clients if investigators are spying on them. My response is yes, and in more ways than you probably realize. Here are some of the most common techniques insurance companies use to gain information that may be helpful to defend an injury case.
Often, insurance companies will hire investigators to follow you while you perform your daily activities. This is legal as long as they are not infringing upon your privacy, meaning if you’re at work or in a supermarket parking lot, recording you is fair game. The good news is that any recording must be turned over to your attorney in discovery.
In today’s information age, spying on you is easier than ever. Investigators often surveil your social media accounts. So, if you post on platforms such as Facebook and Instagram you can expect that those images and statements will find their way into your case. Further, making your settings private will not stop insurance companies from getting your posts. Most judges will allow access through a subpoena if you maintain social media accounts.
Insurance companies will not entertain a settlement of your injury case without first receiving authorization to obtain your medical records. This is to be expected. But often times your medical records contain a detailed history of your prior treatment, this often allows an insurance company to snoop even further into your history and get even more details about you to help defend a case.
My advice to people pursuing a personal injury claim is to realize that you are being spied on, but as long as you are telling the truth it doesn’t matter. For example, don’t claim you are bedridden while you were actually out shopping. This way if there is a video of you shopping it doesn’t matter. Exaggerating or lying usually doesn’t help an injury case because your medical records tell the story of how bad your injuries are. However, getting caught in a lie will always ruin a case.
Steven Palermo is the managing partner for Palermo Law, Long Island’s Personal Injury Law Firm. He has been helping people receive compensation for their injuries for over 21 years. He focuses on cases involving car accidents, truck accidents, construction accidents and slip and fall injuries.
His book The Ultimate Guide to Handling New York Car Accident Claims details the ins and outs of a car accident claim in a simple, easy-to-read manner.
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.
By New York State law, every insurance carrier must offer Supplemental Uninsured Motorist (SUM) Coverage. This type of coverage is extremely important if you’re ever seriously injured by a driver who is underinsured, uninsured, driving a stolen vehicle or commits a hit and run against you. If the at-fault driver is uninsured or underinsured and has little-to-no assets, your compensation comes from your Supplemental Uninsured Motorist coverage. If the at-fault driver is insured, their Bodily Injury Liability (BIL) coverage will compensate for your medical costs, lost wages, and pain and suffering until that coverage is exhausted. Your SUM coverage will then make up the difference of the compensation you’re entitled to until it is exhausted. Many drivers choose the minimum amount for both BIL and SUM coverage, and if this is the case, you could be at a loss to recuperate your damages. Especially if the at-fault party has little-to-no assets. Choosing the minimum amount for these two types of coverage can lead to a serious financial crisis.
The minimum coverage New York State insurance carriers offer is $25,000 for one person, $50,000 per occurrence, and $10,000 for property damage. But what could this amount really do if you are seriously injured? How would this scarce amount of money help fully compensate for your damages? And what if other family members were seriously injured in this type of accident? In many cases, it simply won’t help at all. $25,000 is a grossly inadequate amount to compensate for damages in a serious personal injury case.
In a vast majority of the car accident cases we’ve seen, the at-fault driver had the minimum Bodily Injury Liability coverage or was not covered at all with little-to-no assets. It’s not always the case, but many times it is. This is why it’s imperative to consider a higher amount for your Supplemental Uninsured Motorist coverage. If you choose the minimum, and the at-fault party is uninsured and with little-to-no assets, you won’t receive compensation from their insurance company, nor will you be able to get compensation from them through a lawsuit. If the at-fault party has the minimum amount of BIL coverage, you’re entitled to that compensation, but it will do little to recuperate for your damages if you’re seriously injured.
As you may know, insurance brokers get commissions based off of their sales. Some won’t tell you about how important it is to have a high SUM coverage to protect you and your family residents. Why? Because they know you may think having a higher-than-minimum SUM coverage will create a drastically higher monthly premium. The last thing insurance brokers want to do is scare you away from an insurance package, and the first thing they want to do is make the sale. So, some don’t push you to have a higher SUM coverage out of fear of losing that sale. But if you actually calculate the annual add-on, it’s not that bad. And it’s worth it.
We urge you to get a simple quote online to see how much money will be added on to your annual premium if you raise your SUM coverage. Whatever amount of money that is, compare it to the amount of money you would lose if you were hypothetically hit by an underinsured or uninsured driver, whether you were in a car or pedestrian accident, and sustained serious injury. You wouldn’t be able to work, you’d experienced hefty medical bills, both your car and your life could be totaled – the list could go on and on. You’ll probably come to the realization that it is most definitely worth it to get the highest SUM coverage you can afford. If you have a high SUM coverage, you and your family residents are protected in case you’re injured by an underinsured or uninsured driver. We simply cannot overstate how very important a high SUM coverage is.