Unpacking Tactics Insurance Adjusters Use To Reduce Or Deny Injury Claims

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9 months ago

Insurance adjusters are tasked with evaluating injury claims made by policyholders, and their job is to ensure the insurer does not pay out more than they need to. Unfortunately, this means many legitimate claims are denied or reduced in value. There have been numerous cases of the aforementioned. However, some countries have passed laws to ensure the insuree’s needs are fulfilled. Take Florida, for instance, which passed a law to fight insurance fraud. According to the country’s Division of Insurance Fraud, there were over 17000 insurance fraud cases in 2014-2015 alone. In such instances, along with being self-aware of the insurer’s tactics, individuals can seek help from professional attorneys.

Reputable law firms like BagenLaw.com have seasoned attorneys on their team who have the experience and knowledge needed to fight your insurance fraud case.

Even though lawyers can help you get the compensation you deserve, individuals still need to understand the tactics that insurance companies usually apply to reduce or deny claims. This can help claimants better prepare for the process and increase their chances of a successful outcome.

In this blog post, we have listed some of the most used schemes and stratagems insurers use to reduce or deny injury claims.

Delay Tactics

One of the most common tactics insurance adjusters use is to delay or drag out the claims process as long as possible. By delaying payment, they hope that claimants will eventually give up on pursuing their claim wholly or be willing to accept a much lower settlement amount than what was initially requested. This strategy can be highly frustrating for claimants who may have mounting medical bills or other financial obligations that need to be met. It is crucial for claimants who feel they are being subjected to delay tactics to document all communication with the insurer and seek legal counsel if necessary.

Questioning Medical Records

Insurance adjusters often employ the tactic of scrutinizing medical records associated with an injury claim to diminish its value, potentially hindering the claimant’s ability to fund medical care. They may search for inconsistencies between medical documents from different providers, question the necessity of certain treatments, or dispute the severity of the injury based on subjective criteria like the claimant’s reported pain levels. To counter such challenges from insurers, claimants should proactively gather comprehensive records from all relevant healthcare providers and maintain detailed notes of conversations about their injuries before filing a claim. These measures can significantly strengthen their case and ensure adequate compensation for essential medical care.

Arguing Pre-Existing Conditions

When dealing with insurance claims, it’s not uncommon for an insurance adjuster to raise the issue of pre-existing conditions or alternative causes for the claimant’s injuries. To counter such arguments, claimants must provide solid evidence that clearly demonstrates the cause and timing of their injuries. It’s essential to emphasize that the injuries in question were not covered by any previous insurance policies, especially if the claimant had coverage with another insurer in the past. Additionally, documentation from healthcare professionals detailing the effectiveness of treatments received after the initial claim submission can serve as crucial support in refuting claims of pre-existing conditions or unrelated causes. By presenting compelling evidence and sound reasoning, claimants can strengthen their case during settlement negotiations and protect their rights for fair compensation.

Pressuring Claimants To Accept Low Settlement Offers

In some instances, insurance companies may exert pressure on claimants to accept low settlement offers, even if there are valid reasons to hold out for a better deal. For example, a claimant might experience lingering effects from an injury sustained during an accident covered under an existing policy with that specific insurer. It’s crucial for claimants to recognize that insurers might rush them into settling quickly to close their files swiftly and prioritize more profitable cases. However, accepting a premature settlement could leave claimants financially vulnerable if further treatment costs arise due to complications from initial injuries. In such situations, seeking legal advice before agreeing to any settlement proposed by insurers is the best course of action to protect their interests and ensure fair compensation.

Conclusion

Being aware of tactics commonly used by insurance adjusters helps injured parties better prepare themselves when filing claims and potentially increases chances of having successful outcomes. Such strategies include understanding delay tactics to push back payment deadlines, questioning the legitimacy of medical records presented to support claims, raising arguments regarding pre-existing conditions, and pressuring victims to accept low settlement offers regardless of future implications. Armed knowledge of these strategies allows injured parties to protect themselves and remain vigilant throughout the entire claiming process.

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