“We’ll work with you on your claim. We just need some information first.” This is the standard pitch an insurance adjuster will make to someone making a car accident personal injury claim.
How do I know this? Because many eventually become what I call “insurance company refugees”—folks who accepted in good faith the insurance company’s offer of “fairness,” only to become so frustrated that they were forced to pick up the phone and call me.
Here’s what may be happening behind the curtain while the injured person waits patiently for the insurance company to do the right thing.
1.Scouring Your Credit History
When you give the at fault driver’s insurance company your Social Security Number, it allows them to tap into many databases, including one known as CLUE. This is an insurace industry database that determines your insurance profile or "risk." If you have ever reported or file a previous insurance claim, it is probably in this database. Furthermore, if the insurace company is so inclined, they can search your credit history. What does that have to do with your injury claim? Nothing. But if your credit history is poor because you have heavy debt, it might make you vulnerable to a lesser offer.
If your auto insurance company pays your auto accident bills, they will typically have a right of reimbursement from the at fault driver’s insurance company, known as “subrogation.” But your insurance company might secretly make a reimbursement claim against the at fault driver’s company by filing for “intercompany arbitration.” This is a private, voluntary dispute resolution mechanism set up amongst insurance companies. Unbeknownst to you, the at fault insurer may reimburse your insurance company, then turn around and argue that your injuries, and your medical bills, were not caused by the accident! A classic example of insurance companies wanting to “have their cake and eat it too.”
3.The Medical Audit
After the passage of weeks or months, the same company that has promised to “work with you” may have already sent your medical records and medical bills for a medical audit. This means that some medical group or physician (whom the insurance company hires on a regular basis) is reviewing your records to determine whether (a) your injuries were not caused by the collision; or (b) your medical treatment was excessive for your claimed injuries. If this review is favorable to the insurance company, you will be notified, about the same time you receive a low ball offer on your claim. On the rare occasion the review comes back in your favor, they will not share this information with you.
Remember these things the next time you’re bombarded with all countless insurance TV commercials touting all the fancy slogans and come ons…