When you file an insurance claim, you will deal primarily with an insurance adjuster, also called a claims adjuster. This person has the power to investigate, accept, or deny your claim.
The insurance adjuster’s job is not to pay claims. Instead, their job is to protect the insurer. A typical claims adjuster will hold your feet to the fire, forcing you to prove the insurer’s legal obligation to pay.
How Liability Insurance Works
Florida requires car owners to buy no-fault auto insurance. After a minor car accident, you will file a claim with your own insurer — regardless of who caused the accident.
The insurer will pay 80% of your medical expenses and 60% of your income losses. If you hit your policy limit of $10,000 or suffer a significant, permanent injury, you switch from the no-fault system to a fault-based system.
Florida law requires car owners to prove financial responsibility for any crashes they may cause. Owners can self-insure by depositing money or bonds with the state. But most owners buy liability insurance to prove financial responsibility.
Liability insurance is a contract between an insurer and a policyholder. If the policyholder incurs a “covered liability,” the insurer agrees to pay the damages up to a preset policy limit.
To get paid, a third-party claimant must prove that their losses resulted from a covered liability. In the case of a car crash, the claimant must prove that a driver on the policy caused the crash in a way that makes them legally liable for the claim.
Liability insurance only pays third-party claims. Unlike no-fault coverage, your liability insurance does not pay for your injuries. It only pays for other people’s injuries.
The Role of the Insurance Adjuster
After you file a claim, the insurance company assigns an adjuster to your case. The adjuster may be an insurance company employee or an outside contractor. In either case, the adjuster’s loyalties lie with the insurer.
The adjuster investigates your claim. This investigation usually includes:
- Reviewing the documents you attached to your claim, such as medical records
- Accessing the police accident report
- Interviewing the policyholder about the crash
The adjuster’s only goal during the investigation is to make sure the insurer only pays what it absolutely must pay as required by:
- Terms of the policy
- Florida insurance laws and regulations
- Florida injury case precedent
As a result, the adjuster must balance two competing obligations. First, the insurer must comply with the law. If you are entitled to injury compensation, the adjuster must make a good-faith effort to pay you. The adjuster’s role in protecting the insurer means they must avoid exposing the insurer to unnecessary lawsuits.
On the other hand, the insurer has a financial incentive to pay the minimum amount possible. If an adjuster can find any plausible reason to deny or reduce your claim, they owe their employer a duty to use it.
Typical Claim Processing
The adjuster assigned to your case will act as the point of contact for your injury lawyer. You may receive the following from the adjuster:
- Requests for a recorded statement
- Requests for additional documents
- Claim denials
- Settlement offers
Your injury lawyer will respond directly to the adjuster to keep your case on track. In most cases, you will try to comply with the adjuster’s requests.
But if the adjuster asks for a recorded statement, you and your lawyer will probably reject the request. A recorded statement is a meeting or phone call between you and the adjuster. The adjuster will ask questions about the accident and record your answers.
Most lawyers recommend against giving a recorded statement. Adjusters will often ask questions designed to trip you up. Since the adjuster can investigate the claim using the information they already have, you do not need to give a statement.
Negotiating a Settlement
If your lawyer convinces the adjuster to accept the claim, you must reach a settlement. The settlement value will come from the losses you incurred.
After acknowledging liability and accepting the claim, the adjuster will make a settlement offer. This offer will usually be unreasonably low. Your lawyer will use this low offer as a starting point for negotiations.
You will settle the case if you can reach a mutually agreeable number. The insurer will cut a check in exchange for a signed document saying you agree to release your legal claims.
If you cannot settle the case with the adjuster, your lawyer may advise you to file a lawsuit.
Contact Us Today for Help Dealing with an Adjuster
Consider hiring an attorney to deal with your claims adjuster. Adjusters have training and experience handling insurance claims. More importantly, they have a bag of tricks they use to settle claims for the minimum amount possible. An attorney will help you protect your rights and interests against the adjuster. To discuss your case and how Roman Austin Personal Injury Lawyers can help you deal with an adjuster, contact us for a free consultation at (727) 787-2500.
