Monday, July 10, 2017

Why Doesn't the Insurance Adjuster Believe Me?

It’s the Adjuster’s Job Not to Believe You!
Mark Wolfe - Personal Injury Attorney
251 433-7766

Having represented insurance claimants for over 30 years, I have received hundreds of calls from people who are upset because, “the adjuster just does not seem like he believes me.” They are angry and frustrated with the adjuster and feel they are being singled-out when they are simply “telling the truth.”  Guess what? It’s the insurance adjuster’s job not to believe you! It’s not that they are necessarily being mean or picking on you, they are simply following the law and they are trained to be skeptical about most claims.

The law requires insurance claimants to prove their claim. It’s not the insurance adjuster’s job to help you prove your claim nor do they have to “disprove” your assertion, but rather you have to prove all elements of your claim.  Let’s take a look at a common claim related to a personal injury claim: lost wages. According the Center for Disease Control (CDC) it is common for someone to miss about two weeks of work for a simple cervical strain suffered in a car accident. You cannot expect to receive compensation for your lost wages by simply telling the adjuster, “I missed two weeks of work and I make $17.50 per hour.” The adjuster is going to require you to produce documentation supporting your wage rate such as a pay stub or a note from your employer. The adjuster will also require you to produce a doctor’s excuse or a medical notation in the records that the time off of work was in fact required because of the injuries you suffered in the accident. They are simply making you prove the validity of your claim. That’s their job!

“But Mr. Wolfe, I’m not like those people who fake a claim or exaggerate an injury to get money they don’t deserve,” is another common statement I hear. Yes that may be true, but adjusters deal with lots of opportunistic fraud claims every day. In my opinion, this has desensitized them to legitimate claims and makes them very skeptical about all claims. This means not only must legitimate claimants meet the legal burden of proof for their claim, they also must overcome the “burden of doubt.” Claims adjusters have been trained to look for certain “red flags” signaling a potential opportunistic fraud claim. The problem is some of the “red flags” are so broad or discretionary they can get attached to a legitimate claim. Claimants are often given a veracity or truthfulness rating. This rating can have a negative or positive impact on the benefit determination for the claim. Yet most claimants, and surprisingly many personal injury attorneys, have no idea how the claimants perceived truthfulness can impact the benefits the insurance company is willing to pay. There are things that can be done to help emphasize the truthfulness of a claimant or overcome a “red flag” that may be associated with a claim. But again, the adjuster’s job is to be skeptical about a claim.

Meeting the “burden of proof” and overcoming the “burden of doubt” can make the claim process seem unfair and frustrating. While not every insurance claim requires or needs a lawyer,  all claimants should know their rights and understand the claim process. Our office provides free consultations to personal injury claimants and other insurance claimants. We also have numerous publications available to help claimants. These can be downloaded at no charge from our web site: http://www.bfw-lawyers.com/publications/

About the Author: Mark Wolfe is a highly rated personal injury attorney with over 30 years of experience prosecuting insurance claims on behalf of individuals and businesses. He has been a guest lecturer for doctors and lawyers about personal injury claims. He has published numerous articles concerning insurance claims, personal injury litigation and law office management in National and Regional law journals. Contact Mark for more information or to schedule your free consultation: mark@bfw-lawyers.com or 251 433-7766.    



REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.


Thursday, January 19, 2017

Three Things We Know About PI Claims That You May Not Know


At Boteler, Finley & Wolfe we’ve been helping personal injury victims present and prosecute their insurance claims for 29 years. We’ve helped thousands of victims recover the full and complete compensation they are owed and most of these claims were settled without ever having to file a lawsuit! Why is that? Because we know and understand three very important factors for recovering full and complete compensation for personal injury claims. Those factors are: Reserves, Computers and Attitudes. Knowing and understanding these three factors allows us to insure our clients get the full and complete compensation they are entitled to!
RESERVES: In insurance jargon “reserves” is the amount of money an insurance adjuster estimates will be required to settle an injury claim. Because money held in reserve to pay claims is not invested in the stock market or bond market, adjusters are under a lot of pressure to keep reserves low so investment profits can be maximized by the insurance company. Yet if an adjuster has “under” reserved a claim, there’s a very good chance the claim will not settle for its true value. At Boteler, Finley & Wolfe, we understand how and when reserves are set and adjusted and we know what information is needed by the adjuster to adequately set the reserves for our clients’ claims.
COMPUTERS: Or more specifically computer assisted claim evaluation programs. Almost every major insurance company uses a computer program to “assist” with the claim evaluation process. Adjusters are required to input data known as “value drivers” into the program. These value drivers can push the “value” of the claim up (positive) or down (negative). Most insurance companies use similar programs and have similar value drivers and most have specific requirements as to when the adjuster can or should input a value driver. These input requirements can be technical and stringent.  This is especially true if the value driver adds value to the claim. Negative value drivers can be overridden or deleted if certain information is included with the claim material. Mark Wolfe at Boteler, Finley & Wolfe has been lecturing and teaching lawyers and medical providers about computer assisted claim evaluation programs for over 15 years! His expertise in this area allows us to make sure all positive value drivers are identified and included in the claim material for our clients and any negative value drivers are minimized or excluded.
ATTITUDES: Did you know insurance adjusters are trained to believe that almost all personal injury claimants are lying, faking or exaggerating their injuries simply to recover “undeserved” compensation? Adjusters go to classes and seminars on “opportunistic fraud” so they can learn how to identify these fraudulent claims. They are given factors to look for when handling a claim to rate the claimants “veracity.” This rating is then factored into the evaluation process. Obviously, if the adjuster thinks a claimant is not honest, the settlement offer will reflect that belief. The truth is many of these veracity factors are so open and vague, it allows adjusters to lump honest claimants in with the dishonest claimants. At Boteler, Finley & Wolfe we only want to represent honest claimants who are truly deserving of compensation for their injuries. To that end, our claim presentation protocol includes several things that accentuate the honesty and truthfulness of our clients and the legitimacy of their claim.
So there you have it! Three important factors that can be the difference between getting full and complete compensation for your injury claim and just taking what the insurance company offers. If you don’t have a lawyer who understands these factors and knows how to utilize and incorporate them into your claim, you may be shorting yourself of the full benefits you are owed. Call us today for a free consultation. 251 433-7766 or get more helpful information about personal injury claims from our web site: www.bfw-lawyers.com (Note: our new and improved web site is under construction. In the interim, please visit our old site.)

REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.