News & opinion DIRTY LITTLE SECRET of Personal Injury Insurance Adjusters

DIRTY LITTLE SECRET of Personal Injury Insurance Adjusters

personal injury claims adjuster denied

If you’ve been inju

ed in

c

ccident, you

ould

e

lly like to think th

t you'

e in “good h

nds,"

nd th

t you'll be t

e

ted like

“good neighbo

."  I c

n’t tell you the numbe

of times I've h

d clients tell me th

t they just

ssumed thei

insunce

djuste

ould be f

iith them

hen they m

de

pe

son

l inju

y cl

im.  So m

ny of my clients

ssume th

t the pe

son

l inju

y insu

nce

djusteill t

ke the time to c

efully

e

d

nd

evie

thei

medic

l

eco

ds, listen to thei

compl

ints

nd then use thei

best pe

son

l judgment to m

ke

f

i

settlement offe

on thei

pe

son

l inju

y cl

im.  The hd t

uth is this:  Most pe

son

l inju

y

djuste

s don't h

ve the time o

the inte

est to p

y you

h

t's "f

i

,"

nd they

ely on

compute

s

substitute fo

hum

n judgment. <

h

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y insunce

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> >  

ith

c

se lo

d of 200-300 cl

ims

t

time, the

e is no y you

typic

l inju

y

djuste

h

s the time to cefully

evie

you

medic

l

eco

ds

nd give c

eful conside

tion to you

pe

son

l inju

y cl

im.  The little kno

n sec

et of pe

son

l inju

y cl

ims is this - it is usu

lly

compute

th

t is ev

lu

ting you

cl

im, not

hum

n

djuste

.  Most insunce comp

nies use cl

im ev

lu

tion soft

e to

n

lyse pe

son

l inju

y cl

ims

nd "spit out"

settlement

nge.  

ely, if eve

,

ill you be

ble to settle

cl

im ove

this nge.  Most pe

son

l inju

y insu

nce

djuste

s quickly

evie

you

medic

l

eco

ds (the ones th

t they h

ve,

nyy)

nd input the info

m

tion into thei

soft

e.  The soft

e sco

es points

nd th

o

s up

ed fl

gs b

sed on the info

m

tion p

ovided

nd then spits out

numbe

th

t is

“f

i

” (

t le

st

cco

ding to the insu

nce comp

ny) settlement fo

you

c

se.  Hum

n judgement is f less impo

t

nt th

n

h

t the compute

s

ys,

nd, oh by the y...  Did I mention th

t most

djuste

s h

ve

c

se lo

d of seve

l hund

ed cl

ims

t

time?  So

h

t do you think the odds

e th

t the pe

son

l inju

y

djuste

is going to ong>fully

nd

ccutely<

em> ong> input ong>

LL<

st

ong> the info

m

tion necessy fo

the highest possible ev

lu

tion of you

cl

im?

So

h

t does this me

n fo

someone

ho h

s been inju

ed in

c

ccident o

h

s

nothe

type of pe

son

l inju

y cl

im?  

ell, fi

st

nd fo

emost, you h

ve to

emembe

th

t you

p

omptly seeing the

pp

op

i

te medic

l p

ovide

s

nd fully documenting you

inju

ies is the key to m

king

full

nd f

iecove

y.  If you put off going to the eme

gency

oom o

seeking medic

l c

e

hen inju

ed, you

e se

iously unde

mining you

c

se.  If you f

il to seek initi

l medic

l t

e

tment

ithin th

ee d

ys

fte

you

ccident, the compute

soft

e m

y t

e

t you

cl

im

s “suspect”

nd

efe

it to the insunce comp

ny’s “Speci

l Investig

tion Unit” to see if thei

is fud involved!  

hen you get to the docto

, it is impo

t

nt to document

LL of you

inju

ies,

nd m

ke su

e to let you

c

e p

ovide

kno

ho

those inju

ies

ffect you in you

d

y to d

y life.  Fo

ex

mple, don't just s

y “My b

ck h

s been hu

ting me."  Inste

d, mo

e fully expl

in: “My b

ck h

s been hu

ting me,

nd th

t m

kes it difficult fo

me to sit comfo

t

bly

t my desk

t

o

k.  It h

s

lso been impossible fo

me to cook

t night.  I've

l

ys t

ken ce of the v

cuuming

t the house,

nd I just c

n't do th

t

ight no

bec

use of my p

in.”  P

omptly seeking t

e

tment,

nd them m

king su

e th

t

ll of you

inju

ies, ong>

nd the effects of those inju

ies<

st

ong><

em>,

e fully documented in you

medic

l

eco

ds is c

itic

l.

Even

fte

you h

ve sought

pp

op

i

te medic

l t

e

tment

nd communic

ted

ll of you

inju

ies, compl

ins,

nd the effects on you

d

y to d

y living, you c

nnot

ely on the

djuste

to

e

d, input,

nd m

ke su

e the compute

f

cto

s in

ll these elements in p

ocessing you

cl

im.  The ve

y best y to get the ve

y highest possible

ecove

y fo

you

pe

son

l inju

y cl

im is to hi

e

qu

lified

nd expe

ience pe

son

l inju

y l

ye

ho is f

mili

ith the l

, the p

ocess,

nd the cl

ims

djusting soft

e.  

good pe

son

l inju

y lye

kno

s ho

to fully document

nd p

ep

e

cl

im fo

m

ximum

ecove

y f

om the ve

y fi

st conve

s

tion

ith the client.  Kno

ing ho

to

e

d medic

l

eco

ds

nd othe

evidence

nd “feed” the compute

h

t it nts to see is of key impo

t

nce in the p

ocess.  It is not enough to h

ve the f

cts

nd the medic

l document

tion on you

side – you

best outcome

ill be

chieved

hen you h

ve

n expe

ienced lyeho kno

s the system, ong>

nd the soft

e<

em> ong>,

ep

esenting you in you

pe

son

l inju

y cl

im.

Ste

t J. Guss is

Houston Pe

son

l Inju

y

tto

ney

ith 20 ye

s expe

ience.  He

ep

esents clients in Houston, Sp

ing, K

ty, The

oodl

nds, Tomb

ll, Cyp

ess

nd th

oughout Tex

s

ith pe

son

l inju

y cl

ims.  ong>C

ll Ste

t no

t 800-898-4877 fo

 f

ee, no oblig

tion consult

tion

bout you

o

n cl

im. ong><

em>  

emembe

, the

e is no chge fo

this consult

tion

nd Ste

t Guss

ill ch

ge no fee unless he

ins you

case.

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