I use reddit to investigate anything and everything before I make a lot of big decisions. Reddit is filled with knowledgeable professionals and hobbyists who can share their knowledge.

One of the big gaps in Reddit's knowledge base is regarding insurance, especially the way accidents are investigated by insurance companies, and how injury claims are valued and settled.

The comments on post were my annual reminder that I can give back to reddit by offering my knowledge about this subject.

I am a licensed personal lines property and casualty adjuster handling claims in North and South Carolina, but I should be able to answer general questions about investigations and settlements wherever.

If anyone wants proof, I can dig up a picture of my adjuster's license and post it.

Personal injury attorneys, and other adjusters, especially my comrades from /r/insurancepros feel free to step in, too!

I am at work, but I'll check for questions throughout the day and try to give thorough and thoughtful responses.

I'm going to answer every single question, but with the speed this is picking up, it's going to have to wait until later today--- keep them coming!!!

Edit-- STILL going to answer every question, but I'm leaving work now and it may be a few hours before I return. KEEP 'EM COMING!

Edit 2-- I'm still working through questions. Won't get to everything tonight, but I hope to by end of tomorrow. Thanks for the questions everyone!!

Edit 3-- This is taking longer than I thought-- I will answer every question eventually-- sorry for the wait, everyone.

Edit 4-- I haven't given up! Just took a break! Feel free to keep posting questions and I'll get to them when I can. I am cautiously optimistic that I have about 50-75 questions left as of 01/04/2019

Comments: 1362 • Responses: 37  • Date: 

rjamestaylor567 karma

I was involved in a 2 vehicle accident in November. I was on a rented motorcycle (on vacation in another state) and was traveling straight across an intersection with lights and unprotected left turns. I was the second vehicle in my lane and the other party turned left in front of me thinking there was a gap between car 1 and vehicle 3–they didn’t “see” me.

Fortunately, I had gear and while I landed on my helmet, lived — although with injury to my neck which still prevents me from using my right shoulder (I’m icing it now after awaking in pain, as usual). Also, fortunately, the police report states the other vehicle “failed to yield” and the other party stated they didn’t see me.

On Friday, the other party’s insurance company recorded an interview with me (my lawyer was on the line) and I gave a simple recounting of my memory of the events. After the recording was done, the other insurance rep stated that they would be accepting full liability.

Question: the damage to the vehicles and initial hospital visit bills are in, but the care to get me back to where I was regarding my neck/shoulder is ongoing (MRI and electro conductivity monitor test results are not yet in due to holiday scheduling), what does the adjusting process look like here forward for the ongoing treatment costs? Or would your part not include this aspect?

Luthalis856 karma

This is actually the first question that is perfectly suited to what I do, haha.

First off, glad to hear you're OK (compared to dead or fractures, etc.) and that the adjuster was reasonable and accepted liability for the accident.

Is your attorney representing you for the loss? That changes the process considerably in a few ways-- I'll go over both for those that are interested.

Attorney represented:

You finish treating and your attorney gathers all the bills and records and writes a letter to the adjuster that includes it all, plus (typically) a demand for $X that is a whole number they want to settle the claim-- a "Full and Final" amount. The attorney doesn't actually expect to get this amount a vast majority of the time-- they will request $40,000 when they know the value is really $8,000, etc. The exception to this is when injuries are very serious, or fatal-- attorneys in those cases may request policy limits and the adjuster will be very glad to write that check and be done without any back-and-forth. This process could take anywhere from 6 months to a couple years, depending on how long you treat and how quickly your attorney works to gather bills and records, etc.

In the event that negotiations break down between the adjuster and the attorney, the attorney may decide to file suit, instead of negotiating the claim. I can only speak to North and South Carolina in this case, but the case would then likely be "mediated" where the insurance company hires a defense attorney to represent their insured. Each party goes to a mediation with their attorney (So, adjuster, attorney on one side, and you and your attorney on the other-- sometimes the insured will go, as well.) A arbitrator mediator, who in my experience is typically a retired judge or very experienced attorney, will act as a referee to try and have the two groups reach an agreement to prevent suit from actually being filed. If no agreement is made, then it moves onto actual court and will be tried by a jury and an attorney would be much better at describing the process from there than I would.

If you're not represented:

I would follow up with you every few weeks to see how your treatment is going and what updates there are. Trying to constantly evaluate how long I think your claim is going to pend for. If you don't have any fractures, I would probably try to get you to settle on a schedule release that says we will pay for your medical bills when they come in (up to X amount, like $10,000), plus I pay you a settlement now. If you say you're not interested in that and that you want to be back to 100% before you even consider settling, then I'll ask you to sign a medical authorization so I can gather your bills and medical records over time and just continue to follow up with you.

You have a soft tissue injury and adjuster's are coached to believe that soft tissue injuries typically self-resolve within 12 weeks a vast majority of the time. I can only speak for myself, but if you aren't interested in settling within a month or two, you're automatically going to be less of a priority for me. I'll call you once a month or so to see what updates you have and if you want to settle, but people who treat soft-tissue injuries for longer than average typically aren't receptive to quick settlements and will only discuss when they're good and ready, so I don't waste time trying to sell you on the idea. Eventually, you'll be done treating and I'll gather all the bills and total them up and figure out what a fair amount for the settlement part is separate from your bills-- what we call the general damages-- and add them together and make you an offer.

Now, this will be contentious with other adjusters and I'm probably in the minority here: ** I typically don't care how much your bills cost** I could care less if I pay $2,000 for your hospital bill or $1,800. I want to find the shortest path possible to writing you a check and never talking to you again. If you don't give me a reason to look closely at your records and bills, I'm not going to. It doesn't benefit me.

If you ask for a ridiculous sum, or get weird holistic treatment over a long period of time then you're setting off red flags that put me on the defensive. People that do those things, a majority of the time, are difficult to settle with and I have to start taking measures to keep from getting hosed-- similar to how we have to work with attorneys.

See, in a perfect world we agree the claim is worth the cost of your medical bills plus $X +/- $500. If you throw out a reasonable number to me, even if it's $500 more than what I want to pay, I'm probably going to say "SOLD!" and settle the claim. The problem is that people don't know what their claims are worth. They read something online, or they had an uncle who got a crazy sum because of some very specific reason in the claim that you don't know about and you have a skewed view of what the claim is worth.

What normally happens with soft tissue injuries that pend for a long time is someone says, "I want $30,000 on top of my $6,000 in medical bills being paid." The adjuster knows that this claim normally settles for around $10,000, full and final and they make you an offer of $8,000.

Why didn't they just offer you $10,000 if they know that's what the claim is worth? Because you don't know that, and you have created a sort of self-fulfilling prophecy where the adjuster has to play the negotiation game with you in order to settle the claim for what it's actually worth.

People tend to interpret this as the adjuster trying to screw them over, but it's actually the adjuster trying not to get screwed. Imagine if the first offer I made was for the true value of the claim? Every rule of negotiation, every personal injury attorney commercial you've ever watched, every reddit post about settling claims has prepared you to think I'm lying to you and want your kids to get cancer. Of course you think I'm out to fuck you.

One thing that should be pretty universal is that you are not getting your bills paid until you settle the claim. IT IS OK FOR YOUR HEALTH INSURANCE TO PAY FOR THE BILLS WHILE YOU WAIT TO SETTLE A lot of people freak out for no reason when their health insurance pays for medical bills that we're responsible for. Cool your jets. We're going to pay them back when we settle. It's not a big deal.

One thing I recommend keeping in mind 100%: Odds are your adjuster just wants to pay you and move on. Don't attribute anything they do or say to malice-- understand every action they take is motivated by getting to the point that they never have to talk to you again. Pissing you off when they don't have to is going to prolong that process. If they are saying something is a way, odds are that's because it is that way. If you feel the need to question something, do so in a measured and logical way and BE NICE.

I probably mentioned it somewhere else in this novel I seem to have written, but adjusters will make "pets" out of people who piss them off. I will teach people every loophole possible and fudge the numbers to get them more money if they are kind and reasonable. Conversely I can allot for having a few extra claims on my desk and draw your claim out if you're an asshole. It's really, really, really hard for us to not pay a medical bill that is related to an accident. But maybe I get your voicemail at 9AM, but I hate you so much I don't want to talk to you and put it off until 4:30. There are lots of little ways I can be your friend.

At the same time, some adjusters are just assholes with an axe to grind. They think every claim is bogus and everyone is faking it. My advice above still applies. Being an asshole to an asshole doesn't make your situation any better.

Whoooo-- that was a lot.. I hope this answers your question, but please feel free to follow-up if I completely dodged it, or you have follow-up. Thanks!

**Edit - /u/spacemanspiff30 pointed out that few mediators are retired judges in his experience, and that, for some reason, means the rest of this information is useless. Please do not listen to anything I've said and contact him directly with future questions.

CodexAnima15 karma

You also have to consider people's policy limits. The person who hit me caused my injury and had a cap of $15k payout on injury. (State minimum suck.) The final letter to the adjuster pretty much broke down the numbers into 'you are going to pay the policy maximum because the case is worth that's with all the medical liens and such. And I have a disk that bulges slightly for good.

Only sticking point was having to send in a paystub to show lost salary. Because they were used to dealing with minimum wage people and my hours lost were.... A lot higher.

Luthalis10 karma

Yep, states like PA have pathetically low liability limits and I've always wondered how they manage to get things settled and if it's easier or harder when all you have to do is stroke a check for policy limits on a lot of your claims compared to relatively few.

It's been a while since I've dealt with PA and I can't recall if underinsured motorist bodily injury coverage is a thing there-- but that would help someone in your situation recover after the other person's coverage is exhausted : )

jocksmells6 karma

This thread makes my stomach churn. Injured people trying to work through a for-profit medical and insurance system is a perfect dystopian nightmare. While this particular insurance agent seems on the side of Nice Guy, you can see he’s got his own axes to grind with people he deems assholes. Meanwhile, to those assholes who are undergoing trauma, they’re less of an asshole but guess what / the system churns on, splintered bones and coagulating blood as lube, claims adjusters shrugging off their daily guilt with a fresh pot of coffee and some social media before the morning commute.

Luthalis7 karma

Yeah, I expected a few comments like this.

"Who are you to determine who gets 100% of your help and who gets less?"

Let me be as clear and candid as I can possibly be without accounting for every single permutation of me considering someone an asshole:

If you don't like how much money I'm offering you, that doesn't make you an asshole.

If you're angry because you got into a car accident that we're at fault for, that doesn't make you an asshole.

If you think that holistic medicine is the best/only way to treat, that doesn't make you an asshole.

Here are some things that do make you an asshole:

Screaming over me when I'm trying to explain something politely makes you an asshole.

Cursing at me or calling my integrity into question makes you an asshole "You fucking pieces of shit probably make $100 for every claim you deny!" Thanks, asshole.

Lying to me for monetary gain makes you an asshole. (And sometimes a felon)

People only see the plaintiff side of insurance claims because that's what TV/Movies and plaintiff attorneys have trained them to do. On the other side of that coin are adjusters trying to keep people from losing their livelihoods and keep premiums down so that people can afford to insure things.

You can keep thinking I'm arbitrarily determining who gets help and who doesn't, but I promise you-- it is very clear who is a prick on my desk, and at the end of the day, they're getting the same offer as anyone else.

acatinasweater213 karma

In woodworking shops there are tools that will immediately stop the blade from moving if they contact skin. Does the insurance industry do anything to incentive purchasing this type of equipment for cabinet shops and similar operations?

Luthalis148 karma

I would love to answer this, but unfortunately commercial policy pricing is a bit out of my wheelhouse as a personal lines adjuster. I investigate and settle injury claims when an individual is liable, like if you hit someone with your personal vehicle, or if your dog bit someone.

Generally speaking there are steps you can take to save you on your insurance premiums, but you'd need to check with your agent to see what those specific things are. Insurance tends to follow the letter of a document very precisely, so if there is a provision for as discount, it would be very specifically spelled out in a document someone.

TL;DR Unfortunately, this would be a better question for an agent, or perhaps an underwriter or commercial claims adjuster. I imagine there may be discounts for safety provisions, but I don't know for sure.

alicecarroll29 karma

IAMA commercial underwriter. 21 years. Can I join in?

Luthalis18 karma

Please do!!

Claminator609180 karma

As an average American suburban homeowner and vehicle driver, what are the best things I can do to protect myself from liability?

I have a dash cam in my car, and am thinking about putting outdoor cameras around my property. Thoughts?

Luthalis299 karma

Having a dash cam already puts you well ahead of the game, so great job there! Cameras around your property can't hurt, as well.

Here are a few random things that come to mind without going too deep down a rabbit hole:

Be aware of defects/exposures on your property that could cause harm to others. Is there a big hole in your yard where the neighbor kid could twist their ankle while mowing your lawn? Does the lip of the 8th stair on the porch bend a bit too much when it's stepped on?

Do you have a trampoline, or a pool? Consider consulting an attorney to draft you a release of liability that people have to sign before using your amenities that includes a list of "rules" like no running, etc. And go over the list with everyone before having them sign it. Hell, if you're having a big party, video tape yourself giving a speech to everyone with all the rules before festivities begin.

Consult your state for laws about recording without permission, but if you're ever involved in an accident having your phone recording immediately when you get out of the car would save a lot of people frustration later. People get scared for silly reasons and change their story later, so having a recording of your initial conversation with the other parties in a loss can be very useful.

Get pictures at the accident scene BEFORE CARS ARE MOVED.

If you let someone drive your vehicle, or house-sit for you-- make sure they are trustworthy because your car/home insurance is on the hook if they screw up.

I may think of others and amend later. Hope these help!

bkcmart209 karma

Do you have a trampoline, or a pool? Consider consulting an attorney to draft you a release of liability that people have to sign before using your amenities that includes a list of "rules" like no running, etc. And go over the list with everyone before having them sign it. Hell, if you're having a big party, video tape yourself giving a speech to everyone with all the rules before festivities begin.

Does/Would anyone really do this?

I really don’t want to live in a world where this is necessary

tatsontatsontats101 karma

Pools and trampolines are what we in the industry call an attractive nuisance and come with a fun thing called strict liability. Protecting yourself from that in any way possible is good.

Edit: but it isn't always practical or possible.

bkcmart63 karma

If I was invited to a party and he host made me sign a waiver, or made me listen to an orientation speech before going in he pool I’d leave.

Sometimes being prudent and being practical don’t fit.

PersonInYourMirror274 karma

As a member of my local BDSM community, I can say that having to sign a waiver is a strong indication that it’s going to be a fun party.

Luthalis76 karma

Hahah, favorite comment in the thread!

gelfin12 karma

Consider consulting an attorney to draft you a release of liability that people have to sign before using your amenities

This might be apocryphal (why I'm asking) but I've occasionally heard people suggest that disclaimers and waivers and the like can be flipped back against the defendant by using them as evidence that he was aware of a danger, like putting up a "Beware of Dog" sign implies the property owner should have put a "dangerous" dog down and chose not to, or "No Running" signs around a pool imply knowledge of a hazard that should have been remedied with whatever insanely expensive and exotic safety equipment the plaintiff can imagine, in hindsight, would have mitigated his specific accident.

Is there any accuracy to that or is it just bunk?

Luthalis16 karma

This is probably irresponsible of me to comment on without being 100% sure, so take it with a grain of salt. To be safe, I'd consult an attorney (Calling any attorneys!!!)...

.....but in NC I Believe that there is specific case law that prevents measures to mitigate an exposure from being used against someone. The example I seem to recall is actually post facto when someone was in a loss that involved a trailer, and afterwards they took steps to make it more visible.I think what happened was it was determined that this could not be used as evidence that they were aware of a hazard.

This is only for NC, and I could be thinking of something else entirely. If I remember, when I'm going back through these, I'll try to find the specific statute/case law that I'm thinking of. Maybe we'll both learn something, haha!

spryfigure1 karma

And go over the list with everyone before having them sign it. Hell, if you're having a big party, video tape yourself giving a speech to everyone with all the rules before festivities begin.

CAUTION: This makes you into a person who has nothing better to do on NYE than answering an IAmA.

I know that you are technically right, OP, but come on...

Luthalis2 karma

But it's true! Shit, I should be doing my actual work now, but I keep getting tempted to check back for more questions lol.

HueSacco157 karma

What was the most difficult claim you had to deal with? (I guess in terms of determining liability, without giving too many details if that might be an issue.)

What was the easiest claim?

Luthalis423 karma

The claims that haunt me are the ones where I don't feel like I had an opportunity to do the right thing by my gut, but have to perform my duties as an adjuster.

Example:

A and B are driving next to each other on the highway and they each say that the other person side-swiped them. A says B side-swiped them, B says A side-swiped them. Minor accident, a couple thousand dollars in damage. Insurance investigates and liability can't be determined so they say no one is at-fault, or they both are (Same difference).

The trouble is, A is really sketchy when you aren't talking about the actual accident. Like, A says they are super injured in the accident and can't stand properly anymore and they go to the emergency room 5 times in 5 days even though there are minor damages to the cars , and they lied about their car having a salvage title (They took a settlement for the car 2 years ago and 100% knew it was salvaged) and are angry that we found out about it, and just generally makes stuff up until they get caught. The trouble is-- both people's statements are pretty basic. I was driving straight, suddenly I felt an impact when the other person merged into me--- there's not a lot you can do with that.

I can't note my file saying, "My insured has proven themselves to be untrustworthy when discussing other matters, so I think they're lying about the loss." That can be considered "bad faith" and will get me and my company in big trouble.

So, you can have a really nice, genuine person and genuinely believe that they aren't at-fault for a loss and still have to deny their claim because some accidents just don't have enough information for you to say your sketchy garbage person of an insured is at-fault.

Other tough claims to deal with are people who are just so far up their own ass they refuse to see logic. I had an insured back into a parked, unoccupied car that thinks not only should we not repair the other car, the owner of the parked car should pay for his damage. Their apartment parking was full and the other person parked perpendicular to the parking spaces against a grassy median. Bottom line, you hit a parked car no matter where it is, and you're going to be at-fault.

He just filed a department of insurance claim on me the other day. The irony of that is adjuster's get garbage all the time for denying claims (I probably deny fewer than a dozen claims a year out of the 200+ that I handle), but this time I'm getting bitched out for paying one.

The easiest claims are the ones where I don't have to do anything--- coverage cancelled 2 years ago and for some reason our insured gave the cop this old insurance card. I tell people, "Sorry, no coverage" and write a couple letters so they can use their own insurance in the easiest way possible.

TL;DR: Hardest: When I can't prove that a liar is a liar., and ignorant assholes. Easiest, when a claim is filed on a cancelled policy.

JP_HACK126 karma

Question: I let my roommate borrow my truck from time to time. If he gets into an accident, does it fall into my insurance or his? The truck is owned and insured by me. I do not believe he has insurance in general as he does not own a car. Is this a big no no?

Luthalis223 karma

Remember this well: Insurance typically follows the vehicle, not the person.

If anyone you allow to use your vehicle causes an accident, your insurance will be primarily liable since they insure the car. This could be different in other states and for other insurers, by my company always handles NC and SC losses this way, and I know 100% that in NC this will always be the case.

Your insurance company 100% wants to know that this person if they are using your car more than once a month. I would have a frank discussion with your room mate about how you two will handle it in the event he gets into an accident while using your car. What about your deductible? What about your increased premiums? What if we kills someone?

After insurance has been exhausted, an attorney would be better suited to describing how the two of you could potentially be pursued personally, but up until that point-- your insurance will be on the hook.

It's not a big deal to let someone borrow your vehicle, but it is important to be aware of the potential consequences.

I hope this helps!!

Edit: As /u/spacemanspiff30 points out, insurance does not always follow the driver. In my experience in NC and SC, insurance companies will still treat the insurance as though it did, however. My company always treats insurance on the vehicle as primary and any unlisted driver insurance as secondary, even in SC. That said, My knowledge of law pales greatly in comparison to an attorney, and you should always defer to their advice in situations like this. Sadly, /u/spacemanspiff30 's main goal seems to be undermining my advice, rather than doing much to help anyone. Unfortunate that we aren't able to utilize his vast knowledge in a more beneficial way, but at least his peers seem to be trying to assist.

lawinvest61 karma

PI Attorney here—

Not sure which company you’re with, but generally speaking, what can we be doing to make your lives easier / increase the speed and efficiency of resolving client’s claims?

Luthalis88 karma

Hey! Here are some things I love to see happen:

Update me on your client's treatment every month.

Update me on the specials as you tally them.

Include an actual demand in your demand letter-- some attorney's just send me a list of specials with no demand for settlement.

Once you've sent me the demand-- let's knock it out. Get authority from your client for your real, true, bottom dollar offer and let's just get it settled. Few things are more frustrating on rep'd claims than waiting a week to get a counter when we could just get it done in 5 minutes and move on.

I get that sometimes that is a bit of a tactic for getting away from a disadvantageous negotiating position, but that is 100% what I'm thinking when I call an attorney to actually start negotiation "Let's just get to the number we're both going for and be done."

Hope this helps!

Ky1arStern50 karma

Often times I'll see threads on Reddit where someone gets in an accident and the car is declared totaled. They claim the insurance company is willing to provide them $X for the value of the car (because the insurance company deems it totaled), but a replacement comparable car might cost $X + $1000, and that number goes up when you factor the time and stop-gap measures needed to actually find and purchase a "new" car. I put "new" in quotes because the car someone is looking to purchase in this case would be a used car, just new to them.

Is there any way you would recommend or any recourse for attempting to get an insurance company to pay more for a totaled vehicle. Likewise how are things like recently bought tires or other maintenance accomplished factored into the valuation of the 'totaled' vehicle?

Luthalis84 karma

Honestly, even though we get a lot of bad press for bodily injury stuff, this is where the bad part of a claims experience lies for most people. I don't handle vehicle settlements as a bodily injury adjuster, but I do talk with a lot of people who are frustrated about their experience.

As /u/dnumov mentioned, building your own case for the value of your vehicle is the best option. The adjusters who handle these types of claims are very hardheaded and see things as black-and-white because that's what their job demands. A car is worth a range from A-B because we can see what the cars are selling for, period-- that's how they view it.

The best thing you can do to get the most out of a total loss is

  1. ALWAYS GET GAP COVERAGE EVERY SINGLE TIME YOU FINANCE A CAR, NO EXCEPTIONS EVER PERIOD

  2. Do your own research and find comparable vehicles to your own within 50-100 miles of your house and compile an easily digestible report that you can e-mail to the adjuster. If you can show that the range is 10K-11K instead of 8K-9K, they will listen. None of the adjusters I know are rated on how much money they save their company-- we are typically rated on how quickly we can get something off our desk. We still have to make sure our files are supported with evidence, but if you can help us prove you deserve more money, we are generally glad to do it.

  3. Don't make a pet out of yourself by being an asshole. Adjusters are super-duper stressed out ALL OF THE TIME-- especially total loss adjusters. If you give them a reason to take it out on you, they will. My favorite people to work with are the ones who don't treat me like the boogey man and can "agree to disagree" without being a dick. YMMV, but I love helping people, even if we disagree about something, as long as they aren't an asshole to me.

HB2410 karma

Is your name Tyler Durdin?

Luthalis28 karma

For you baby, I could be.

icheezy2 karma

It is shocking how many times you mention not to piss off adjusters because they will make you a "pet" and how much you feel you can help the people who are nice to you. What an astonishing position to take when you are making critical decisions for people potentially dealing with massive amounts of pain and life changing situations. Thank you for being a nice person, but in my opinion insurance is a really messed up model that puts profitability and humanity in direct contention, and we should get rid of the industry as a whole

Luthalis6 karma

I understand where you're coming from, but honestly the advice tracks in a lot of important interactions with have-- the loan officer at the bank, the car salesman, the police officer who pulled you over for a broken tail light--- the best advice I can offer in every situation with another human is that it is not beneficial to be an asshole.

I mention it a lot on here because people tend to think of adjusters as scum of the earth and that can give the impression that it's OK to go confront them half-cocked and demand what you feel you're owed.

The point that I'm trying to make by saying you can be made a pet of is that dealing with a claim can be a very frustrating experience for the individuals affected and taking it out on the adjuster can affect you in ways similar to the other situations I mentioned above. There are abuses of power in every possible opportunity for them, but generally speaking if we are kind to each other, we reduce the opportunities for motive to abuse said power. Not eliminate them, but at least mitigate them.

With all of that in mind, few people are suggesting we get rid of cops, or banks, etc. because they could dislike us and slow or stop whatever process we're trying to get through.

Does that make sense?

KSrager9222 karma

Insurance defense attorney here. I have heard stories, but never really confirmed. At around 4:00 p.m. and on Fridays, do the phones and email servers on the claims floor tend to shut off? For some reason, we usually find it difficult to reach our clients at this time. Is there a 4:00 party we never get invited to? A friday get-together we are missing out on? Perhaps even an adjuster ritual you have to have special membership to participate in?

Thank you!

Luthalis42 karma

So, every Friday we pile all of the claims we settle that week into a big pile and set them on fire and burn them in effigy to the claims Gods asking for then to bless us with low pending and reasonable claimants.

We used to invite defense attorneys, but there was an issue where one used to work as a personal injury attorney and when we were doing the ceremony, he too caught fire and so we decided it's better safe than sorry.

You're not missing much, they never get enough pizza to go around.

KSrager9213 karma

This gave me a good laugh! Thanks!

I'm rather new to the insurance defense game, so if I can ask one more question. Aside from missing important deadlines and serious mistakes, what would you say are the top three things that are sure to get one of your attorneys (or firm) fired from an account?

Luthalis12 karma

Oh geez, those decisions are made well above my head. We have a litigation team that handles files in suit, and I've been to a few mediations myself, but never seen a firm get fired from a case.

In watching leadership work through who to hire or not the only big things I hear are who has the most experience, who got us a good verdict this one time, etc. Etc. It seems to be a really hard game to break into unless you've done the work before.

Sorry I cant be more helpful here, but I wish you luck!

Bathbodyworks14 karma

Is it true that some adjusters scan social media to see if people are exaggerating their injuries? And what other methods do you use to investigate the legitimacy of reported injuries (other than medical records)?

Luthalis63 karma

There are degrees of severity when it comes to injury claims. Typically social media is only getting checked when there's a lot of money on the line-- 6-figures+.

However, there have been a few odd characters that I have checked out on facebook because they made it obvious they thought they hit the lottery when we tapped their car in a drive-thru.

Typically, there's not much I can do with those except feel validated in believing they are garbage whent hey post a FB status like, "SOME HO HIT ME AT MCDONALDS?! GIRL U NO THIS BITCH BOUT TO GET PAID! HOLLA!!!". When someone seems to see their injury as a positive event in their life, I get highly suspicious-- again, not much I can do about that for a low dollar claim.

I had a person who claimed their phone screen shattered in the accident. Something she did/said made me really suspicious or curious about her, so I looked her up and she had posted to facebook that they dropped the phone when they were at the ER after the accident and it shattered. I screencaptured that it put it in my file and told her about it. She wasn't happy, tried to say that she broke it in the accident, too, but the ER drop just made it worse (And decided to only post once). We didn't pay for her phone.

Now, when it comes to high-dollar claims insurance companies will actually pay specific people to do social media searches and come back with the result. I know that reddit tends to look on this as companies trying to underpay claims, but in my experience, it gets used in legitimate ways.

Your attorney keeps telling us that you love fishing and you fished 4 days a week and now you can't fish any more because your neck is hurt so badly and it was the one thing you enjoyed doing with your grandson. Well, we have a facebook photo album showing you backpacking through the mountains with 50lb of gear followed by a dozen pictures of you fishing and holding up fish, along with a status that says, "Loved fishing with my grandson this weekend! #Blessed"

Why shouldn't we use that to tell your attorney that they're full of shit? If that were true, what might that be worth? Hundreds? Thousands? So, when we can prove that it's not true are we supposed to say, "Damn, they got us this time" and pretend we never saw it?

We actually will pay people to covertly follow folks that we think are faking high-dollar injuries. I mentioned a story on reddit a few months ago of a lady who hauled a bunch of groceries from wal-mart and lifted the gate of her SUV when her foot and then an hour later when she goes into her doctors office she's borrowed her mom's cane and is wearing a neckbrace and can barely walk. We will absolutely use that. Again, this is only for truly highly valued claims. If your claim is worth less than $200K, you're not being followed, more than likely.

And you know what? The attorney will come back and say, "Well, my client's pain is intermittent and can strike at any time! The claim is actually worth even more than if she was in pain all the time because she never knows when this debilitating injury could affect her!"

Snowup14 karma

When someone comes on your property without your knowledge or permission (such as the neighbor kid jumping on your trampoline while you’re not home), and they get hurt, can you still be sued and held liable?

Luthalis25 karma

Yes, it is called an "attractive nuisance" and is generally applied to liability when children get hurt. The idea is that they can't be expected to resist things that tempt children, like toys, or stuff that they can play in/on.

A lot of homeowners insurance carriers will require you to disclose the trampoline on your application and will deny or augment coverage unless you take precautions like tall netting with a locked zipper, etc.

roudyrod12 karma

Here is something I've always wondered. Let's say I'm at home drinking beer and decide I need to go grab some smokes. I've had a few and my BAC is .10. I am waiting at a red light, it turns green, I enter the intersection and someone runs their light and T-bones me.

Without alcohol being involved, it's 100% their fault, does the fact that I'm DUI when the accident happened play into that at all?

Luthalis33 karma

This can be complex. If you're in motion when the accident happens, yes, your BAC is going to affect your claim. In some states in the US, like NC and VA, your claim will be 100% denied because of this.

However, I have paid claims where the claimant was drunk, but was stopped at a red light and we rear-ended them or something. Happened at a hockey game in Charlotte, actually-- a group of friends had all gotten hammered at the hockey game and were struck in traffic afterwards in 2 cars. Our insured came along and rear-ended one car, pushing them into the other. Both other drivers were drunk, but stopped-- they were even arrested for DUI afterwards, but I paid their injury claims and for their car damages. That one sucked because I loathe drunk drivers.

gatoradetiddies8 karma

I’m a claims adjuster fresh out of training (almost two months ago) and took my first fatality call today. The girl who died was drinking and driving and I had to file the claim with her mom. It was terrible. I knew before that drunk driving was awful but after having to speak with this girl’s mom... I can’t really express how much hatred I have for drunk driving now.

Luthalis7 karma

Welcome!

Yes, I am similar in that I've always hated it, but being an adjuster has cemented my hatred in ways I couldn't have anticipated. It is truly a selfish and horrible thing to subject other people to.

FluffyBlizzard6 karma

there is a hockey team in charlotte?

Luthalis7 karma

Oh hey, good call. I swear I remember it being in Charlotte, but I guess I'm wrong. I dont follow sports, so I never would have noticed if you hadn't said anything, haha.

kitikitish8 karma

What's for dinner?

Luthalis10 karma

I hope curry! A friend turned me on to this a few years ago and it's the only thing I have on monthly order from amazon. Highly recommend!

Mrsamsonite67 karma

Does it feel like you are at work right now having to answer all of these questions?

Luthalis27 karma

Man, if some random billionaire would pay me $70k a year to talk about insurance with people full-time I would 100% do it.

There is something about educating people on stuff that just scratches an itch for me. When you're working with someone on their claim, they don't want to hear what you have to say about the subject-- it's all lies, as far as they're concerned. On here, I at least get the benefit of the doubt from people looking for information.

Compared to actual work, this is paradise : )

somanyroads5 karma

How much money does a claims adjuster such as yourself make? What are the qualifications that improve one's income?

Luthalis12 karma

I believe the national average is $65K-- I make $51K in NC, but I don't have a degree, or any professional designations. I've been an adjuster for over 4 years, worked in insurance for over 7.

Designations definitely help. They are basically letters after your name that signify you've completed certain certifications. Most of the designations adjusters use come from a particular place called "The Institutes" that has a monopoly, basically.

The one that everyone in insurance wants to get is the CPCU-- the chartered property and casualty underwriter designation. It's 9 tests meant to be taken over a period of 9 months to 2 years or so-- each has it's own text book and classes you can take and costs between $250-500, but a lot of companies will reimburse your costs if you pass. My company even pays a bonus for each, and another when you complete.

Check out theinstitutes.com for a full list of designations-- there are 10+ I can think of.

imbobness4 karma

If someone rear-ends someone completely obliterating the other drivers car is driving on a suspended license and the insured in the passenger seat. Would the insurance company generally cover the accident? I know this is probably oddly specific but my BIL actually just had this happen and the company of the uninsured/illegal driver couple told him to eff off.

Luthalis10 karma

I am assuming that what you're asking is:

A driver with no license was operating a vehicle while the owner was in the passenger seat. They rear-ended your Brother-in-law and the insurance company is now denying the claim. Would this loss normally be covered?

If I'm wrong-- answer the questions below so I can better understand:

Who is driving on a suspended license- The person being rear-ended or the person doing the rear-ending?

The insured is a passenger in which car? The rear-ending vehicle, or the rear-ended vehicle?

Who is uninsured-- the rear-ending vehicle, or the rear-ended vehicle?

216132161310 karma

This is confusing. Please clarify the roles of the characters in this scenario.

Luthalis3 karma

I try to parse out better in my response, but yeah, it's quite confusing.

xBlaze1214 karma

How much is a kidney worth?

Luthalis10 karma

You selling? Let's talk in DMs >_>

wltdflwr3 karma

About 3 years ago, my son (then a Junior in HS) was hit with a baseball in the eye during practice. He had a concussion, orbital fracture, a hole in his retina and received stitches. As bad as it was, the injury could have been so much worse we were glad he was ok. The school never reached out to us and we never filled any sort of claim or complaint. His vision has never fully recovered in that eye and it effected his game play (He stopped playing baseball the following year after having played since he was about 8. He's 20 now. If he chose to, could he file some sort of claim against the school? We live in Chicago.

Luthalis5 karma

Possibly!

The operative question is what is the statute of limitations in Illinois. In NC, it's 3 years, but when a minor becomes an adult, that statute can reset from their 18th birthday, allowing them to pursue once they're older.

This is a case where I would definitely get an attorney involved to do the leg work for you here. It's worth enough to them that they should be willing to consult on this for free.

I hope this helps!

iamjacksliver662 karma

Is the formula car manufacturers use in fight club to figure out if a recall is done accurate. Basicly if cost of recall is greater then liability payout then the dont issue one? I'm actually serious on this.

Luthalis5 karma

This would be a question for, I believe, an actuary. Unless I'm mistaken, they are the ones who perform these sorts of assessments and make recommendations on what is/isn't an acceptable risk.

Actuaries feel free to chime in!

rasterbated2 karma

Does life insurance pay off triple if you die on a business trip?

Luthalis2 karma

Different type of insurance-- sorry, but I honestly don't know : / Maybe a roaming life insurance adjuster will happen upon us.

JudgeGusBus1 karma

What is your company's internal process for investigating suspected fraud, and reporting it to law enforcement?

Luthalis2 karma

My own workflow is that if I suspect fraud I refer the claim to our special investigative unit, or SIU. They are typically trained former law enforcement with some insurance background and they are pretty great at what they do because the field is very competitive to get into.

The SIU rep will determine if the claim merits reporting to the state for review or not. Every state has a different budget and different focus for fraud that changes over time. South Carolina for example is basically owned by personal injury attorneys and it's impossible to get people prosecuted there.

Putting on my tin foil hat here, but, suspiciously, the state has a very, very small budget and workforce for it's fraud bureau relative to where the state ranks in insurance fraud standings. Makes you wonder if the people making money off of fraud are influencing budgets for investigating said fraud.