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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.

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.


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.

Luthalis414 karma

Have your disabilities influenced the traits your children tried to mock as toddlers? For example, my son sees me put product in my hair every morning and so, as a 2-year-old, he puts any liquid he finds in his hair and tries to style, and any spray bottle is automatically hairspray.

Luthalis353 karma

FBI agents are the new black Friday.

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!