Turns out insurance companies are not on your side. It is a hard truth, but insurance companies market themselves as if they are here to put your interests first while using the power they have to decide who gets paid, and who gets denied. In 2015, the Texas Department of Insurance reported millions of newly filed claims, but over half of these cases were closed without any payment. The toll of the tactics used by insurance companies is clear: injured Texans are not compensated.
Complex cases, especially those without attorney representation, can take lower priority. Insurance companies recognize that a lawyer is more likely to know the law and what insurance companies are required to do. They know they can try to take advantage of a person who does not have this specialized knowledge or negotiation skills.
The less clear liability is, the easier it is to try to confuse or delay the process in an attempt to reduce or deny payment. Most insurance claims do not even reach an insurance company’s attorney, and are left in the hands of the claims adjuster who is free to use any tactic to save the insurance company money.
- Running Out the Clock
Several months can pass while insurance claims adjusters manipulate the system to try to avoid having to pay claims and save their company money. They recognize that the average person may not be familiar with the laws or deadlines that apply to their claims, and use it to their advantage. If it means paying less money, many insurance adjusters are willing to wait patiently to see if the injured claimant will simply give up, cut their losses and disappear.
Meanwhile, an insurance company has the resources to play the waiting game and improve their bottom line. A working person cannot always afford to fight the claim and go to trial. An insurance company will not reward its adjusters for paying your claims quickly.
- Paying in Pieces
Insurance companies would rather pay a fraction of the claim to avoid any charge that the claim was completely denied. This can be done in many ways.
The adjuster can undervalue the claim by recognizing that some money damages should be awarded, but fail to pay the full value of all the damages due. This means that even if your claim could be worth $100,000, they can find ways to reduce it by thousands of dollars. Never settle for less than your claim’s worth. Without evidence of a particular injury’s value, the insurance company may simply state how much they think the claim is worth and tell the injured claimant to take it or leave it.
Insurance companies can also use a forced structured settlement. This means that, rather than paying a claim all at once, the company will pay the claim in little amounts over time. The insurance company is then free to invest the money they save for its own benefit.
By making a low offer to settle a claim, an insurance company can try to force the claimant to make multiple requests on the same claim. After, the claimant is forced to file a lawsuit just to recover the total amount of the claim’s value.
- Sending you to their doctor
In some cases, insurance companies can simply send you to their pre-approved doctors to get biased medical opinions on treatment and what they think the value is of the damages you suffered. This can also happen in worker’s compensation cases. The insurance company is not going to send you to the best doctor who is going to recommend you get the full extent of treatment possible. The insurance company is going to send you to the doctor who favors the insurance company over the patient, and who may minimize the injuries suffered. For example, the insurance company doctor can say you only need basic medical care, rather than long term rehabilitation.
Insurance companies can also assume that you can return to work as normal without ever seeing a vocational rehabilitation specialist. And if a person does not seek medical treatment because they do not have insurance, insurance companies assume no injury happened even if the injured person could have been compensated for the injury.
In fact, many attorneys recommend that their clients do not to sign any paperwork while at the doctor’s office without understanding what exactly they are signing and ensuring the client and doctor are only ones in the doctor’s office — not someone who claims they need to be in the room but actually reports back to the insurance company.
This also applies to experts. Insurance companies not only pick which doctors to send you to, but they also pick experts who will support any claims the company makes. Experts can testify on everything from safety requirements and policies to what they believe should have happened, instead of what actually happened in your accident. They are given one task – to justify the insurance company’s position for denying or reducing your claim. But this smokescreen is to justify and cover up the fact that the adjuster or supervisor’s simply decided to deny or reduce your claim.
Similarly, they may use depreciation tables that have nothing to do with your case to convince you that your claim is worth a lot less than its actual value.
Some insurance companies go as far as invent a fake witness who gives a statement that the claimant is actually at fault for the accident. This is because Texas is a modified comparative fault state, meaning if the court decides you are more than 50 percent at fault for the accident, you are unable to recover any damages.
- You’re on the record
In some cases, defendants or insurance companies will ask injured claimants and witnesses to give a recorded statement. Presenting it as a routine matter to go over the basics of what happened with your accident, the insurance company can ask claimants and witnesses to give recorded statements over the phone or in-person. Then, the insurance company turns around and uses it against them later.
- Social Views and Stigmas
Whether it is your social life, like being a member of a particular organization, the clothes you wear to court or your lifestyle, insurance claims representatives consider how they can use the simplest aspects of your life to create a storyline against you. Many will even check out your social media pages like Facebook or Instagram to see if the injuries you claim to have are as serious as you are making them seem. For example, if you claim you hurt your arm in an accident, and then post online about playing baseball, the insurance company will claim you were not really injured.
- Forcing Arbitration
Even though you are entitled to the same benefits, some insurers may refuse to investigate unless the injured claimant enters arbitration of their claim. Arbitration is a kind of meeting where both sides come together outside of court and have their issues decided by an impartial third-party arbitrator. While sometimes this is the right call, you should have an experienced attorney help you plan your case since some cases that go to trial result in more money for the claimant.
- The Blame Game
The insurance company can also blame the claimant for not doing his part to help himself. If it can, the insurance company will say the claimant let his injuries get worse out of neglect or on purpose to try to get more money than they need. The insurance company will ask why the claimant did not do everything he could to make the situation better and mitigate his own damages. It may also rely on the fact that you did not provide all the required documents for your claim to create delay and shift responsibility. By shifting the focus of the issue, the insurance company tries to put injured claimants on the defensive. Rather than allowing you to build up your claim, insurance companies use these techniques and more as strategies to get you to back off your claim.
- Keeping quiet
In some instances, insurance companies can also simply keep quiet and fail to tell you what you are entitled to receive. For example, it may try to hide the fact a claimant is able to get a rental vehicle and suggest the claimant have a friend or family member drive him or her around. Another example happens when the insurance company tells an injured claimant who missed work to use vacation or sick days instead of paying for lost wages. The insurance company can refuse to pay for the loss in value of an expensive vehicle that is damaged in a car accident and loses market value as a result (often called a diminution in value).
Contact an experienced personal injury lawyer
Navigating complex personal injury cases and handling insurance companies can make the recovery process even more difficult. Experienced attorneys strategically weigh the cost and benefits of each case to minimize the time and expense involved while maximizing their clients’ compensation.
Are you trying to secure your financial recovery with the help of experienced attorneys? If so, we can help.
The Pusch & Nguyen Law Firm has helped countless Texans handle their insurance disputes. Our experienced trial lawyers have gone up against some of the biggest names in the insurance industry while successfully bringing home payouts for clients. Our successful reputation speaks for itself, and with offices in both Houston and San Antonio, we are well equipped to assist Texans who are in dire need of our services. Register online for a free case evaluation or call us today at 713-528-8108 (Houston) or 210-702-3000 to schedule an appointment with a member of our team.