There are several ways an insurance adjuster may attempt to reduce the value of or deny an injury claim. The following are some of the specific methods insurers may use to achieve this.
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Shared Fault
Insurance adjusters may try to find out if the injured party contributed negligence or fault in the accident. Even if the injury victim shares minimal fault, some states may consider this to be contributory negligence and deny a claim entirely. In other states where comparative fault comes into play, the courts will determine what percentage of fault the injury victim shared, which can significantly reduce the value of the case.
Pre-Existing Conditions
Adjusters may also attempt to argue that a pre-existing condition contributed to a victim’s injuries following an accident, potentially further reducing the value of a claim or leading the adjuster to deny it entirely. This is why it’s crucial for injury victims to avoid signing a release for adjusters to obtain medical records without first consulting an attorney.
Diagnostic Tests That Don’t Reveal Injuries
If an individual shows no visible signs of physical injury after an auto accident or another incident, adjusters often reduce the value of costly tests such as CT scans and MRIs. These tests typically come at a high cost and insurance companies are hesitant to cover them completely. Subsequently, if tests don’t reveal the injury and there are no other clear visible signs of injury, adjusters are likely to reduce the value of the claim.
Early Medical Expenses
Adjusters frequently reduce the value of claims for certain medical expenses. For example, they may discount the value of early medical bills for a work-related injury if they cover early treatment, particularly if early treatment consists largely of diagnostic testing. Adjusters in these cases may argue that the injury victim hasn’t experienced a substantial amount of pain and suffering during the diagnostic process.
Previous Claims and a Criminal Background
Adjusters are likely to look for flaws in the claimant’s background to give them reasons to devalue a claim. For instance, injury victims could have a criminal history, or they may have filed previous claims. However, injury victims are able to get around these potential issues with a valid and well-supported claim.
Keeping all of these elements in mind can help injury victims determine how best to navigate the claims process.
