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How do I deal with the Insurance Adjuster?

 

I once took the deposition of an insurance executive who became quite upset at my questions about why my
client’s claim was not paid promptly. Ultimately, the angry insurance executive blurted out the essence of the
problem, “Insurance companies are not in business to pay out claims!” Not every insurance representative is out to
cheat you, but they all have one thing in common, they are paid by the insurance company, not by you. This
economic reality explains why it is sometimes so difficult to deal with adjusters after an accident or other claim is made.

Many people who are in accidents attempt to deal directly with the responsible party’s insurer or with their own
insurance company. Obviously, it is the motivation of the responsible party’s insurance company to pay you as little as
possible to make the problem go away. If you cannot reach an agreement on the amount or terms of the settlement then you
have some options.

A. File a suit in small claims court. Small claims court cases make sense if your damages involve small amounts. These cases can be a faster, less expensive, and less stressful way to resolve differences. You don’t necessarily need an
attorney to represent you in such courts. Small claims courts have a maximum amount for which you can sue
depending on state law.

B. You can contact your state’s department of insurance and file a complaint. It is unlikely that the agency will take action on your behalf, but you may spur a company to do the right thing and increase the settlement offer. Your state agency may investigate if the insurance company acted improperly or refused to negotiate a settlement.

C. You can file a lawsuit against the party responsible for the accident. You may be better off consulting an attorney if the time limit for filing suit is coming up, the damages are severe, there are competing legal issues at play, or if you simply do not have a personality type that is comfortable dealing with the situation.

If you are dealing with your own insurance company and have not been able to come to an agreement the situation is bit little different. The policy you signed up for is a specialized contract. You agreed to send in your premiums and the insurance company agreed to provide coverage.

As part of most insurance agreements there is an arbitration provision. Arbitration provisions in insurance policies are sometimes called appraisal clauses. Either the insured or the insurer can invoke the appraisal clause when an agreement can’t be reached. Generally, both the insured and the insurance company get an appraiser to review the claim and they determine a settlement figure. If the appraisers can’t agree another appraiser is asked in to look at the situation. Typically, a decision by two of the three appraisers is considered binding. The arbitration process can take weeks to months. Arbitration is not free. Both parties must pay for appraisers and share in the cost of the third appraiser if needed. These costs may be more than what you’re hoping to get.

Another form of dispute resolution is mediation and is often confused with arbitration. Mediation is when a mediator meets with the parties and tries to help the parties resolve the dispute. Mediation is generally not binding. Another factor, to take into account is that insurance representatives deal with these issues on a daily basis; the typical person seeking payment does not. It is generally a good idea to seek the opinion of an experienced attorney when dealing with insurance issues.

The Law Office of Julie Johnson, PLLC is dedicated to the protection of client rights. This blog is not intended to be specific legal advice; rather each situation must be reviewed to determine the rights and duties that may be presented by each unique set of circumstances. If you believe you have been injured through the negligence of others please fell free to contact us through our website, www.juliejohnsonlaw.com.