Each week, I get calls from new clients who tell me tales of insurance adjusters who have excuses why they can’t pay claims. Without exception, it’s not because they aren’t fair and reasonable. As an injured person after a crash caused by somebody, it’s maddening when you have to call, write and fight with an insurance adjuster for money to which you are legally entitled to. As a reminder, adjusters are supposed to “adjust” claims- that is pay them. Two simple steps: 1. See what the claim is worth (investigate) and 2. pay it. It’s that simple. Again, 1. investigate the claim; 2. pay it. Simple. It’s their job and it pretty simple. It’s so simple 
for these folks, there’s even a CODE of adjusters’ ethics they can follow and a Florida Government department that regulates them. Yet, the priorities of insurance companies (the employers of adjusters)- (to take in money and not pay it out- see my other posts) encourages, facilitates and justifies these adjusters to not follow this Florida Code and delay or under pay legitimate claims.
One of the problems injured people who don’t hire lawyers or make the mistake of hiring a billboard/TV lawyer is that they don’t know how to put the hammer down on the babbling brook of excuses from the PD adjuster. Billboard/TV lawyers don’t even help with the property damage in a crash. So, the list of things they come up with for excuses for not paying is amazing.
Let me give you a list of excuses and will discuss them so when they happen to you you know how to handle them. The insurance company adjusters have three ways delay, underpay or not pay. Let’s talk about delay.
When adjusters delay the claim.
“I was on vacation.”
This is simply the most unbelievable excuse. In billboard, radio and T.V. advertising, all the time insurance companies are telling you what big companies they are, what MASSIVE staff to hanndle your every need after a crash, enormous great service “teams” they have and how they get on your claim right away and they “work together to help you recover from a loss.” It’s all B.S. None of that is true. Here’s the truth: the insurance company assigns one adjuster to your claim. It’s hardly and rarely a team. Oh, sure the insurance company has a lot of people. That’s like billboard/TV lawyers have a bunch of paralegals for their victims, er, client. With insurance companies, it’s one poor, over-worked, well-meaning but overwhelmed adjuster in a cubicle in some office building with “golden handcuffs” and a phone headset.
That one adjuster can be cranky, sick, have a sick child or parent, have a crash themselves, get cancer, give birth…. etc. When that happens, your claim sits there until the adjuster gets back on it. Period. You can pound sand and scream all you want as a claimant- they are busy and the insurance company will not assign another adjuster or move your claim any faster.
“You don’t have all the documentation; you need to provide us with more documentation.”
Wait… let me repeat myself one more time…. Insurance companies are under an AFFIRMATIVE DUTY BY REGULATION FROM THE INSURANCE COMMISSIONER to affirmatively TAKE STEPS and adjust the claim. Getting documents is simply and JUST THEIR FREAKING JOB!! That’s ALL THEY DO!!! If you provide all your information and paperwork (crash report, walk-in or hospital bills, doctors’ names ). You are done. It should be like: “When can I expect my check.” And instead it’s
“You got a ticket; Our insured didn’t get a ticket”
It is pretty surprising when an adjuster uses this excuse. The reason why is because tickets are not admissible in a personal injury case and the adjuster knows that. So, it’s irrelevant. The cop was not there for the crash anyway. His ticket is hearsay; it’s inadmissible. (In fact, most all of the information on a Traffic Crash Report (TCR) is inadmissible in court. Court, for you non-billboard lawyers, is a place where insurance companies get spanked for their bad behavior. It’s why trial lawyers (who really do go to court) get better settlements for their client. The insurance companies know who will take them to court. Throwing around irrelevant facts to delay your claim is the way insurance companies get sued by me.
“Our insured has a different version of the facts.”
This it is another unusual statement I have heard come out of an adjuster’s mouth. Their version of the facts is unimportant if the other driver was at fault. Why? Their insureds caused the crash and they want to “bend” the facts (lie?) so as not to have their insurance premiums go up. If their insured got a ticket or if their insured was listed as vehicle number 1 on the crash report- we are done here. Enough, give my client a rental and pay the property damages.
“We haven’t determined liability yet;” “We need a recorded statement;” “Our insured hasn’t called us;” “We haven’t spoken to any witnesses.”
Ostriches do not really stick their heads in the sand; its a myth. Adjuster, on the other had, actually do, but only figuratively. If it’s clear someone injured you, it’s pretty hard to dispute the adjuster’s customer is without fault. When they say “we haven’t determined liability yet” I just want to ask, when are you going to? (Remember the affirmative duty thing?). The only way to motivate these prima donnas is to let the know, if you do not get a rental, a check, an approval or what ever they are supposed to be doing by (X) days, “we will be filing suit.” Adjusters only respond to deadlines. They have them at work and they understand them if this case is to be filed in court by a trial lawyer court it’s going to cost them a lot more money. Their supervisor and their claims manager will be wondering: “why didn’t you do your job and Pay this claim in a timely fashion.” the adjuster knows this. However, they are so overworked this is a Trick they used to stall your case while they work on other ones. This is the same thing when they claim “the insured hasn’t called ‘us.'” This is flat – out stupid… remember they have an affirmative duty to investigate. They need to go to the scene, go to the insured’s house, go to wherever and figure out their customer is at fault. and they need to do it now. There is a reason why the State of Florida Insurance Commissioner has a complaint page for regular people. It’s because stall tactics that insurance adjusters use.
“Please send us the proper forms/receipts/bills/ coding.”
Adjusters have phone numbers. Adjusters have letters, stamps, mail boxes and fax machines. They can get all this information. That, again (for the 4th time?), is their job to gather the information. Unless the adjuster strokes a check for your time and energy, effort, missed work and gas, well then, after you have provided names, numbers and addresses you have, they are suppoonly Godsed to get all this.
When insurance adjusters underpay what’s owed.
PIP deductibles, Work loss exclusion, damage evaluations, excluded drivers.
in Florida, like many other states there is a “No-Fault” system in place. This system is called “Personal Injury Protection” coverage. It pays 80% of the first $10,000.00 of medical bills, 60% of lost wages and some other benefits. Many substandard insurance companies, like Windhaven, Infinity and Direct General (and even some major ones) allow, $1,000.00 deductibles on PIP insurance. If you’re one of the many people who has no health insurance getting a deductible gives you a $1,200 bill the minute you get healthcare after crash. It’s just not a smart thing. Never get a PIP deductible. Another insurance company scam is “work loss exclusions.” If you are injured such that you cannot go to work, PIP will pay 60% of your wages, unless you get this “work loss” exclusion. It is bad idea. Without a disability policy from your job, you will go without work for as long as it takes for you to get back to work. If you have a doctor tell you you can’t go back for six weeks, you will really need PIP to pay your wages. Never get a work loss exclusion on your PIP.
Insurance adjusters not paying what’s owed.
Often, you may be riding in a car and have a crash. Adjuster have several excuses to avoid the terms of the policy through technicalities. This trick is a classic scam by substandard insurance companies like Windhaven, Security Auto, Mercury, Direct General, etc. The first scam is when they claim: “you misled us on policy when you apply for it. This is called the “material misrepresentation” defense. The usual form this takes is when they say: “You said there were no other drivers/or and unlisted driver.” What they try to claim is you were “committing fraud” because you didn’t list your husband (who doesn’t have a drivers license), or your cousin (who moved in two weeks after you got the policy) and you didn’t tell them (despite your cousin having his own car and insurance). they have a legitimate beef, if this unlicensed driver is a material risk. If not, it’s just a scam.
“Using your car for work” is a really good scam if you are a driver for a ridesharing company like Lyft or Uber. There are a lot of questions and the law is kind of unsettled at this point, but we do know a few things. First, if you’re not driving for a ride sharing service at the time of the crash, your insurance applies. Most ridesharing services (when you are logged into their application) consider you to be an employee and therefore you are covered under their insurance policy. Second, Florida law still applies to you while you’re driving a vehicle on Florida roads. Insurance adjusters try to make a big deal out of the fact you work from ridesharing service. They are just trying to avoid paying anything.
A third scam is the “uninsured motorists permission.” This is an old trick that you don’t often see because it’s highly unethical. However, they still do it. The background is your insured motorist protection protects you in the same amount as your bodily injury coverage if you are hit by one of the 24% in Florida of the people on the road without any insurance whatsoever. Bodily injury coverage protects you if the other person has it. You should have it simply for the fact that you needed to get uninsured motorist protection. If you have it, and the other person has low limits, you have to get your insurance company’s permission to accept the other person’s insurance limits. If you don’t it’s a huge “gotcha.” in that case,your insurance company will not pay under its uninsured motorist coverage.
If you have been a victim of an insurance company delaying your claim, making you jump through hoops or giving you the runaround, call me.
If you are injured and searching the web for an attorney, stop clicking.
I am a full-service personalized, personal injury lawyer with a statewide practice in all 67 counties. I have 31 years of experience to put to work for you. Call so I can answer your questions: 1-800 – 535 – 3002. Email: [email protected] Skype: ScienceCan Facebook: https://www.facebook.com/JSteeleLaw/ Twitter: @JSteeleOlmstead or @FlaBicyleLawyr Whatsapp: J. Steele Olmstead Instagram: jsteeleolmstead.
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