AREAS OF PRACTICE

What you need to know about insurance companies

Despite insurance companies' warm catchy slogans and clever sales pitches, when you have been injured and make a claim the insurance company becomes your adversary. They no longer are "like a good neighbor," nor are you in their "good hands." The clever gecko with the down-under Australian accent becomes a vicious reptile. Insurance companies are for-profit businesses, and you have become a cost to be measured against their profits.

Insurance companies take in money in two ways: by charging premiums for the policies they sell, and by receiving interest on their corporate investments. Insurance companies pay out money in two ways: by paying claims to injured people, and by losing money in bad corporate investments.

Insurance companies want to collect as much as possible in premiums and pay out as little as possible in claims. The difference between premiums collected and claims paid is the insurance company's profit. Because a person making a claim is requesting that money be paid out, the insurance company will do everything it can to avoid paying the claim and thus protect its profit. (This is true even if you’re making a claim against your own insurance company, which you’ve been paying premiums to for years.) Insurance companies profit by paying you the least amount possible for your claim. This does not necessarily mean the company will treat you unfairly (though frequently it will), but it does mean that the insurance will nearly always minimize your injuries and attribute them to other causes or events.

Insurance companies are infamous in their attempts to find new and clever ways to reduce how much they have to pay out. They will sometimes deny liability in cases where liability is very clear. They will say that you are to blame. They will dispute whether you really needed to see a doctor as much as you did. They will question whether you are as hurt as you say. They will even question whether you are as hurt as your doctor says. If possible they will attribute your pain to some event years ago, even though you have had no problems in all those intervening years.

Insurance companies will usually evaluate your claim by comparing it to other cases they have handled and catalogued over the years. They have massive computer programs (one such program is known as "colossus") into which they will enter your case "facts" in an attempt to standardize your case and thereby reduce its value by eliminating the most important element of all – you and your individual circumstances and your personal integrity and credibility. When you are represented by a skilled and experienced attorney, insurance companies can and do settle even these "standardized cases" for what a jury would probably award. But you will not get there on your own. Since we have the benefit of knowing you and listening to your story, and since we have carefully reviewed your medical records, we can make solid and specific arguments in your favor. We can sometimes convince insurance adjusters of the errors of a case evaluation via a computer. Because the insurance company computer program cannot meet the injured person and hear her story, the insurance company computer program is frequently wrong. All the insurance company programming in the world cannot describe what it is that makes up a human life and the impact that devastating injuries have on that individual life. If the insurance company will not agree to pay fair compensation, we can file a lawsuit (always with your permission) and take your case to a fair and impartial jury or arbitration panel. Juries frequently (and appropriately) compensate injury victims better than insurance companies were willing to pay.

Collectively insurance companies handle millions of these claims, and they are using their expertise against you. This is their job. It’s what they do every day. Most people involved in a claim are entering this new realm for the very first time. Attempting to represent yourself in a serious personal injury claim is like a sheep voluntarily bargaining with wolves. You need an experienced personal injury trial attorney to protect you and champion your cause.

Dealing with Insurance Representatives

Because the adjuster is paid by insurance companies, she will be more interested in what the insurance company thinks of the settlement than in what you think of it. And what the insurance company thinks about settling cases is: keep the numbers low. The insurance adjuster is not on your side and is not looking out for your best interest. Insurance companies carefully train adjusters how to minimize settlement amounts and how to persuade injury victims not to see an attorney. The adjuster’s job is to get you to accept as little money as possible to make you go away.

You need someone on your side who is familiar with insurance company tactics and who knows how to respond to them. An attorney negotiating on your behalf levels the playing field because the adjuster now knows that if she does not offer a fair settlement, you have the power to go to trial where a jury will decide the amount of damages. Until a trial attorney is on the case, the threat of trial doesn’t have any teeth and the adjuster will discount your claim accordingly.

Insurance adjusters will try to persuade you that you do not need an attorney, and will tell you that an attorney will just consume a portion of the settlement that the adjuster would have paid anyway. (They are taught how to do this.) What they do not tell you is that without an attorney your total settlement is likely to be only a tiny fraction of what it would otherwise be if you had an attorney. In cases involving serious injuries a skilled personal injury attorney will balance the scales. We provide a free first interview and will let you know if you need us or if your case is small enough that you can go it alone. There’s no cost and no obligation.

Should I give a recorded statement?

Insurance companies often call soon after an accident to obtain the injured person's "recorded statement." The adjuster will be friendly and cooperative. But the recorded statement is usually not to help you, it is to give the insurance company a reason to deny your claim or limit the amount it will need to pay. If you have not already given a statement, do not. Be polite of course, but indicate you’d rather wait and discuss it first with an attorney.

If you have already given a recorded statement, don't panic; it’s okay. Not all adjusters are out to trap you, and you may have held up just fine. But because adjusters are trained in how to obtain these statements, you should consult with an attorney before giving a statement.

Remember as you’re dealing with an insurance company. The insurance company is not your advocate, and its interests are directly opposed to yours. Any money you receive will come out of the insurance company's pocket. If you doubt the insurance company's motives, just ask them if you can take a recorded statement of their insured. They will not allow that. You can even ask if you can have a copy of any recorded statement given by other people at the scene. The answer will be no. Basically, the insurance company wants as much information as possible about you, but will not share anything with you about their own client. They may agree to provide you a copy of your own recorded statement (if you gave one) and a copy of your medical records. They do this because the law requires them to do so.

Remember - your interests are opposed to that of the insurance company and its representatives.

What is an IME? Do I have to go?

IME is a false set of initials standing for “independent medical examination.” There is nothing "independent" about such examinations. They are bought and paid for by insurance companies who will usually send you to a doctor whose opinions are predictable and favorable to the insurance company and against the injured person. While a few doctors who perform these examinations are honest and report with integrity, many of them will say almost anything to keep the insurance money flowing to them. Some of the IME doctors have retired from the active practice of medicine (sometimes under circumstances suggesting a lack of competence) and have learned they can make vast sums of money in relative ease by consistently finding in favor of the insurance company. (ORCP 44) When you make a personal injury claim the other side's insurance company may require you to be examined by a doctor of its choosing. In an auto accident case, even your own insurance company may require you to attend an IME in an effort to disqualify you from receiving PIP benefits.

If this really sounds like a "defense medical examination," that’s what it is. (We call them a "DME.") An "independent" medical examination would require an unbiased expert with no interest in the outcome. Doctors who routinely perform IMEs make much of their money doing these exams. Because they rely on defense counsel and insurance companies for their income they have an incentive (conscious or not) to tell insurance companies what they want to hear. Insurance companies don't want to hear that your injuries are real and are the result of their insured's wrongful conduct.