What Do Insurance Adjusters Look for When Evaluating Your Claim?

Posted: August 27, 2020

If you or somebody you care about has been injured by the actions of another person, company, or entity, you should be able to recover compensation for your losses. However, dealing with insurance adjusters in the aftermath of an accident can be incredibly difficult, and it is important to understand what insurance adjusters are looking for when you make a claim. If you have any additional questions regarding your accident claim, the Denver car accident attorneys at Fuicelli & Lee, P.C. can help you deal with the aftermath and meet with you for free.

What do insurance adjusters look for when you make a claim?

There is no one thing that insurance adjusters are looking for when someone makes a claim. It is important to realize that many insurance carriers have entire departments dedicated to investigating the validity of claims, and insurance adjusters are naturally suspicious of the facts and circumstances presented to them by those making the claim. Some of the main “red flags” insurance adjusters may use to delay or deny a claim include the following:

1. A lack of medical treatment following the accident

It is incredibly important that any injury victims seek medical treatment immediately following an accident. Not only does this ensure the well being of the person who is injured, but it also establishes a link between the injury and the accident. If a person is claiming an injury and they did not seek medical care immediately after an accident, the insurance claims adjuster may question why this is the case.

2. An inconsistent course of medical treatment

It is also important for injury victims to continue all medical treatment until their doctor says they have reached maximum medical improvement. Anybody who decides to enter treatment early or go against a doctor’s orders will be viewed with suspicion when making an injury claim, particularly for ongoing costs of medical care or disability.

3. The decision to forego surgery

In some cases, a doctor may recommend that the most effective treatment for an injury is surgery. However, the claimant has the right to decide not to undergo a surgery. However, a decision to decline a surgery could affect the impact on their claim for damages. This is because the law will not allow someone to collect damages for the consequences of an injury that could be reasonably addressed through a lower risk surgical procedure.

4. Treatment from plaintiff-friendly medical providers

There are various medical providers that are considered to be “plaintiff-friendly,” and you can be sure the insurance claims adjusters will know which medical providers these are. If an injury victim is working with one of these medical providers, their entire claim may be viewed with suspicion.

5. Clients that are difficult to reach

Any person who is making an injury claim with an insurance carrier should be easy to get ahold of, at least that is how the insurance carrier will view the situation. In fact, the insurance claims adjuster may view their difficulty to get ahold of you as an indication that you are possibly participating in activities that would show you are not injured.

6.  Immediate notice of legal representation

If the injured party ends up hiring an attorney immediately following an accident, an insurance claims adjuster may view this as suspicious activity. However, do not let this deter you from securing an attorney after you have sustained an injury caused by another party. An attorney will be able to work quickly to ensure that all of the evidence in the incident is preserved and that you obtain maximum compensation for your case.

Contact Fuicelli & Lee, P.C. For Help Today

If you or somebody you care about has been injured in an accident caused by the careless or negligent actions of another person, seek legal assistance immediately. At Fuicelli & Lee, P.C., we pledge to conduct a full investigation into your case so we can secure any compensation you may be entitled to. This can include:

  • Coverage of all medical bills
  • Lost wages if you cannot work
  • Household out-of-pocket expenses
  • Pain and suffering damages
  • Loss of personal enjoyment damages

When you need help with aggressive insurance adjusters, Call our Denver personal injury lawyers at (303) 355-7202 or fill out an online contact form.