It’s the Adjuster’s Job Not to Believe You!

Having represented insurance claimants for over 30 years, I have received hundreds of calls from people who are upset because, “the adjuster just does not seem like he believes me.” They are angry and frustrated with the adjuster and feel they are being singled-out when they are simply “telling the truth.” Guess what? It’s the insurance adjuster’s job not to believe you! It’s not that they are necessarily being mean or picking on you, they are simply following the law and they are trained to be skeptical about most claims.

The law requires insurance claimants to prove their claim. It’s not the insurance adjuster’s job to help you prove your claim nor do they have to “disprove” your assertion, but rather you have to prove all elements of your claim. Let’s take a look at a common claim related to a personal injury claim: lost wages. According the Center for Disease Control (CDC) it is common for someone to miss about two weeks of work for a simple cervical strain suffered in a car accident. You cannot expect to receive compensation for your lost wages by simply telling the adjuster, “I missed two weeks of work and I make $17.50 per hour.” The adjuster is going to require you to produce documentation supporting your wage rate such as a pay stub or a note from your employer. The adjuster will also require you to produce a doctor’s excuse or a medical notation in the records that the time off of work was in fact required because of the injuries you suffered in the accident. They are simply making you prove the validity of your claim. That’s their job!

“But Mr. Wolfe, I’m not like those people who fake a claim or exaggerate an injury to get money they don’t deserve,” is another common statement I hear. Yes that may be true, but adjusters deal with lots of opportunistic fraud claims every day. In my opinion, this has desensitized them to legitimate claims and makes them very skeptical about all claims. This means not only must legitimate claimants meet the legal burden of proof for their claim, they also must overcome the “burden of doubt.” Claims adjusters have been trained to look for certain “red flags” signaling a potential opportunistic fraud claim. The problem is some of the “red flags” are so broad or discretionary they can get attached to a legitimate claim. Claimants are often given a veracity or truthfulness rating. This rating can have a negative or positive impact on the benefit determination for the claim. Yet most claimants, and surprisingly many personal injury attorneys, have no idea how the claimants perceived truthfulness can impact the benefits the insurance company is willing to pay. There are things that can be done to help emphasize the truthfulness of a claimant or overcome a “red flag” that may be associated with a claim. But again, the adjuster’s job is to be skeptical about a claim.

Meeting the “burden of proof” and overcoming the “burden of doubt” can make the claim process seem unfair and frustrating. While not every insurance claim requires or needs a lawyer, all claimants should know their rights and understand the claim process. Our office provides free consultations to personal injury claimants and other insurance claimants. We also have numerous publications available to help claimants. These can be downloaded at no charge from our web site: http://www.bfw-lawyers.com/publications/

What Should I Know About Hiring A Personal Injury Attorney?

[ Written by: Mark Wolfe, Attorney at Law. The following information is provided as general advice and without charge. Questions about specific issues or situations should be directed to an experienced personal injury attorney. A portion of the following article is reprinted, with permission, from the Summer 2004 edition of Legally Speaking. NOTE: The following material is protected by all applicable State and Federal Copyright laws. Published August 2017.]

As more and more lawyers and law firms utilize TV commercials, billboards and internet ads to attract clients, it is important for consumers to know how to select an attorney that is right for their case. Flashy TV commercials and catchy slogans promising large monetary settlements may be enticing, but the consumer who needs to hire a personal injury attorney should consider and discuss three key areas before hiring a personal injury attorney. These areas are: 1) the fee for services, 2) the attorney’s experience and knowledge with similar cases, and 3) the resources the attorney has for your claim or case.

CONTINGENCY FEES

Most people now know that attorneys who represent personal injury victims do so under a contingency fee contract. (The attorney fee is a percentage of the money recovered by the attorney.) Yet the percentage or contingency amount can vary greatly between lawyers. Also, the consumer should know exactly how the contingency fee is going to be calculated. When discussing attorney fees and representation costs, there are two areas for inquiry by the consumer. The actual fee amount to be charged and how the expenses related to the claim or case will be handled. One question for consumers to ask is whether the contingency fee is going to be charged against the property damage recovery and/or medical payments (med-pay) benefits from your own insurance carrier. Many experienced attorneys do not charge fees related to property damage claims or med-pay benefits. The second area for inquiry is the amount of expenses related to the claim and/or case.

Under Alabama law an attorney can advance expenses related to a client’s claim or case such as medical record expenses, filing fees, deposition expenses, etc. However, the client is responsible for reimbursing those expenses from their portion of the settlement proceeds. Most contingency fees for simple motor vehicle accident liability claims authorize a fee percentage of around one-third (33 1/3%) plus expenses.* It is important for the consumer to know how much the expenses will be for their particular claim and/or case. Sample questions that consumers should ask about a lawyer’s contingency fee: Does your contingency fee apply to property damage? Does your contingency fee apply to benefits recovered from my own insurance, such as med-pay benefits and/or health insurance benefits? How much do you think the expenses will be for my claim and/or case? How will the expenses be handled? Do you have a sample distribution schedule for a similar case? Will I get a copy of the fee contract? * For more complicated and expensive cases involving defective products, contingency fees generally range from 40 to 50% of the net recovery (the amount after reimbursement of expenses).

EXPERIENCE AND KNOWLEDGE

You should not be afraid to ask the lawyer about his or her trial experience in handling similar legal matters. The goal in handling a personal injury claim or case is to resolve the matter for a fair amount without having to subject the client to the stress, strain and uncertainty of a trial. While it is true that most civil claims and cases settle without a trial, trial experience is critical when hiring a personal injury attorney. Insurance adjusters know and rate the experience level of the attorney representing a claimant. This is a factor in their evaluation of a claim. Talk with people in the community about their recommendations. Many healthcare professionals who treat injury victims have knowledge about the skill and trial experience of local attorneys. Sample questions that a consumer should ask about a lawyer’s trial experience: How many cases similar to mine have you actually tried in Court? Tell me about the results of those cases. How many cases have you litigated involving this insurance company? What attorney or law firm does their insurance company use? And, how many cases have you tried against that lawyer and/or law firm?

You should also listen to the attorney as he or she explains the various issues related to your claim or you case. Does the attorney know and explain issues in a way that makes you feel confident in his or ability to handle the matter? Sample questions would include: How does the injury claim process work? What factors are important when valuing my claim or case? What can you tell me about how insurance companies use computer assisted claim evaluation programs when reviewing and evaluating claims?

RESOURCES

When hiring a personal injury attorney you should also consider the resources of that lawyer and law firm. This includes the financial resources necessary for the expenses of the claim or case and the general resources such as personnel and technology. A lawyer’s commitment to having skilled and qualified support personnel is reflective of an attorney who wants the best for his or her client. Likewise, attorneys who want to be efficient and effective for their clients utilize current technology and state of the art office equipment. Simply put, if the lawyer does not want to, or can not afford to, invest adequate resources into his or her own practice, what makes you think he or she will invest adequate resources in a claim or case? Sample questions a consumer should ask about the lawyer’s resources: Do you have the financial resources to adequately prosecute my claim or case? Who else in your office will be working on my case and what will they be doing?

CONSULTATIONS ARE FREE

So why not talk to several attorneys. Consumers should be cautious of attorneys who push too hard to have a representation agreement signed immediately. Most personal injury attorneys do not charge for consultations and this allows consumers the opportunity to talk with several different lawyers or law firms before deciding which lawyer or law firm to hire. When consulting with an attorney ask for copies of material and information they have available for potential clients. NOTE: There are situations and times when immediate legal intervention may be necessary, but the attorney should fully explain such a situation.

CONSUMER ALERT: BEWARE OF MISLEADING ADS BY TV LAWYERS!

READING THE FINE PRINT ON LAWYER TV ADS. Recently there have been numerous TV commercials for lawyers where someone brags about how much money the lawyer recovered for them. These people generally appear fine and gush about what a financial windfall the lawyer got them for their injury claim. The problem is the fine print disclaimers that accompany the commercials usually scroll across the screen so quickly, or are so small, you can’t read them. Many people don’t even see them let alone read them. Here’s a compilation of some of these disclaimers from some TV lawyer ads:

– Not an actual client testimonial or based upon a specific case.
– Dramatization: Not an actual case. Your results may vary.
– Fictionalized account for advertising purposes only
– Actor portrayal, not a real client.
– The monetary result referenced is not from an actual case.
– The monetary recoveries referenced are not typical of most injury claims and [law firm name omitted] in no way guarantees or promises similar results for specific injury claims. – Not a typical injury case recovery.
– [Lawyer name omitted] will not be the lawyer responsible handling your claim or case and the financial recoveries referenced herein are generalizations of atypical injury cases. No warranty or guarantee of a specific monetary result is made herein.
– Not a real client or real case result.
– Not an actual case result or recovery. [Law firm name omitted] processes claims and cases via a referral to an affiliate law firm. Referral law firms are solely responsible for claim and case presentation and remit a portion of the attorney fees to [law firm name omitted.]
– Actor and/or spokesperson is compensated for services and any reference to financial recoveries are of non-typical personal injury matters.
– Actual results may vary. Not licensed to practice law in Alabama.

Legal? Maybe. But doesn’t this smell of deception? A commercial runs with a “client” boasting of a huge financial recovery but hidden in the commercial is a “fine print” disclaimer stating the results are not true or not typical. Seems like the old bait and switch sales tactics used by shady salesmen of days gone by. Trust between an attorney and his or her client is critical to a good relationship. Clients must rely on and trust their attorney to help them through a difficult time. If the initial basis for that relationship is based upon deception, can the client really be confident that the attorney has the client’s best interest at heart?