The insurance adjuster wants to take a recorded statement from me. What do I need to know?

5 Things you Need to Know BEFORE Giving a Recorded Statement to the Insurance Company.

by Mark Wolfe

NUMBER ONE: Set up the recorded statement for a time and date that is convenient for your schedule and get a transcript or copy of your statement. As you will see below you will need to do some basic preparation before your give your recorded statement so make sure you schedule the statement in advance so you can prepare. Also, make sure you have enough time for the statement so you are not rushed or hurried. Most recorded statements do no last more than fifteen to thirty minutes, but you may want to allow up to an hour just in case it runs longer. Ask if you will be given a chance to review the statement or at least be given a transcript or copy of the statement. [Most legitimate insurance companies will provide a copy but you must ask for it.] If the adjuster wants to know why you want a copy you can explain it is simply to make sure the transcript is accurate and that you would like to have a chance to correct any misstatements, inaccurate responses or mistakes you may have made. If the company agrees to give you a transcript or copy, verify this in a written communication. Some companies such as Omni Insurance Company now require the claimant to pay $15.00 for a transcript of the recorded statement. Even if you have to pay for the copy or transcript, it’s worth it to make sure it is correct.

NUMBER TWO: Prepare for the recorded statement: 1) Review the accident report before giving the statement. If you do not have the accident report, get a copy or ask the adjuster to furnish you with a copy before scheduling the statement. [Again, most legitimate insurance companies will mail, fax or e-mail you a copy of the accident report but just as with getting a transcript of your statement, you have to ask for it.] 2) Make sure you know your direction of travel and the name of the road you were on. You will also need to be able to identify the direction of travel for the other driver and what road he or she was on. 3) Make sure you know the time of the collision. 4) Review in your mind your route of travel and be able to tell the adjuster where you were going and the purpose of your trip. 5) Know the names of all passengers and if possible their contact information, especially if you believe they can help validate your account of how the collision occurred. 6) You will need to know the weather conditions and if safety belts and/or child restraints were being used by you and your passengers. 7) You will need to be prepared to describe the property damage to your vehicle and the other involved vehicles as well as describe the post-collision position of the vehicles. 8) You will need to have the contact information for any witnesses known to you. 9) You will probably be asked for information about your employment such as how long you have been employed, the type of work you do and your job’s physical requirements, your pay rate and the name and telephone number of your immediate supervisor. NOTE: If you are making a lost wage claim or loss of revenue claim, you can anticipate a more detailed inquiry into these areas. 10) If you were injured, even slightly, you need to be prepared to describe your injuries with specificity and in detail. Your description of your injuries should always be honest and never exaggerated but you need to make sure all injuries are mentioned. Bruises and small contusions from seat belts are often forgotten or not mentioned as are small cuts or abrasions. If you have received medical attention, or are still receiving medical care for injuries from the collision, be sure you have the healthcare providers name, address and telephone number available and be prepared to tell the adjuster about the number of visits and what you have been told about your injuries. Also, if you were injured in the collision and making a bodily injury claim for medical bills and related damages, be prepared to answer questions about your past medical history, i.e., other similar injuries, other prior accidents or incidents, etc.

NUMBER THREE: What to do when giving the statement: 1) Relax and try not to be nervous. 2) Be polite and use yes or no instead on unghn-hughn or ungh-ungh’s. The later responses can be very difficult to discern and transcribe and are easily transcribed incorrectly. Also, remember this may be your only chance to interact directly with the insurance company. For the remainder of the claim process, you are primarily just another claim number to the insurance company. You want to make a good impression. See Claimant Profiling information in Suggestion Five. 3) Answer the question. Many times people go into a long narrative in response to a simple question. Try to be concise and accurate in your response. 4) Confirm on the record that you will be getting a transcript or copy of the statement. Many companies will now send you a digital sound document of your statement by e-mail. 5) If you were injured in the collision and anticipate making a bodily injury claim, ask the adjuster on the record and at the end of the statement if he or she has a preferred healthcare provider or doctor you need to go see to verify or validate your injury. Most of the time at the end of the statement the adjuster will give you an opportunity to say or add anything to the statement and this is the perfect time to ask the adjuster about a preferred healthcare provider. WHY THIS IS IMPORTANT. Most companies do not have preferred healthcare providers for you to see and most will not ask you to see a doctor of their choice to validate the claim, but by offering to do so, you are telling the adjuster early on that your injury claim is legitimate and meritorious because you are willing to allow them to “independently verify” the truthfulness of your injury claim. Obviously in catastrophic injury situations or broken bone claims, this offer is not as important, but if you have a soft-tissue injury such an offer can help establish in the adjuster’s mind that your claim is legitimate and you are not trying to present a fraudulent or exaggerated claim.
NUMBER FOUR: What not to do when giving the recorded statement: 1) Do not exaggerate or overstate any aspect of the collision or your injuries. Be honest and candid in your account of the collision and your injuries. 2) Do not speculate. If you do not know an answer it is OK to say you do not know; however, try to give an estimate if at all possible. NOTE: Excessive use of “I don’t know” is often considered by adjusters as being deceitful or not completely honest or candid. 3) Do not give out personal information such as your date of birth and your social security number during the statement. You can confirm the last four digits of your social security number but in this day and age of identity theft it’s better not put your personal information into a statement that will be transcribed by someone you do not know. Understand the adjuster will need this information to process your claim. We are not advocating that you not provide said information, we just do not believe the recorded statement is the appropriate place to disclose said information. Often times this information can be confirmed with the adjuster after the statement is over and the recorder turned off. 4) Do not agree with any commentary or suppositions asserted by the adjuster about your actions or details of the collision. In other words, do not let the adjuster “put words in your mouth.” NOTE: Most legitimate insurance companies do not allow adjusters to do this, but some companies encourage, or do not strongly discourage, this type of gamesmanship by their adjusters. Some examples: “So you’re saying you’re really not hurt that bad and aren’t going to need medical care.” – “OK, if I understand what you’ve said, you’re not really really 100% certain the accident was our insured’s fault.” – “Based on what you’ve told me so far, wouldn’t you agree that you could have avoided this collision if you would’ve swerved just a split second sooner?” – “So based upon what you’ve told me about your work requirements, wouldn’t you agree you could probably be working even though your doctor told you to stay off work for two to three weeks.” If you find yourself confronted with this situation, you can simply tell the adjuster you are not going to agree or disagree with any of his or her characterizations. Also, if you do not believe the adjuster is being fair to you because of these type of forced questions, stop the statement. Giving a recorded statement is a courtesy and if the adjuster is going to abuse that courtesy then you have a right to stop or cancel the statement. NOTE: If you stop or cancel the recorded statement for whatever reason, send a written communication to the adjuster documenting why you felt it necessary to cancel or adjourn the statement. If you do not believe the adjuster was being fair or if he or she was rude and/or ugly, describe the adjuster’s behavior in detail.

NUMBER FIVE: A few last things to consider. 1) While the adjuster’s main job in a recorded statement is to gather information related to the claim, he or she will also be gleaning notes for your “Claimant Profile.” Most major insurance companies now use some sort of “claimant profile” in the claims process. A claimant profile can be very detailed and complex or it can be something very simple but the main idea is to bring into the claims process some sort of general assessment about the personality and background of the claimant. We live in the information age and information is power. The more information about you an insurance company can gather the more accurate their profile of you will be. This profiling can be very complex and include personality traits, such as “likelihood to consult an attorney,” “easily discouraged,” “financially distressed, “ ”very anxious and impatient for claim resolution,”etc. The company will have also reviewed your past insurance claims history and may bring that into your claimant profile: “Past bodily injury litigant.” Your driving history will also be pulled in to your claimant profile. How you handle yourself during the recorded statement may also find it’s way into your claimant profile: “Claimant was polite and well spoken during statement. High credibility assigned.” So remember to be polite and courteous during the recorded statement. 2) Try to be understanding of the adjusters job and position. While most adjusters handle themselves in a professional and civil manner please remember because of continued cut-backs by insurance companies, most adjusters are overworked, underpaid and mostly unappreciated by their company. Sometimes the stress of their job is reflected in the way they communicate with claimants. So even if the adjuster is having a bad day, try not to react in-kind. Stay calm and polite. Finally, 3) if the insurance company sends you a transcript or digital recording of your statement, take time to review it as soon as possible. Send a written communication to the adjuster with any corrections. Also, if you think one of your responses may need further explanation or more details, make the additions in the written communication.

If you would like a free consultation with Mark (or any of our attorneys) about your insurance claim, please email him at mark@brwlawyers.com or send a text to 251 533-9548 (cell). You can also call Mark directly at 251 410-7761.

REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). Statement in compliance with Florida Bar Advertising Rules: “The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience. [Florida Rule 4-7.2(d)]. General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

Medical Causation Often Overlooked in Personal Injury Claims

No matter the type of personal injury –  automobile accident claim, worker’s compensation claim, longshoreman’s claim, slip and fall claim, or product liability claim – an often overlooked legal issue is medical causation.  In any personal injury case, the burden is on the injured person to establish the incident/accident caused or was the contributing cause of the injury.  Said another way, proof that an injury “could have” or “possibly” resulted from an incident/accident does not meet an injured’s legal burden.  Instead, it is necessary the evidence reflect that the injury “more than likely” or “ to a reasonable degree of medical certainty” resulted from the incident/accident.  While typically this “test” requires the testimony of a doctor, the courts often look at the full context of all the lay and expert witnesses’ testimony before determining whether the injured person has met his/her burden.  This said, in a majority of personal injury cases in the southeast, testimony from the injured’s treating physician is often sought to satisfy the medical causation “test.”  As a consequence, it is important, if not critical, for the injured person to be patient and forthright with his/her treating physician.  Additionally, it is important to explain the mechanism of injury to the doctor early on so that the provider’s records provide a date certain the incident/accident causing the injury occurred.

Insurance Claims: Five Tips for Giving an Effective Recorded Statement

READ THIS BEFORE YOU GIVE A RECORDED STATEMENT TO AN INSURANCE ADJUSTER. The Boteler, Finley & Wolfe Insurance Guide for Recorded Statements is a four page publication that can be downloaded at no charge. It provides five tips for insurance claimants that will help you avoid common mistakes that can delay claim payment or even result in a claim being denied. Tips include why it is important to get a copy or transcript of the recorded statement, how to prepare for the recorded statement, how to respond and answer questions during the recorded statement and what not to do or say during a recorded statement. It also explains how adjusters sometimes use recorded statements to “profile” claimants and what you can do to help your “claimant profile.” At BF&W we understand that not every insurance claim requires a lawyer. However, we believe every person or business making an insurance claim needs to know their rights and understand the insurance claim process. That is why we offer more free insurance claim information material than any other law firm on the Gulf Coast area. We also believe a consultation early in the insurance claim process can be very beneficial to better understand what legal issues may be involved in a specific insurance claim. Consultations are free. Here is a list of free guides and resources available from the Boteler, Finley & Wolfe web site: Motor Vehicle Collisions: A Victim’s Handbook – Ala ed Motor Vehicle Accidents: Property Damage Claims – Ala ed Alabama Guide for Insurance Claims Insurance Claims: Guide for Effective Recorded Statements Medical Malpractice Laws in Alabama Alabama Law for Slip & Fall Claims Small Claims Court: A User’s Guide Alabama Guide for Life Insurance Claims 10 Tips for Locating Life Insurance Policies

Denied Life Insurance Benefits

IMPORTANT INFORMATION ABOUT LIFE INSURANCE CLAIMS© By: Mark Wolfe, Attorney at Law mark@bfw-lawyers.com insurance_claim_form_424While most of us hope that a life insurance claim arising from the loss of a loved one will be a simple and hassle free process, the fact is many life insurance claims are wrongly denied. The denial of life insurance benefits can be for many reasons. Some times the reasons for such a denial are legitimate, but many times they are wrong. In fact many insurance industry experts say that up to 40% of life insurance claim denials are done so improperly.  [IMPORTANT: If you are a beneficiary of a denied life insurance claim, please read the last section on appealing the denial of life insurance benefits.] Why are so many legitimate life insurance claims denied? Most life insurance claims adjusters recognize that many life insurance claimants do not question or challenge a denial of life insurance benefits. This means that if there is a “close call” on whether or not benefits should be paid, they automatically opt for denial first in hopes the claimants will just “go away.” Insurance companies often use legalistic terminology in their denial of benefits letter and may also reference complex medical terms or conditions.  These type of denial of benefit letters are so well crafted they often discourage beneficiaries from seeking legal advice or consultations about the legitimacy of the denial.  Our experience in this area of law has shown there are two common areas of life insurance benefit denial. These are “material risk” and “accidental death.” Material risk as a  reason for denial of life insurance benefits.  Many times if a basic life insurance claim is denied, it is done so based upon a process known as “retroactive underwriting.” This is a claim investigation technique that allows the insurance company to more fully and completely examine the deceased’s prior medical history. These prior medical records are reviewed thoroughly to see if the deceased left out or failed to disclose a pre-existing medical condition when completing the life insurance application. This “failure to disclose” is then used as grounds to deny the life insurance benefits. However, most claimants are not aware that such a denial must have materially effected the underwriting risk associated with issuing the policy.  In other words the insurance company must prove that “but for” the undisclosed medical information, they would not have issued the policy. The issue of “material risk” is a complex legal issue that is often debatable and framed by case law interpretation of that term and/or insurance regulations. The case law and regulations can vary from State to State. Read more here. Denial of accidental death or double indemnity life insurance benefits. Some companies issue stand alone accidental death life insurance policies or some standard life insurance policies have a “double indemnity clause” which pays twice the face value of the policy if the death is caused by an accident. Yet the policy language concerning the term “accidental death” is often drafted so vaguely that it gives the company lots of “wiggle” room to initially deny accidental death benefits. These type policies often have provisions or clauses that require the “accident” to be “the only cause of death without contribution from any other medical condition.”  They may also include vague activity restrictions at the time of death such as “strenuous or dangerous sporting events.”  Even when a death certificate lists cause of death as “accidental” many companies still try to use these vagaries in the policy to deny benefits.   BEFORE YOU FILE AN APPEAL OF A LIFE INSURANCE DENIAL. If you have questions about the denial of any life insurance benefits, make sure you fully understand your rights and obligations under the policy. Most life insurance policies allow claimants to file an appeal of the denial of life insurance benefits. Yet many times claimants are unaware of the potential consequences of simply “appealing” the denial.  They send a quick letter back to the company saying, “I appeal the denial of life insurance benefits.” Generally, once a company has denied the life insurance claim, the claimant has the burden of identifying specific reasons for the appeal and providing supporting documents or records to support the appeal. If the life insurance policy in question has been provided through the decedent’s employment or through a group, the failure to comply with the appeal requirements can be extremely detrimental. In one extreme example a Federal Court determined that the claimant’s failure to submit any “new evidence” during the appeal process precluded the claimant from presenting that new evidence at trial. What You Need to Do. Until the claim is paid in full: Keep copies of all correspondence and documents sent to the life insurance company. Keep all letters and material sent from the life insurance company. If a claim is denied, make sure you understand and comply with the requirements for an appeal. Also, if the claim is denied consider consulting immediately with an experienced life insurance claims attorney in your State. Note: Most attorneys who handle life insurance claims for beneficiaries do not charge for a consultation and work on a contingency fee (no benefits = no fees). Also, many times an experienced attorney can help resolve a denied claim before having to resort to filing a lawsuit. About the author: Mark Wolfe is recognized as one one of the Most Qualified Attorneys for Injury Victims and Insurance Claimants. He has represented numerous families in Alabama and Mississippi regarding denied life insurance claims with a 90% success rate. If you have questions about a denied life insurance claim, call him today at 1 866 975-7766 or e-mail him at mark@bfw-lawyers.com and put Life Insurance in the subject line. Consultations are free and all claims and cases are handled on a contingency fee, meaning no recovery, no attorney fees.   Required Disclaimers:

The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free Background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997).
Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers.
General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

Ten Tips for Locating Life Insurance Policies

TEN TIPS FOR LOCATING LIFE INSURANCE POLICIES & BENEFITS
by Mark Wolfe, Attorney at Law and Advocate for Insurance Claimants
mark@bfw-lawyers.com

Locating Additional Policies. It’s a fact, many life insurance benefits go unclaimed because beneficiaries do not realize a policy exists. Below are some tips for locating additional life insurance policies.

1. Review the decedent’s check book or bank statements looking for premium payments to a life insurance company.

2. Review the decedent’s tax returns for the last several years to see if interest or cash dividends from a life insurance policy were listed. There should be a corresponding 1099-INT from the life insurance company. These payments will be reported directly on form 1040, 1040A and 1040EZ or on Schedule B if an itemized tax return was filed.

3. Contact the decedent’s employer and/or former employers to see if any type of life insurance was offered through the company’s group benefit programs and if the decedent purchased a life insurance policy or was provided a life insurance policy through employment.

4. Review all disability policies for the decedent to see if death benefits are also provided.

5. Review any known life insurance policy to see if additional benefits such as double indemnity for accidental death may apply.

6. Check with the decedent’s auto insurance company or homeowner insurance company. Many of these companies will also offer life insurance policies for their customers.

7. Check with the decedent’s bank or financial institutions to see if life insurance benefits or policies were offered in connection with a checking or savings account or in connection with a brokerage account.

8. If the decedent’s death was accidental and in conjunction with travel or a trip, check with the credit card company to see if it offered accidental death benefits for travel or trips paid for with the credit card.

9. Check with any Union, Trade Organization or Professional Association the decedent may have belonged to to see if they offered life insurance benefits to members and if the decedent had purchased a policy through the organization.

10. Use a policy search internet site. There are several internet sites that, for a fee, offer to search for life insurance policies.