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/