Getting Claims Started
Usually the at-fault driver calls his/her insurance company from the scene of the accident to report it. If this happened, chances are his/her insurance company will call you first such that you don’t have to notify them of the claim. Nevertheless, if you have not had any contact with the other driver’s insurance company, you should notify them immediately of your claim.
Almost all car insurance policies require prompt notification of an accident that may result in a claim. You need to notify everyone and their insurance company who MIGHT be at fault for the accident. This includes:
- All drivers of every vehicle involved in the accident. If you were a passenger in a car being driven by someone else, you need to notify his/her insurance company that you intend to make a claim. As a passenger, you are never at fault. If your driver and the other driver were both somewhat at fault, the insurance companies will agree to assign a percentage fault to each driver to cover your claim. Also, if the other driver is completely at fault, you might be able to use your driver’s UM insurance to give you additional money to cover your claim.
- Owners of all the cars involved in the accidents. Sometimes the owner may be different then the person driving the car. The police report will tell you the driver AND the owner. They appear separately on the report. The reason you are notifying the owner is because sometimes they may be liable for lending a car to the driver, like when they know the driver is a habitual DUI driver, etc.
- Employer of any driver. If one of the cars is a commercial or business vehicle, you will want to notify the driver’s employer because sometimes an employer is liable for its employee’s actions. Employers will also have a separate insurance policy that may cover your claim or provide you insurance money in addition to other policies. Just notice everyone and let the insurance companies figure out who is going to handle and pay the claim.
- Parents of any minor (under 18) driver. In some states, parents can be liable for their child’s negligence. Parents may have separate insurance policies that could provide you with additional sources of compensation.
- Your insurance company. This is important because your claim with your insurance company is controlled by your insurance policy, which may have a bunch of requirements and duties you must follow to have a valid claim. Prompt notice is usually such a requirement, as is a duty to cooperate in the investigation.
Use the Notice Letter Form to notify each insurance company that you were hurt and intend to file a claim. Sometimes you won’t know who the insurance company is for a lot of the above people. In those cases, use the Notice Third Party Form to send a letter directly to the above person. Send the letter via certified mail so you can show they received it. This letter tells them to immediately contact their insurance company and explains why it is in their best interest to do so.
Most of the time people call their insurance company from the scene of the accident. But, you should not assume or rely the other driver notifying his/her insurance company. Get the police report as soon as possible, find out who the at-fault driver’s insurer is and notify them immediately.
Calling Claims Departments
When you call the claims department, you will most likely be talking to a call center, not an adjuster. The claims department’s job is to open a claim in their system and take basic information. Nonetheless, you must be careful not to say anything prematurely that could affect the value of your claim. For example, it is not uncommon for people to not feel pain from the car accident until 2 to 3 days after the accident. Adjusters and claims departments will invariably ask you during the first conversation if you were hurt. You don’t want to say “No.” Instead, tell them yes, but that you are waiting to talk to your doctor before you know what was hurt. You only want to give them the time and place of the accident, tell them you were injured, and that you intend to file a claim.
First Adjuster Contact
The rules for talking to your insurance adjuster versus the other driver’s insurance company are different. If you’re talking to your insurance company, you have a duty to cooperate which affects some of the postures you can take with the adjuster.
If the other driver reported his accident to his insurance company, you will most likely not need to contact his/her insurance company. Your phone will be ringing within 48 hours of the accident. Adjusters are trained to contact you as early as possible. Insurance studies show that claimants who are contacted early settle for less money and do not hire attorneys. The latter does not concern us because you are handling your own claim. The reduced value statistic is driven in part because the offer of settlement comes early on before a claimant understands his/her true injuries and damages. Adjusters who contact you early are trained to build rapport.
You will usually be contacted by two different adjusters for two separate claims. There is your property damage claim (i.e. the damage to your car) and your bodily injury claim. Insurance companies usually assign a different adjuster to each claim.
Inevitably, the adjuster will ask you during the first conversation what happened (liability!) and were you hurt (damages!). They will also ask to record the conversation (evidence!). The whole purpose of the call is to lock down your claim and offer you a nominal settlement before you can fully develop your claim.
The first thing to remember is to remain calm and professional. There is no debating that your claim and injuries is a very personal matter and potentially a very emotional one. Adjusters, however, view your claim as a file and business transaction. Lashing out an adjuster will not increase the value of your claim. You cannot brute force your claim into a higher value. What you can do is earn the respect of the adjuster such that he/she will respect the true value of your claim. The whole ClaimClinic methodology is going to demonstrate to the adjuster that you are organized, understand your claim, and understand the insurance adjuster’s job. This is what’s going to cause his adjuster to want to help you and approach his/her upper limits of authority or your claim.
When you begin the first call you should immediately ask the other person to identify their self, their company, who they represent, their address, their direct dollar phone number, and their claim or reference number. Write this down on your ClaimClinic Master Sheet. Not only do you need this information to understand what you’re going to be talking about and how to document the call, but you are also you taking control of the conversation from the beginning by showing the other person that you are competent, knowledgeable, and organized. First impressions are everything.
The adjuster is going to ask you for similar information. Tell them your name, home address, and phone number. You can also tell them what you do for a living and who your employer is. But do not discuss the hours you work, your salary or wage, or anything else about your personal finances. Do not give the adjuster your Social Security number or any other personal information. They may tell you they need this information to begin documenting your claim. Calmly explain to them that you will be collecting all the documentation, including medical records, bills, and lost wages verification. And that you will provide all this information to them with your demand package. Talking this way shows the adjuster you know how to professionally handle a claim. There will be no need for them to have this information and/or request documentation about you or your medical treatment from any third party. You will be providing that to them. Again, control your claim. Do not let the adjuster have the power to go off and dig around into your medical care or history. Social Security numbers are used to run you through a claims index so that an adjuster can see if you have a history of making other insurance claims.
The adjuster will also ask about your injuries and what hurts. You want to be vague here and say you are still working with doctors to identify all the injuries. The adjusters are asking because they want to get a feel for the size of your claim and so they can set reserves. You don’t want to say you have a strained neck early on come to find out later you have a disc injury in your neck. That is because you will cause the adjuster to go back and have to adjust their reserves, which causes them to go to the superior, etc. At the same time, you need to tell the adjuster if your injuries’ severity has changed ASAP so that they can get their reserves in order.
To show a willingness to cooperate with them, but still maintain control over your claim, ask the adjuster:
- If they have a copy of the police report. If not, offer to send them a copy.
- If they prefer to get all your medical records at the end, in your Demand Package, or whether they would like to have them trickle in as you get them. Again, you are getting the records and supplying them to the adjuster. You are simply asking when they would prefer to receive them from you.
Talking To Your Insurance Adjuster
Handling the claim with your insurance company (an underinsured/uninsured motorist claim for example) has one significant difference. You most likely have a contractual duty to cooperate with the adjuster’s investigation into your claim. The duty to cooperate is found in most UM policies. If you fail to cooperate, you could be jeopardizing coverage. If you want to verify your duty to cooperate, ask the adjuster to show you where in your insurance policy it says you must cooperate.
Even with the duty to cooperate, you can usually seek to limit its affects. You probably have to sign medical authorizations or HIPAA Releases and provide a recorded statement. But, you can still try to limit these requests. For example, you can limit the providers and dates of service on your medical records release, below.
The adjuster may ask you for a recorded statement about the accident or to talk about your injuries. When an adjuster interviews you or takes your recorded statement, they have the following goals:
- Get your version of the facts – they are looking at whose fault the accident was so they can determine liability.
- Determine the nature of your injuries – they want to know what was hurt. You need to do a balancing act with this one. On one hand, you don’t want to speak too soon and limit your injuries by giving the adjuster your list and then having another injury come out after you get into treatment. For example, what you think is whiplash or neck strain can really be a spine or nerve injury that does not start radiating down your arms until several weeks after the accident. On the other hand, you need to give the adjuster some sort of sense of the extent of your injuries because they are going to set reserves on your case.
- Determine your losses – adjusters are looking to get a feel for the type of treatment and diagnostics you are incurring. You can tell them the types of doctors you are seeing. For example, you can tell them you went to the ER, then followed up with your primary care physician, who ordered you to physical therapy. You can also tell them what x-rays and MRI’s you have had. Again, the adjuster is trying to get a feel for the size of your claim so they can properly set reserves.
- What kind of witness do you make? – rarely talked about but the biggest single factor in your case. Credibility is everything. Do you exaggerate or are you honest and fair? Do you complain and whine, or do you maintain a solid footing when talking about your case. Do you stay consistent with your claim’s story or are you contradicting yourself.
You are under no obligation to provide a recorded statement and can politely decline. Adjusters are trained to ask certain types of questions in recorded interviews that are designed to pin down your injuries and claims. This is called “boxing in” because they put a box around all of your injuries using questions such that you cannot later say you forgot something without looking like a liar. The only time you may want to provide a recorded statement is if there is a question about who was at fault for the accident. If this is the case, request the statement and questioning be limited to only liability and not your injuries. Otherwise, we suggest you decline and tell the adjuster you will provide a narrative (i.e. story) about how the accident occurred in your Demand Package.
If you agree to a recorded statement, we suggest:
- You make it conditioned on you getting a copy of the transcript and insist that at the very beginning of the recording that you both stipulate (agree) on the record that the adjuster has agreed to send you a transcript.
- That you schedule the recorded statement to take place on another day and time so that you can collect your thoughts and make some notes first.
- You may want to limit the statement to just liability – how the accident occurred and not your injuries. Many adjusters will agree to this limitation.
Do not go into details about the accident. Tell them only the date time and location that the accident occurred. Do not tell the adjuster where you were going, where you were coming from, how fast you were going, what you were doing when the accident occurred, what the other driver said, or anything else. Then tell them that you are still in the process of investigating and documenting the accident and waiting to review a copy of the police report. Tell them you would be more than happy to talk about the accident, but only after you’ve had a chance to complete your investigation. You are telling the adjuster this because you want to know how the police department documented your claim before speaking to the adjuster about your version of what happened. You also want to be able to make an outline of what you want to tell the adjuster about your accident ahead of time so that you are not just talking off the top of your head. You want to choose your words carefully and describe the accident in such a way to maximize your claim.
Again, do not discuss your injuries or pain. Next to hearing your version of how the accident happened, this is the adjuster’s primary reason for calling you. You want the adjuster to understand the severity of the accident so that they can begin reserving (setting aside) money to cover your claim. But you need to balance this with the adjuster’s real purpose of wanting to pin you down early on as to what your injuries are. They will confront you with your statements at a later date if you tell them later on that you have more injuries than what you originally said during your first telephone conversation. They are cynically going to insinuate that you were making up additional injuries to exaggerate your claim. Now this is not the case. It is well-known that some injuries do not manifest for several days after an accident. Also, pain management doctors will tell you that a patient will not feel some injuries because a primary injuries pain masks the other injuries. You simply need to let your injuries and medical treatment run their course before you can accurately state what are your injuries are. Like not telling the adjuster how the accident occurred, tell the adjuster here that you’ve been hurt and that you do not know how severe those injuries are yet because you are still seeking out medical treatment. The adjuster may want to know doctors or facilities you are going to. Calmly tell them that you provide all that information to them as part of your demand package and that you will also provide all the medical records for each medical provider you have treated with.
In addition to the above considerations, you want to be mindful to not do the following:
- Do not sign any release or a HIPPA form that would allow the adjuster to go and get your medical records, or information from your employer. Deny the request and explain that you know enough to provide them with supporting documentation as part of your demand package.
- Do not discuss income, salary or how much money you make. You can tell them your employer and what you do for a living.
- Don’t discuss how many days you missed from work or what your work schedule is. Politely tell them you will provide all of this in your Demand Package.
- Do not give a statement about how the accident occurred before you have obtained and reviewed the police report. If you already gave a statement prior to coming to ClaimClinic, request the adjuster send you a transcript of your statement.
- Do not identify witnesses. Say only that there may be some witnesses and you will disclose them at the appropriate time.
- Do not talk or discuss your injuries! Say you were hurt and don’t yet know the true extent of your injuries.
- Do not disclose who your doctors are or who you have seen for treatment, including hospitals, etc. Again, politely tell the adjuster all of this will be obtained and copied in your Demand Package.
8.Do not talk about an early settlement. Politely say there is no way for you to begin talking settlement until you have completed your investigation and treatment.
First Adjuster Correspondence
The first letter from the insurance company and adjuster will have some important information and some requests designed to help the insurance company at your expense.
First, check the letter’s claim info and adjuster contact information against the information in your Claim Master Sheet to make sure everything is correct – names, addresses, claim numbers, policy numbers, phone numbers, fax numbers, emails, etc.
The first letter will usually also contain some forms or authorizations for you to sign. Do not sign anything. Do not sign any HIPAA release, a document that allows the adjuster to get your medical records directly from your doctors. Remember, you control the tempo and flow of information and documents. Do not do the adjuster’s investigation for them. Part of their job is to investigate claims. In reality, adjusters are so overworked that much of the time they will not do their own investigation and will rely on your Demand Package instead.
Sometime during your first conversation with the adjuster or when you receive your first letter from them, you are going to be asked to sign a Medical Authorization form. These are also called HIPAA Releases, after the federal law that requires authorization to disclose your medical information to third parties.
We recommend you decline the authorization. They are easily abused by adjusters and enable them to obtain any medical record you have from any time in your life. You want to keep control of your claim and letting the adjuster have a wide open authorization to go digging around in your medical records is not control. Don’t fool yourself into thinking you will help your case by cooperating with the request. The sole purpose of the Release is to have access to all your records to look for other reasons to blame your injuries on.
Most adjusters will accept your refusal to sign the Authorization if you tell them you will be providing all them medical records and bills in a Demand Package. If you say it like this, the adjuster will get that you know what you are doing and will be serving up the information needed to document your claim and their offer.
Some people will still want to sign such a release because they want to appear cooperative. If you are intent on letting the adjuster have a HIPAA Release, then you should at least do the following to protect yourself and limit the scope of their investigation:
- Specifically list all the Medical Providers (hospitals, doctors, chiropractors, physical therapists, etc) that the HIPAA Release applies to. That way, the adjuster can’t use the Release to go digging around in your past , like getting OB/GYN records.
- You should also specify the date range (also called Dates of Service) for which the medical provider can release records. Make the starting date the day of the accident. That way, you are limiting the adjuster’s ability to see records that pre-date the accident.
- Finally, you should make your Release conditioned upon the adjuster providing you copies of everything they get on you at the insurance company’s expense.
You should think long and hard before agreeing to sign a HIPAA Release if you have highly personal things in your records. This could be everything from mental health type stuff to former addictions you are disclosing to the doctor. All of this will appear in your records for the adjuster to read and use against you. If you keep control and supply the records as part of your Demand Package, you can omit or redact records that contain these types of information.