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ClaimClinic: Adjuster's First Offer

The adjuster will most likely call you to give you his/her counter-offer to your Demand Package.  You need to be prepared for a low ball offer to start the negotiations.  Adjusters are trained to do this to feel out those who will take the first thing offered.  Do not get emotional. Remember, this is a financial transaction.  This is nothing more than the lower bracket – the low number that you and the adjuster will use to negotiate between his low offer and your high demand.

You will not be making any arguments or revising your demand amount during this call.  Your sole goal is to get his/her counter offer and there basis for the number.  You are then going to hang up the phone, wait a day, and then WRITE a letter with a revised demand along with an explanation of why you think your claim is worth more then what the adjuster offered.  It is important for you to slow down the negotiation process and do it in chunks.  You want time to think and choose your words before responding to the adjuster.  That is why we advocate using a letter to set out your response instead of having to be put on the spot in a phone call.

During the first call, the adjuster will give you an offer.  Take careful notes.  Let them talk without asking any questions at first.  One trick in negotiating is to remain silent.  The other party will fill the need to fill the silence by continuing to talk.  The more the adjuster talks about their evaluation, the more opportunities you will have to negotiate.  Your side of the conversation should only be questions.  Ask a question and take note of their response.  Do not make any statements or posture in any way.  If you taped and replayed your conversation, you should hear yourself only asking questions.

Get The Component Numbers

The adjuster is just going to offer you a number.  They are not going to volunteer all the components that went into coming up with that number.  You need to ask questions to get them to explain how the assigned money to all the various damages.  It is extremely important that they do this for you.  Otherwise, you won’t know where to focus your efforts on your Counter Demand.

Ask how their Offer is apportioning:

  • Medical Expenses,
  • Lost Wages,and
  • Pain and Suffering?

In other words, how much of their number are they figuring is for your medical expenses and how much are they saying is for your pain and suffering.  You don’t want to deal with a lump sum. You want them to identify the sub-components of their number because this will give you lots of mini-negotiations on each component.  It will also quickly identify the areas where the adjuster is discounting your claim.  You may find out that you only need to spend time negotiating one of the damages because the other components are fair or reasonable.

You can try asking the adjuster for an itemization of all damages information that he/she inputted into their claims software.  They may not agree, but if the do you will have solid information on what the adjuster used as data points to drive his/her offer.  You will want to go through the damages and make sure they account for everything you itemized in your Demand Letter.

Discounting Liability

First, you need to make sure the adjuster is not apportioning any fault to you.  If they are, it could dramatically reduce their value range.  For example, if the adjuster is applying 20% fault to you, that 20% will operate to reduce your overall offer by 30%.

Dissecting Injuries

The adjuster’s settlement offer range depends greatly on how they coded your injuries into their claims software.  Ask the adjuster to identify each specific injury he/she identified and used.  It may be that the adjuster coded shoulder pain when you really had shoulder pain radiating into your neck – which are 2 injuries instead of 1.

Also ask if there were any injuries you identified in your Claim Dissection Worksheet or Demand Letter for which he/she did not find documentation in your medical records.  You want to know this because the adjuster may not be considering certain factors because he/she was unable to find them in your records.  Remember, if it is not in your medical records, it did not happen.

Adjusters commonly use dissection sheets, pick lists, and injury questionnaires to go through your claim.  Because you are not an attorney, you can try asking if they will share their worksheets with you.  Tell them you want to review it to make sure everything you have identified in your records has been picked on the worksheet.  The adjuster may or may not share it with you, but it is worth a shot.  If you get to see it, review it to make sure the adjuster did not miss something.

Dissecting Medical Damages

If the adjuster does not offer you the full value of your medical expenses, you need to dig in to his/her rationale.

  • Ask them how they are justifying giving you less than full value.
  • Ask them what in your claim makes them believe they don’t have to pay full medical expenses.
  • Ask them to specifically identify which, if any, treatment they are saying was not reasonably priced (i.e. they think was over charged).
  • Ask them to specifically identify any treatment they think was not medically necessary.
  • Ask them if there were any diagnosis or treatment that was not entered into their claims software and ask the reason for omission.

Dissecting Lost Wages

If the adjuster identifies that he/she is giving you less than your full lost wages as documented in your Demand package, ask them to explain.

Sometimes adjusters will only give you “Net” wages instead of gross.  In other words, adjusters are only giving you what your take home pay would have been and are backing out taxes and social security.  Many adjusters who do this will reduce your gross lost wages by 20% to get to a Net number.

If you are faced with a situation where the adjuster identifies less than full lost wages, the first thing you should do is ask him/her  if there is any additional documentation that would permit them to re-evaluate their lost wages.  It might just be that something was not documented to their satisfaction.  For example, some adjusters and insurance companies require a doctor’s note releasing you from work before they will compensate missed work as part of your claim.

Your only other option if there is no addition documentation to be had is to argue with them over the reduction.  Tell the adjuster your full gross wages are admissible at trial and that is the only number a jury will hear.  While this may persuade the adjuster, you have to keep in mind that this is pre-suit litigation and the adjuster can handle the numbers however they see fit, even if it flies in the face of the rules of evidence at trial.

Dissecting Pain & Suffering

After learning what the adjuster assigned to your medical expenses and lost wages, you can subtract those amounts from the total offer to get at what they are offering in the way of pain and suffering.  Ask the adjuster to confirm you quick calculations and commit to the amount they are putting on pain and suffering.

Next, ask them why they think your pain and suffering is worth the number they attribute to that part of your damages.  This is going to be the part where you are tempted to get angry and respond.  Don’t.  Listen and take notes.  You are not going to be able to change their mind at this early stage.  You only goal at this point is to understand their rationale for their pain and suffering offer.  You questions should be the Why’s and How’s.

Beyond Policy Limits

The adjuster may come back in their first Offer and say that your Demand is above policy limits.  If you have not already obtained it, request that they send you a certified copy of the at-fault driver’s Declarations Page.  The Declaration Page will list the policy limits so you can confirm for yourself that this is the case.  If they aren’t willing to give you the Declaration Page, you need to explain to them that you are negotiating and evaluating your claim based on their policy limits assertion and it is important that you verify this fact.  If they are still unwilling to do it, ask to speak to their supervisor.  When asking to do so, kindly explain that you are not intending to remove the adjuster out of negotiations, but you just need someone who will send you the Declarations Page so you can evaluate policy limits before relying on the stated policy limit to reduce your Demand.

Additional Considerations

Adjuster Desk Authority

Ask the adjuster what their total authority is for cases generally.  You are not asking for what their top authority is for your claim, but how much authority does he/she have for her position/desk before having to go to a supervisor for more money.  They may not give you this information but it does not hurt to ask.  Tell them you are only asking because you want to make sure the adjuster is not shorting the claim to keep the file at her desk instead of having it kicked to another adjuster with more desk authority.  You want to try to identify and or remove this behavior if it is going to limit the fair value of your claim in the insurance company’s eyes.

Seasonal or Holiday Demands

Beware of low ball offers around Thanksgiving and Christmas.  Adjusters know that for many people, money is tight around this time.  Adjusters will float a low ball offer to see if you are desperate enough to take it.

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