By Mitch Rice
After filing an injury claim through insurance, most people expect compensation. However, a large number of claims are either outright rejected or require a fight. Insurance companies fight injury claims aggressively because large payouts reduce their profits. To protect revenue, insurance adjusters push back and look for reasons to deny and devalue claims as much as possible. When they can’t deny a claim, they’ll make a lowball offer, hoping the injured party will take the money and go away.
If you’ve been injured in an accident, understanding how and why insurance companies fight payouts will give you a better chance at getting paid fairly.
Here’s what you need to know.
Serious injuries threaten revenue
It’s not hard to see how catastrophic and long-term injuries cost insurance companies more than other claims. When a claim involves surgery, permanent disability, lost future earnings, or lifelong care, insurance adjusters treat it like a liability.
Future medical costs are typically included in insurance payouts and serious injuries cost more. For example, if you experienced a spinal injury or traumatic brain injury (TBI), you might need years of ongoing treatment. Lifetime care costs for some injuries can reach millions of dollars. That’s why insurers aggressively challenge treatment recommendations and projected medical costs associated with serious injuries.
Serious injury claims are likely to include extensive damages for pain and suffering and lost earning potential. For example, a 20-year-old worker who can no longer perform physical work might lose decades of income potential. The value of their claim will rise significantly if their quality of life has been permanently altered to the point where they are no longer independent or have limited mobility.
Delayed claims are a strategy
In many cases, delays are intentional and designed to create financial pressure. Insurance companies know that when someone’s bills start piling up they’re more likely to accept the current offer. Missed paychecks and late rent force many injured people to accept a low settlement.
Insurance adjusters often request years of medical and employment records along with test results and sometimes even tax returns to verify claims of lost earnings. They don’t ask for detailed records to verify an injury. They’re actively searching for reasons to deny a claim. For example, if you have a pre-existing injury or medical condition, they’ll use that against you. And sometimes they will intentionally prolong their investigation just to see if you’re going to continue getting consistent treatment. If not, they’ll use that to deny your claim.
Reducing credibility is a financial protection strategy
Since insurance adjusters are only concerned with protecting their profits, they’ll try to find ways to reduce the credibility of your claim. They’ll look for inconsistencies, alternative explanations, and evidence that can be used to either deny or devalue your claim. For example, they’ll go straight to your social media accounts and comb through all of your photos, posts, comments, and check-ins looking for something they can use to argue that your injuries aren’t that severe. Unfortunately, even harmless posts can be misrepresented.
If your case is serious enough, they might even hire a private investigator to document your physical activity in your daily life and compare what they find to your reported limitations.
Insurance adjusters scrutinize medical records to protect profits
Just because you’ve been seriously injured doesn’t mean you’ll automatically win compensation. It’s not your injury that determines the value of your claim – it’s the type of medical care you receive. For example, if you don’t need a lot of medical care, your claim will be worth less than someone who needs more treatment. If you miss your appointments or stop therapy early, the insurance company will lower the value of your claim.
When trying to get a personal injury claim approved, it’s critical to get opinions from specialists because they carry more weight. However, the insurance company might require you to undergo an evaluation with one of their doctors to verify your injury and limitations.
Large claims trigger defense teams
Insurance companies have lawyers, experts, accident reconstruction analysts, and investigators on deck waiting to evaluate large claims. To assess how much risk you pose, they’ll evaluate your situation to determine if a jury might issue an unusually high award if your case goes to trial. That evaluation will inform their negotiation strategy.
Insurance claims are a battle because the stakes are high
Insurance adjusters are aggressive because they’re protecting their profits. They fight serious injury claims because they want to avoid high payouts. Serious injuries tend to come with higher medical bills and a higher chance of long-term disability. If you’re dealing with a major injury claim, protect your right to fair compensation by contacting a personal injury attorney as soon as possible.
Data and information are provided for informational purposes only, and are not intended for investment or other purposes.