Attorney Edens Discusses 12 Things You Need To Know About Insurance Companies

An insurance company is a business and just like any other business, their main goal is to make a profit.  The bigger the profit, the better the company performs. Simply put, they have to take in more money than they pay out and ultimately this is what determines just how big their profits will be. While there is nothing wrong with this premise from their standpoint, it does leave you, and your future, vulnerable to their greed.  In an effort to achieve their profits, I have noticed FIVE primary traps insurance companies and their adjusters say, and do, hoping that you fall into them.

1.     Believing the insurance adjuster is on your side and is going to treat you fairly.

After your accident the insurance adjuster who calls you will be pleasant, friendly, and will just want you to answer a few questions so they can help you. Customarily, they will tell you that your medical bills and lost wages are covered and may even offer to pay them as soon as you send them copies. Once received, they will give you one reason or another why the claim cannot be paid and they can’t pay your lost wages. This is the first of many false promises and the first of many excuses you will hear.  The goal is to get to a quick settlement and prevent you from retaining an attorney.

In other cases they may not want to settle at all.  Initially the problem may appear to be something that can easily be remedied by a few actions. Either they will request something else from you or they will state that they need to take care of something additional on their end. However, their primary reason is to stall as long as possible. The longer they can stall you, the more likely the Statute of Limitations will run out and you will never be able to recoup your medical bills and other expenses for your injury.

2.     Believing that you have to give a recorded statement. 

When it comes to recorded statements a good rule of thumb is “anything you say can and will be used against you.”  Most people readily admit to their role in their on the job accident because they honestly believe that the insurance adjuster is sincerely trying to help them and understands that the nature of some jobs are dangerous. This is one of the biggest traps they hope you fall into. Once they have your version of events they can start building a case against you. If an employee claims they were trying to finish a job that can translate into they were careless and therefor caused their own accident. If they state they were not feeling well at the time of the accident, then the employee should have stayed home.

You should not give a recorded statement. As stated in the prior chapter, the adjuster will make an employee believe that a claim can’t be processed until they provide a recorded statement. They will also try to convince a worker that it is just part of their procedures or policy. There is no law or rule that requires anyone to give a recorded statement.  The insurance company may have this “policy,” but it does not mean the worker is bound by their “policy” or that it is even enforceable.

Besides being held to a specific version of events, the adjuster has been trained to ask very specific questions in a very specific way and, most likely, in a very specific order. The same question phrased slightly different can result in two completely different responses.  For example, when asked: Do you always wear your safety equipment?  A typical response would most likely be a resounding yes. However, asked slightly different such as:  Have you ever forgotten to wear your safety equipment?  The answer  might be“on occasion I have” without much hesitation. Not only has the employee just admitted to not abiding by company policy, they have just admitted doing it on multiple occasions.  Although this may seem to be an extreme example, I have seen adjusters ask injury victims questions much like this.

I would highly suggest you don’t, but the decision to give a recorded statement is entirely up to you.

3.     You Do Not Have to Sign a Medical Release or Wage Loss Authorization.

Just as with the recorded statement, the insurance adjuster will likely tell an employee they need to sign a medical authorization form in order to process your claim. Again, an employee need not and should not sign a medical authorization that allows the insurance carrier full access to all medical records.  This authorization will give the carrier unlimited access to records relating to prior injuries, pre-existing conditions unrelated to your injuries, illnesses, surgeries, hospitalizations,, medications and all other medical history. Some authorizations even give the defendant’s insurance carrier access to your complete educational records or worse; blanket authority to obtain any and all records that can be used against the employee. The insurance company may attempt to use these records to frighten or embarrass a worker into not filing a lawsuit or settling for less than they deserve. They are preying upon the fear that this information will be made public. Please know, they will take every opportunity to exploit any and all information obtained to avoid paying the damages deserved.

Similarly, they usually want a worker to sign a wage loss authorization that may allow the insurance company blanket access to all the persons employment records, past and present, including salary, bonuses, any disciplinary actions, reviews, paid time off, and disability information. They will use this information to reduce a claim for lost wages. If an injury was caused at work, obviously they may already have some of this information.

Finally, an employee SHOULD NOT sign a check from the insurance company that says “Final Payment” or “Final Settlement.” The insurance companies know if someone falls for this trick, it will be nearly impossible to file a lawsuit at a later date.

4.     The Insurance Company May Not Always Tell You The Truth. 

I have already stated that the insurance companies are in business to make money. Recently, Fortune Magazine named insurance companies as one of the top 50 most profitable businesses. Most insurance companies are publicly held. The better they perform, the more valuable their stock becomes, and the larger and more powerful they become.

Don’t be fooled into thinking an insurance company, or their agents, and adjusters will tell you the correct answers to your questions. Don’t believe they will give an honest estimate of what your injuries are really worth. Finally, don’t believe the insurance company is not going to give you what you ask for your injuries if they can pay you less. 

5.     Your Injuries Were Pre-Existing and Not Related to Your Accident. 

You can bet if an employee has ever been treated for even a minor injury in the same area of their body, the insurance company will find out and the adjuster will tell them all of their symptoms are due to that prior injury. Most people suffer injuries beginning in early childhood, and periodically throughout their adult life.  Therefore, statistically it is quite likely that at some point in the past a person has injured the same area on more than one occasion such as a knee.  Don’t try to hide a prior injury from the doctors or nurses treating you, or your attorney, because it will give the insurer another reason to avoid paying you.  There is nothing harder to deal with in front of a jury than a client caught in a lie about their injuries or how they happened.  It is imperative that you are honest and let your attorney determine how best to present your case.  

6.   The Insurance Company Does Not Want You to Know the Type of Damages You Are Entitled To. 

Most accident victims already know that they are entitled to compensation for their medical bills and lost wages. The secret the insurance companies are keeping from them is that they are also entitled to recover damages for many other things.  Just a few of the more common damages include:

a.     Future Loss of Income – If an employee’s injury results in the loss of income in the future, in any way, they are eligible for future lost wages.  This can be due to future treatment or any condition which would impair their earnings in any way.  The amount of the damages is equal to the present value of the wages they would have earned during their entire lifetime, if applicable.   

b.    Pain and Suffering (Past and Future) – This term is often familiar to people, but the reasoning behind it is often misunderstood. Sometimes it is viewed as an unnecessary and greedy attempt by an accident victim to get rich from the incident.  The value of this element of damages is also not easy to measure.  The amount of medical bills is straight forward, but what is the value of the days, weeks, or even years of painful healing? In reality, the after effects of an accident are far reaching. Victims and family members can suffer severe, and often, long lasting anguish, fear, depression, and other side effects.

c.     Loss of Useful Life – An employee is  entitled to recover damages for the diminishment in their ability to enjoy and perform the daily activities caused by the accident. This is in addition to, and separate and apart, from pain and suffering. It covers both past and future inability to enjoy life’s pleasures including relationships with spouse and children, work, hobbies, driving, housework, gardening and any other activity you could and did do before the incident, but can no longer do or do with added difficulty.

d.     Disfigurement or Amputation – Scars, loss of limbs, or unsightly marks resulting from an injury entitle the victim to recover damages for the disfigurement, along with the humiliation and embarrassment caused by the disfigurement. In many cases, these damages can be quite substantial.  Yet, many victims unknowingly place no value on this, completely unaware that they can recover for their physical scars. 

e.     Wrongful Death – While money can never compensate for the loss of a loved one, it is the only means our system of justice leaves available to compensate the loved ones left behind. Those eligible to recover include; spouses, children, parents, and other relatives, through blood or marriage, who were dependent upon the deceased at the time of the accident. In addition to monetary compensation for the wrongful death of their loved one, survivors may receive damages based on a direct cause of action for injuries to them for loss of companionship, affection, attention, comfort, protection, marital care, parental care, child care, guidance, advice, training, education, mental anguish, and pain and suffering. If the deceased suffered prior to their death, their estate may be entitled to damages as well.  Under many circumstances this can be very substantial depending on the length of time between the injury and the death of the victim. 

7.   Insurance Companies Do Not Want You to Know, or Learn How to Find Out, What Your Injuries are Actually Worth. 

Insurance companies go to great lengths to prevent you from learning how much your injuries are actually worth. The biggest way they do this is to try to prevent you from hiring an attorney.  They know that once you do, statistics show you will receive two or three times as much for your injuries.  Another way is not to inform you of the resources for valuing your claim.  If you are dealing with an adjuster, ask them where you could go to value your claim.  I bet they won’t direct you to the local jury verdict reporter or a website like mine that will do just that. 

8.     The Insurance Company Might Try to Blame You for Your Injuries. 

While an employee may be in part, or in some cases fully, responsible for their injuries this in no way excludes them from receiving full benefits. Many injured workers’ wrongfully believe this to be true and therefor may not even seek Workers’ Compensation Benefits. If you have been told this by your employer or the insurance company please call me to discuss the details of your case. Your consultation is always FREE. The information you receive may be priceless! 

9.     The Insurance Company Does Not Want You to Know the Long Term Consequences of Your Injuries. 

One reason insurance adjusters are often so eager to process a claim and offer a quick settlement is to prevent the victim from discovering the extent, and possible long lasting effects, of their injuries. Only you and your doctor can really answer this question and it usually takes time.  On the other hand, the insurance companies use a “cookie cutter” technique to assign a value to each injury, or combination of injuries, and assess a dollar amount based on this formula. The Act does assign certain weeks of benefits for loss of limbs and has very specific guidelines. However, it is arrogant on the part of the insurance company, and insulting to you, when they attempt to classify all victims and their injuries into narrowly defined “one-size-fits-all” categories.  You are unique, your injuries are unique, and you deserve individualized personal attention to every aspect of your case. 

10.   The Insurance Company Does Not Want You to Know   What a Third-Party Claim is or if One is Available to You. 

A third-party claim would involve a set of facts which could make a third-party, someone other than the insurance company’s client, responsible for your injuries.  These claims often dramatically increase the value of your case.  However, if you settle the claim without preserving the 3rd party claim, in some circumstances you may lose this opportunity.

Some examples of third-party claims are:

a.     Accidents caused by faulty equipment or manufactured products.
b.    Injuries caused by an employee of another company at your job site.
c.     Injuries as a result of unsafe premises when owned or operated by someone other than your employer.
d.    Car accidents caused by someone else’s negligence when you are driving as part of your job.

If you are not aware that you can file a claim against a third-party, in almost all cases, the insurance company is not going to tell you.  If you think someone else may be liable for your injuries, I highly recommend you call me to discuss how it may affect your claim. 

11. The Insurance Company Does Not Want You to Know That Accident Victims Receive 2-3 Times More Money With an Attorney. 

Victims represented by an attorney typically receive two to three times more money than they obtain when they represent themselves.  Insurance companies don’t want you to know this.  If you are dealing with an adjuster, ask him if they would advise you to speak to an attorney before proceeding any further.  I bet you will hear a lot of things, but one thing you won’t hear is “yes, I suggest you seek legal counsel immediately.”  This is why the insurance companies want to settle your claim quickly and why the adjuster will do everything possible to keep you from hiring a lawyer.

In Illinois, statistics show that the average settlement for an auto accident in 2010 was a little over $30,000 if the individual was not represented by an attorney and between $60,000 and $90,000 for the same damages if they were represented by an attorney.  However, small accidents, typically under $5,000 in damages, may not require the assistance of an experienced personal injury attorney.  You still should know what to expect when dealing with a potentially unscrupulous insurance adjuster.  Therefore, it is always a good idea to call me for a free, no obligation case analysis and just get some good, honest advice on what to do and what the settlement value of your case likely is given your injuries. 

12. The Insurance Company Will Look for Many Reasons   to Deny Your Claim, Hoping You Won’t Challenge Them.

Insurance companies will sometimes give you multiple or repeated reasons why you are not eligible for certain benefits. Some of the more common ones are that you did not go to the correct doctor for your particular injuries and will therefore try to deny coverage to certain types of doctors including, but not limited to, chiropractors, plastic surgeons, and orthodontists. Additionally, they will argue certain treatments were unnecessary or excessive, even if prescribed as part of your overall recovery plan. Then there will be facilities they try to exclude too. Sport medicine clinics routinely perform physical therapy, yet the insurance company will claim your injury does not qualify you to be seen there or that you were over treated.  The insurance company tries to inject itself into the doctor-patient relationship and dictate treatment.  They have no business here, but a trained attorney is needed to deal with these issues