The Adjuster Is Investigating My Claim. Do I Need a Lawyer, or Can I Settle My Injury Claim Without Hiring an Attorney?

The Adjuster Is Investigating My Claim. Do I Need a Lawyer, or Can I Settle My Injury Claim Without Hiring an Attorney?

Topics of Interest:
Attorney's Fee in injury cases
Settling Injury Claims
Adjuster is Delaying Payment and "Investigating" Claim
Medical Care After an Accident
Notice of Hospital Lien Against Case
Should I Use My Health Insurance After an Accident?
Multiple Car Accidents and Injuries
What You Can Recover in Injury Cases

Call the Law Office of Doug Goyen at (972) 599 4100 if your car accident injury claim is being "investigated".   The signal the insurance company is giving you is that they are looking for a reason to deny your claim.  They likely have a "theory" where they think they can deny the claim, if they just get the right information.  If you don't have experience handling claims, you will not know what they are doing.  Our law office is experienced handling claims, over 20 years of experience.  Once we see the facts, we will know what they are attempting to do, and can gather the evidence or information needed to "head off" the insurance company's attempt at denying the claim.  If you wait around, you are increasing the likelihood of the insurance company finding or creating the information they want to use to deny your claim. 

The insurance adjuster is telling you that it needs to finish its investigation before it can pay anything on your injury claim or accident.  Should you be worried?   In short, yes. 

Call the Law Office of Doug Goyen.  We handle personal injury cases, do not try to settle your personal injury case on your own.  The insurance company has lawyers, you need one too.  The phone call is free.  Our car accident injury lawyers will ask you the questions that are relevant to settling your injury claim.  If your case does have any serious problems with it, we will let you know what those problems are, so you are prepared, and so you are not surprised when the insurance company brings up those problems later. 
If you have an injury that has caused serious injury or financial difficulties then we want to talk to you about your case so we can represent you. 
If your auto insurance company is delaying payment on your claim because it has not "finished its investigation" then you are on notice that they are looking for a reason to get out of paying your claim.

Attorney Doug Goyen worked as an insurance claims adjuster for many years prior to becoming an attorney, and handled personal injury claims for insurance companies, and now handles them for injury victims. 

Adjusters are trained to handle claims in a particular order. 

First, the adjuster will determine if there is coverage.  Just because the other driver had their insurance card does not mean there is coverage for this particular claim.  The adjuster looks to see if payment was made, if the correct vehicle was used, if the vehicle is being driven by the correct person, if the vehicle was being used for a purpose that voids coverage, if the person driving the vehicle was licensed, and the list goes on.  If there is a reason to deny coverage, then they will not pay the claim. 

Just because they paid for part of your claim does not mean they won’t come back later and deny coverage.  They can pay for your vehicle, and then later on, while investigating your injury claim, discover some fact or issue that voids coverage.  For example, they may not realize in the beginning investigation of the claim that their driver was using their car for “business purposes”, such as delivering pizza.  If they find out later that it was being used for business then it becomes a problem, as their personal auto policy might not be rated for "business use".  If the vehicle was being used for business, they will deny coverage for the injury claim, even though they already paid for your car’s damage. 

After confirming if there was coverage, the adjuster looks at liability.  In other words, was their driver at fault?  Were you at fault?  Was someone else at fault?   Was nobody at fault?  They will try to find a way to say that their driver is not at fault, or find a way to put at least some of the blame on someone other than their driver in order to reduce the amount they will owe. 

Finally, they will look at the damages.  Damages are what your medical bills incurred or needed in the future, lost wages, pain and suffering and mental anguish, among other costs (or out of pocket expenses) that were incurred due to the accident or injury.  Other examples are damage to your vehicle, rental bills, towing bill, disability, disfigurement, wrongful death, and other losses and harms caused by the accident or injury.  Insurance companies review any bills, estimates or receipts to verify they are related to the incident in question, and not due to some other reason.  If the documentation isn’t clear, or if there is a large gap in time, the adjuster may claim that he doesn’t believe your documentation (bills, estimates, or receipts) are related to the accident or injury in question.  The adjuster will see if you did your part to minimize the damages (called “mitigation of damages”).  A person is required under the law to try and keep their damage to a minimum if reasonably possible.  The insurance adjuster will verify that the amounts claimed are reasonable.  Did your medical provider or body shop charge an excessive amount compared to what is normally charged?  Are the medical providers charging for something that didn’t need to be done?  If so, the insurance adjuster will try to deny covering that part of your claim – leaving you to pay that part of the bill.  Our Dallas injury lawyers have gone through this procedure thousands of times over the past 20 years, so we know what is happening and what the insurance adjuster is looking for.  If we are hired from the start, our knowledge of what the insurance company is trying to do in different situations helps us defeat any attempts to find a reason to deny the claim.  

Often insurance adjusters claim that some part of your claim was excessive, but give you no guidance on how they came to this opinion.  This leaves you with little or no help in dealing with your medical provider or body shop when they are asking for payment.  You can’t just tell them “your bill is too high” and expect the medical provider or body shop to accept that.  But that is what insurance adjusters often do when evaluating claims.  We are your advocate in these situations.  We have the information available that is needed to counter the insurance company's attempts at avoiding payment to you.

If your insurance claims adjuster is delaying paying your claim because they need to “finish their investigation”, then this can mean multiple things, but it all boils down to one thing . . . they are trying to delay paying your claim, and looking for a reason to not pay it at all if possible.  

As discussed above, investigation for an insurance company is done for the following reasons: a) coverage issues; b) liability issues; c) damages issues. 

a)  Coverage Issues:  If they are investigating a coverage issue, then this means they are looking for a reason to say there is "no coverage" and then deny your claim.  Like discussed before, it can be for non-payment, for a person driving their car who was not supposed to be driving it, for the other person driving a car that was not listed, for no coverage for the time or date of the accident, for their driver "not cooperating" with them - meaning they aren't calling in the claim.  Yes, they can deny coverage because their driver never calls in the claim - getting the insurance company off the hook for paying your claim.  They "want" their insured driver to not call.  This gives them an excuse to delay paying you and hold on to the money just a little longer, and gives them an excuse to deny coverage at some point in the future in case their person never does call in the claim.  

b)  Liability Issues:  If the insurance adjuster has told you that they need to “confirm liability”, or that they need further investigation regarding liability, this means they are looking for reasons to place the blame on someone other than their driver.  They may try to place the blame on you, or your driver for something they claim you did (didn't put on your brakes in time, cut them off and then slammed on your brakes, failed to veer right or left to avoid the collision, didn't use your horn so the other person would know to get out of the way) . . . or maybe they will try to blame a "phantom vehicle".  Often, the other driver will claim that some vehicle that nobody else saw suddenly cut them off and they had no choice but to hit your vehicle.  They will claim that it wasn't their fault, but the fault of this "phantom vehicle" that nobody saw, and nobody has a license plate for.  This will give the insurance company an excuse to try and deny your claim. 
Sometimes they will blame it on God himself.  They call it an "Act of God".  Acts of God include weather, sun, wind, rain, or ice.  Everyone on the road may be driving normally, and within the limits that the weather dictates, but their driver has decided to drive too fast for the conditions, or change lanes when unsafe and loses control on the water, or gets sun in his eyes, and tries to place the blame for the accident on an Act of God.  This gives the insurance company a reason to deny liability, because their driver did nothing wrong - it was Mother Nature, or God who caused the accident. 
 c)  Damages Issues:  If the insurance company is waiting to pay because they have to confirm some issues about "damages" (medical treatment, lost income, or other out of pocket expenses), then they are looking to see if they can find a reason to not pay your damages (medical bills, lost income, or other out of pocket expenses).  If you had another accident or injury claim with another insurance company from an auto accident, or from a Workers Compensation claim, or from a premises liability case or slip and fall, then they are likely contacting those other insurance companies to see what injuries you had in those older cases to see if your injury you are claiming now is similar.  If it is similar at all, they will try to blame your current injury on your old accident or injury, and claim that they do not owe it.  Insurance companies have access to databases that let them know about all your other injury claims you have had, with all the different insurance companies you have made any claim with.  They will know about any prior claims of injury, even if it was just a minor complaint, and they will use that information against you and try to blame your current injury on the old claim - in order to get out of paying. 
In summary, if the insurance adjuster is delaying payment on your claim due to "investigation" reasons, contact the Law Office of Doug Goyen at (972) 599 4100.   The call is free, can save your case, and help get your case resolved, but you need to call.  The insurance adjuster is looking for a reason to get out of paying - coverage, liability, or damages - they are looking under each rock to see what they can find, and if they find something, they will use it against your claim.  Always protect yourself.  If you have a serious injury, then you have serious financial problems caused by the accident or injury.  These financial problems don’t handle themselves.  With the different insurance companies involved (auto, liability, health, workers comp, Medicare, Medicaid, etc.), the rules and requirements are complicated and trying to deal with this on your own can cause you even more problems if you don't deal with them properly.   Contact us today.  The call is free.  The initial phone consultation is free.  Call (972) 599 4100.