The Adjuster Is Investigating My Claim. Do I Need a Lawyer?
Attorney Doug Goyen is a car wreck accident attorney licensed in Texas since 1997 with decades of experience representing individuals in personal injury-related cases. We receive phone calls daily from concerned people regarding insurance practices. One of the most common concerns, when people call our office, is when an “adjuster is investigating my claim” and the investigation is leading to delays or even denials of payment. Many times this is a delay tactic that an adjuster is using to avoid doing the work needed to be done on the case. With a personal injury case, you need a lawyer to help push the adjuster out of their “excuse” mode and either pay the claim or deny it so a lawsuit can be filed when necessary.
The Law Office of Doug Goyen has negotiated, litigated, and taken to trial thousands of cases and obtained millions of dollars in compensation for our clients. Our clients receive experience, expertise, and motivated representation from the Law Office of Doug Goyen. Our desire for justice for our clients enables us to achieve proven results in cases. Contact us at (972) 599 4100. We will begin working on your case right away.
Yes, if the “adjuster is investigating” your claim and there is an injury claim involved, then you should retain the services of a lawyer. The insurance company employs experienced adjusters and attorneys who will look for reasons to deny or avoid paying a portion, if not the entirety, of your claim. If you have an experienced personal injury lawyer working on your case, your lawyer can help you avoid the mistakes that people who do not hire a lawyer make. If you hire a personal injury attorney, the amount you receive will more than cover the cost of your attorney.
Insurance adjusters investigate every accident claim to put your mind at ease. They must obtain their driver’s report regarding what occurred, even if there is a police report that clearly favors your side of the claim. The police officer could have mixed up the names or cars, or simply didn’t hear their driver’s story clearly, the insurance adjuster believes. If the insurance company is delaying because they are unable to contact their driver, a witness, or a police report, this is not unusual; however, it may be a sign that you should proceed with caution when presenting your claim, and you should consider hiring a lawyer to protect you and your claim. If you were injured, you should hire a lawyer because injury claims cause the insurance company to look for ways to deny insurance coverage, liability, and damages.
The insurance company will assign the claim to a more experienced “injury adjuster” in injury cases. This injury adjuster is investigating your claim more thoroughly than insurers do with non-injury claims. Prior to becoming a lawyer, I worked as an injury adjuster for insurance companies. We were taught to look for ways to avoid paying claims, which usually fell into one of three categories:
1) Coverage – Did their insured pay their monthly premium? Is the car they are driving listed? Is the person driving their vehicle supposed to be driving it? Were they on their way to work at the time of the accident? All of these (and other) factors can influence whether or not a claim is covered.
2) Negligence – Was the accident “unavoidable”? Was it the result of bad weather or an “Act of God”? Was it your fault that the collision occurred? Is it possible that the collision was caused by another driver who caused their driver to lose control? These are reasons to clear their driver of negligence – if the collision was unavoidable, caused by weather, caused by another driver, or if they can get you to say something that leads them to believe you had some responsibility, they will use this information to avoid paying your claim.
3) Damages – Your injury may be out of the ordinary. Because the diagnosis may be difficult, the bills may be higher than usual. Your injury claim could be for an injury to a previously injured part of your body. The older we get, the more likely it is that we have previously injured several areas of our body in some way, and the collision may cause a dormant injury (one with no symptoms) to suddenly awaken with symptoms worse than they have ever been. It could be a new injury as well, but because it is near the area of your body where you had a previous condition, the injury adjuster could use this information against you. These previous injuries or conditions may jeopardize your claim. These prior injuries or conditions may actually help your claim if presented correctly by an experienced lawyer.
The sense of urgency you feel like the victim of a negligent driver is not what the negligent driver feels. Because the negligent driver is concerned about raising his or her insurance rates, they may delay reporting the claim, refuse to deal with it, or even change their story to try to convince the insurance company that it wasn’t really their fault because they have had more time to think about it.
If this occurs, the negligent person’s liability insurance will side with their driver, assuming their driver’s story makes sense. The longer it takes for the other party to report the claim to their insurance company, the more likely it is that they will have “thought about it” and come up with an excuse for why the collision was not their fault.
If your car accident injury claim is being “investigated,” where the adjuster is investigating on a seemingly endless basis, contact the Law Office of Doug Goyen at (972) 599 4100. The insurance company is sending you a signal that they are looking for a reason to deny your claim. They most likely have a “theory” that they believe will allow them to deny your claim. You won’t know what information you need to counter the theory they’re trying to develop, and you won’t know what evidence to present them that shows they’re barking up the wrong tree if you don’t have experience handling claims.
Our law firm has over 23 years of experience in handling claims. We will determine what the insurance company is attempting to do once we have all of the facts (the facts will tell an experienced lawyer what the insurance company is looking for to deny your claim). If your claim is valid, we will gather the necessary evidence or information to “thwart” the insurance company’s attempt to deny the claim.
We will also notify you if your claim is going to be denied due to a lack of evidence or if the evidence is biased against you for some reason. Waiting increases the likelihood that the insurance company will gather the information necessary to deny your claim. Once they’ve decided your claim should be denied, it’s much more difficult to persuade them otherwise. If you have an attorney working on your claim from the start, we can gather evidence in your favor that will help you overcome any fabricated reasons that some injury claims adjusters try to use to deny claims.
You need a lawyer because the insurance company has lawyers evaluating their cases and reasons for denials. The phone call is free, as is the case evaluation, and there are no fees unless you win. Our accident injury lawyers will interview you and determine what is required to ensure that you can recover compensation for your injuries. If there are any serious issues with your case, we will inform you of them and discuss how to address them in a way that causes the least amount of harm. We want to talk to you about your case if you have suffered a serious injury or financial difficulties as a result of an accident.
If you were injured in a car accident, you will need the services of a auto accident attorney. If an adjuster is looking into your claim, you’ll need a lawyer who has experience with the type of accident you were in, such as car accidents, truck accidents, motorcycle accidents, pedestrians hit by cars, or bicycle riders hit by cars.
If the amount of money at stake is greater than you are willing to lose, you should consult with a lawyer. By contacting a personal injury attorney, you have nothing to lose. Phone calls are free in order to determine if we can assist you in your specific case. Contingency fees are charged by personal injury lawyers, which means that we take a percentage of what we recover on a case. If we do not win there is no fee.
If the insurance adjuster is investigating and delaying payment on your claim for “investigation” reasons, call our claim lawyer in Dallas, Doug Goyen at (972) 599 4100. The call can save your case and help you resolve it, but you must make the call. The insurance adjuster is looking for a reason to avoid paying – coverage, liability, or damages – and if they find something, they will use it against your claim.
Always protect yourself. If you sustain a serious injury, you will face significant financial difficulties as a result of the accident or injury. These financial issues do not resolve themselves. The rules and requirements are complicated because of the various insurance companies involved (auto, liability, health, workers comp, Medicare, Medicaid, and so on), and attempting to deal with them on your own can cause you even more problems if you don’t deal with them properly. Please contact us right away. Call (972) 599 4100 or fill out our contact form on our website.
Attorney Doug Goyen is a claim lawyer in Dallas that represents clients injured in auto accidents suffering personal injuries as well as financial losses resulting from their crashes. We ensure that our clients receive the full value of their claims and that they are compensated for their injuries. We provide free phone consultations and strategy sessions to people who are looking for a lawyer to represent them in a personal injury case.
To maximize your recovery, you need an attorney who will aggressively pursue all of the evidence, witnesses, reports, video, records, and other documents involved in your case. For our clients, we have recovered millions of dollars in settlements. There is no fee unless you win. The following is a summary of some of the services we provide:
- We deal with the insurance company/business on your behalf so that you do not have to. We relieve you of the burden of dealing with the insurance company in connection with your injury case.
- We ensure that the insurance company/business does not take advantage of you. You’ll need the assistance of a lawyer to fight for your personal injury claim.
- We make certain that you take advantage of ALL of the benefits available to you. You need to hire an experienced lawyer to review your case and ensure that you are taking full advantage of these benefits for your injury case.
- We assess the worth of your claim and negotiate a settlement with the insurance company/business. Our years of experience handling personal injury cases ensures that we will be able to evaluate your case and then fight to get you every dollar you deserve on your case.
- We will fight for your side of the story. To fight for your case, you’ll need a lawyer in the Dallas area.
- If necessary, we will refer you to a reputable body shop. Sometimes people don’t know where to turn to get their vehicles repaired. Our years of experience can assist you in locating body shops with a good reputation in the Dallas area.
- If your vehicle is a total loss, we can assist you in gathering information about its value. We assist you in locating the information you require to confirm that the value they provide is an actual fair value.
- We assist you in locating reputable medical treatment facilities where you can be treated for your injury. We can locate medical facilities that can and will treat you for your injury so that you can begin to heal because of our years of experience handling injury cases in the Dallas area.
- We compile all of the information that the insurance company requires in order to pay you or evaluate your case. We have experience and understand what the adjusters are looking for in order to pay on your case.
- We can assist with almost any aspect of an injury claim. Our years of experience have provided us with the knowledge and expertise to handle your injury claim from beginning to end and obtain results that will help alleviate many of the problems that injury cases can present.
Adjusters are taught to handle claims in a specific order. They look for coverage first, then liability, and finally damages. At each stage, the adjuster is determining whether or not to pay the claim. If they can find a reason not to pay the claim, they will do so.
1) Is there coverage?: The adjuster will first determine whether or not there is coverage. The fact that the other driver displayed their insurance card does not imply that they are covered for your claim. The adjuster looks to see if the premium payment for that month was made if a covered vehicle was driven if a covered driver was driving if the vehicle was used for a purpose that voids coverage (such as business use when the insurance company was not informed the vehicle would be used for business purposes) if the person driving the vehicle was licensed, and so on. They will try to avoid paying if there is a reason to deny coverage.
The insurance adjuster may pay for your vehicle only to discover later while investigating your injury claim, that some fact or issue voids coverage. Because of your injury claim, the injury adjuster is constantly looking for reasons not to pay – as long as your claim is still open. For example, they may not realize during the initial investigation of the claim that their driver was using their car for “business purposes,” such as pizza delivery. If they later discover that it was used for business purposes, it becomes a problem because their personal auto policy may not be rated for “business use.” If the vehicle was used for business purposes, they will almost certainly try to deny coverage for the injury claim, even if they have already paid for the damage to your car.
2) Is there any risk?: After determining whether or not coverage exists, the adjuster considers if there is any liability. To put it another way, was their driver at fault? Were you to blame? Was it someone else’s fault? Was there anyone to blame, such as if the weather caused it or if it was unavoidable? In order to reduce the amount they will owe, injury adjusters will try to find a way to say that their driver was not at fault or to place at least some of the blame on someone other than their driver.
3) What are the damages associated with the claim? Finally, they will assess the damage. Damages include your medical bills or money needed for future medical treatment, loss of earning capacity or lost income, pain and suffering and mental anguish, disfigurement, physical impairment or disability, and other costs (or out-of-pocket expenses) incurred as a result of the accident or injury. Other examples of damages include vehicle damage, rental bills, towing charges, wrongful death, and other losses and harms caused by the accident or injury.
Insurance companies scrutinize any bills, estimates, or receipts to ensure they are related to the incident at hand and not the result of another cause. If the documentation is unclear, or if there is a significant gap in time, the adjuster may claim that he does not believe your documentation (bills, estimates, or receipts) are related to the accident or injury at issue. The adjuster will look to see if you did your part to mitigate the damages (also known as “mitigation of damages”).
A person is required by law to try to keep their damage to a bare minimum if at all possible. The insurance adjuster will check to see if the claims are reasonable. Did your medical provider or body shop charge you an exorbitant fee in comparison to what is customarily charged? Are the medical providers charging for services that were unnecessary? If this is the case, the insurance adjuster will attempt to deny coverage for that portion of your claim, leaving you to foot the bill.
Our Dallas car accident attorneys have seen this procedure thousands of times over the last 23 years, so we understand what is going on and what the insurance adjuster is looking for. If we are hired from the beginning, our understanding of what the insurance company is trying to do in various situations aids us in defeating any attempts to find a reason to deny the claim.
If you have tried to handle the claim on your own but have run into roadblocks with the insurance company, you should hire a personal injury lawyer with experience in car accident injuries to get your case back on track.
Insurance adjusters frequently claim that a portion of your claim was excessive, but they never explain how they arrived at this conclusion. This leaves you with little or no assistance in dealing with your medical provider or body shop when they demand payment from you but you are not receiving adequate compensation from the insurance company. You can’t just say, “Your bill is too high,” and expect the medical provider or body shop to accept it. However, insurance adjusters frequently do this when evaluating claims.
In these cases, we can assist. We have the information required to counter the insurance company’s attempts to avoid paying you. If the bills are excessive, we have the ability and knowledge to negotiate a reasonable amount for your bill with the health provider.
If your insurance claims adjuster is delaying payment on your claim because they need to “finish their investigation,” this can mean a variety of things, but it all boils down to one thing: they are attempting to delay payment on your claim and, if possible, not paying it at all.
There are different deadlines for different types of auto accident injury claims. The time limits for enforcing your claims for liability coverage, uninsured motorist coverage, and personal injury protection – as these are the most common types of coverage dealt with in Texas auto personal injury cases – are as follows.
1) Auto liability insurance: If you file a claim for an injury against another person’s auto liability insurance, there is no time limit set by statute for the insurance company to complete their investigation. In Texas, you have a 2-year statute of limitations (time limit) from the date of the injury to settle your claim or file a lawsuit. If you do not resolve your claim within that time frame and do not file a lawsuit before the two-year limitations period expires, you will forever lose the right to pursue your case.
Texas Insurance Code sections 542.051-542.061 address Prompt Payment of Claims in first-party claims. It does not apply to third-party claims against someone else’s insurance in liability claims, such as when you sue someone else’s insurance for an injury caused by their negligence. In general, under Insurance Code section 542.055, an insurance company has 15 days in first-party claims to acknowledge the claim, begin an investigation, and request any required statements and forms. The insurance company then has 15 days after receiving everything it has requested to accept or reject the claim, according to 542.056. There are exceptions in the statute that allow the insurance company more time if certain timely requests are made. According to Texas Insurance Code section 542.057, the insurance company must then pay the claimant within 5 days of accepting the claim. This statute covers first-party coverages such as uninsured motorist claims and personal injury protection claims.
2) Uninsured Motorist Coverage: If you file a claim against your own insurance for Uninsured Motorist Coverage, your insurance will fill in for the uninsured driver (taking the place of the insurance that the other driver should have had). In Texas, the typical time limit for resolving a claim against another driver is two years (the time period of the Texas Statute of Limitations). However, in Uninsured Motorist cases, you have four years after your claim is denied to sue your own insurance company. This is due to the contractual relationship that exists when filing a claim against your own Uninsured Motorist Coverage. However, you should never wait this long to pursue your case because evidence can vanish or become impossible to find if you do.
3) Personal Injury Protection: You have up to three years to file a claim under Personal Injury Protection (PIP), and if your claim is denied, you have up to four years to file a lawsuit (the contractual statute of limitations time period in Texas).
Defendant (person who caused the injury): On the other hand, if you are the defendant and your actions were the cause of the collision, your liability insurance company will defend you in any way they can. They don’t want to pay the claim if they don’t have to. They will look for reasons to avoid paying the person with whom you collided. However, be cautious because there may be conflicts of interest.
The insurance company is concerned with how much money and time your crash will cost them, but they are less concerned with your money and time. When the driver with whom you were in an accident suffers a serious injury, this can become a problem. If they sustain an injury that will cost more than the coverage you have with your insurance company, you should be concerned about a conflict of interest with your insurance company.
In this situation, your insurance company has a financial incentive to protect itself, but they have no financial incentive to protect you if the other person’s injury claim is serious and the value of that claim exceeds the amount of liability coverage you have.
Plaintiff (injured person): You must hire your own lawyer during a claims investigation if you believe you need a lawyer to protect yourself. If you file an injury claim against the other driver’s liability insurance policy, no one will represent you unless you hire an attorney. You have no contract with the other insurance policy if you file a claim against someone else’s liability insurance.
In Texas, the other insurance company is not bound by the duty of good faith and fair dealing that is required when dealing with your own insurance company because they have no contractual relationship with you. There is no duty to you if you do not pay for the insurance policy against which you are claiming.
If you were injured in a car accident, you are probably concerned about being compensated for your injuries. An injury can result in financial difficulties that did not exist prior to the accident.
With an injury accident, you are concerned not only about the cost of your own vehicle repairs, rental car costs, towing costs, and storage, but also about medical bills such as ambulance bills, hospital bills, bills from the doctors at the hospital, bills from the radiology department at the hospital, and bills from whatever follow-up care you are required to receive to treat your injury. You may miss work and lose earnings, which exacerbates the situation: you have all these new bills that you did not have before, and you are working fewer hours, so you are earning less money to pay for all of these new and unexpected bills.
- Do you have medical bills from the accident that you are concerned about paying?
- Do you have any concerns about lost income?
- Are you wondering how you’ll pay for the medical care you still require?
- Do you want to ensure that you receive the full value of your car accident injury claim for all of your damages?
If you answered yes to any of the questions above, you should contact the Law Office of Doug Goyen. We produce results for our customers. We obtain compensation for your medical bills on your behalf. If you require assistance in locating a medical facility to treat your injury, we can assist you. We seek restitution for your lost wages. We gather evidence to prove your case and obtain the full value of all of your damages so you can be compensated for your injuries.
Attorney Doug Goyen is a personal injury attorney, Texas licensed since 1997. We have represented people who have been injured in car accidents for over 23 years. During that time, we have represented thousands of people in personal injury claims and have recovered millions of dollars for our clients. For a free phone consultation, strategy session, and case review, please call (972) 599 4100 or use our website contact form.
Directions to our main North Dallas Office: (Click the following link for directions to our Addison office:
Law Office of Doug Goyen
15851 Dallas Pkwy #605
Addison, Texas 75001
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