The Adjuster Is Investigating My Claim. Do I Need a Lawyer?

The Adjuster Is Investigating My Claim. Do I Need a Lawyer?

To put your mind at ease, insurance adjusters investigate every claim.  They need to get their driver's report regarding what happened - even if there is a police report that is clearly in your favor.  For all the insurance adjuster knows, the police officer mixed up the names, or cars, or just didn't hear their driver's story clearly.   If the insurance company is delaying due to their inability to contact their driver or some witness, or a police report, this is not unusual, but it may be a sign that you need to proceed carefully in presenting your claim and you may need to consider hiring a lawyer to protect you and your claim.  

If there is an injury involved, the insurance company will assign the claim to a more experienced "injury adjuster".   This injury adjuster will do a more thorough job investigating your claim than insurers do with non-injury claims.   I worked for insurance companies as an injury adjuster prior to becoming a lawyer.  We were trained to look for ways to avoid paying claims - which typically fell into three categories 1) Coverage - Did their insured pay their premium that month?; Is the car they are driving listed?; Is the person driving their vehicle supposed to be driving it?; Were they driving for their work at the time of the collision?  All these factors (and others) can affect if there is coverage for a claim.  2) Negligence - Was the accident "unavoidable"?; Was it caused by the weather, or an "Act of God"?; Was the collision partly your fault?;  Was the collision caused by some other driver who caused their driver to lose control?  These are reasons to clear their driver of negligence - if the collision was unavoidable, caused by the weather, caused by some other driver, or if they can get you to say something that makes them believe you had some responsibility, then they will use this information to avoid paying your claim.  3) Damages - Your injury may be unusual.  It may be difficult to diagnose, so the bills are more expensive than usual.   Your injury claim may be to an area of your body where you had previously been hurt.  The older we get, the more likely we have injured several areas of our body in the past in one way or another, and the collision may cause a dormant injury (one with no symptoms) to suddenly awaken with symptoms worse than they have ever been.  It may be a brand new injury as well, but because it is near the area of your body that you had some prior condition, the injury adjuster may use this information against you.  These prior injuries or conditions can hurt your claim.  If presented correctly, by a lawyer with experience, these prior injuries or conditions may actually help your claim.   

If the amount of money at stake is more than you are willing to lose, then you need to contact and consider hiring a lawyer.  You have nothing to lose by calling a personal injury lawyer.  Inquiry phone calls are free in order to determine if we can help in your particular case.  Personal injury lawyers charge contingency fees - which means that we take a percentage of what we recover on a case.  If there is a problem with the case and money cannot be recovered (ie, if no coverage, or unable to locate insurance, or a bus full of nuns suddenly appears as witnesses against you, etc.), and those factors cause us to be unable to recover in your case, then there is no fee.  

The urgency you feel as the victim of a negligent driver is not the same urgency the negligent driver typically feels.   The negligent driver is worried about his or her rates going up, so they might delay reporting the claim, not want to deal with it, or may even change their story to try and convince the insurance company that it wasn't really their fault as they have had more time to think about it.   

If this happens, then the negligent person's liability insurance will take the side of their driver, if their driver's story makes sense.  The longer it takes for the other person to report the claim to their insurance company, the more likely they will have "thought about it" and come up with an excuse for why the collision was not really their fault.   

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 your claim.  If you don't have experience handling claims, you will not know what information you need to counter their theory they are trying to develop, and will not know what evidence to present them that shows they are barking up the wrong tree.  

Our law office is experienced handling claims, over 22 years of experience.  Once we see the facts, we will determine what the insurance company is attempting to do (the facts will tell an experienced lawyer what the insurance company is looking for to deny your claim).  If your claim is a valid one, we will gather the evidence or information needed to "head off" the insurance company's attempt at denying the claim.  If you have a claim that is going to be denied due to a lack of evidence or the evidence is against you for some reason then we will let you know that as well.  If you wait you are increasing the likelihood of the insurance company gathering information they need to try and deny your claim.  Once they have determined your claim should be denied, it becomes much more difficult to get them to change their mind.  If you have an attorney working on the claim from the beginning, we can gather evidence in your favor that helps overcome any contrived reasons some injury claims adjusters try to use to deny claims.  

Call the Law Office of Doug Goyen.  We handle personal injury cases.  The insurance company has lawyers evaluating their cases and reasons for denials, you need a lawyer too.  The phone call is free.  Our accident injury lawyers interview you, and determine what is needed to ensure you can recover on your claim.  If your case does have any serious problems with it, we will let you know what those problems are and will discuss ways to confront those areas so they do as little harm as possible.  If you have an injury that has caused serious injury or financial difficulties then we want to talk to you about your case.  


Adjusters are trained to handle claims in a particular order. 

Is there coverage ?:  First, the adjuster will determine if there is coverage.  Just because the other driver had their insurance card does not mean they are covered for your claim.  The adjuster looks to see if that month's premium payment was made, if the correct vehicle was driven, if the driver is driving, 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 try to avoid paying. 

The insurance adjuster might pay for your vehicle, and then later on, while investigating your injury claim, discover some fact or issue that voids coverage.  The problem is that your injury claim causes the injury adjuster to constantly look for reasons to not pay - as long as your claim is still open.   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 likely attempt to deny coverage for the injury claim, even though they already paid for your car’s damage. 

Is there liability?:  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 - such as if the weather caused it, or if it was unavoidable?  Injury adjusters will try to find a way to say that their driver is not at fault if possible, 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. 

What damages are related to the claim?:  Finally, they will look at the damages.  Damages are your medical bills incurred, or money needed for medical treatment in the future, loss of earning capacity, pain and suffering and mental anguish, disfigurement, disability, other costs (or out of pocket expenses) that were incurred due to the accident or injury.  Other damages 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 from you, but you are not getting enough money from the insurance company.  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 can help in these situations.  We have the information available that is needed to counter the insurance company's attempts at avoiding payment to you.  If the bills are excessive, we have the ability and knowledge to deal with the health provider to obtain a reasonable amount for your bill. 

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.  

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.