When you make an insurance claim whether it’s for property damage, personal injury, or something else, the insurance company will almost always launch an investigation before they agree to pay what you deserve. This process is led by insurance adjusters who will review the incident and determine how much, if anything, you’re entitled to receive.
They might visit the scene of a collision, inspect your vehicle, examine property damage, request your medical records, or ask for recorded statements. If your claim aligns with their findings, you may be offered compensation.
Unfortunately, that’s not what always happens. As many as 18 percent of insurance claims are denied, according to one recent study. Other studies show that underpayment is common, especially when injuries and loss are less tangible.
Because of these reasons and more, insurance adjusters are frequently viewed as the “bad guys.” But is that true? As an injury and vehicle accident law firm in Hamilton, Ohio, we’ve worked directly with insurance agents on countless cases.
To understand their true nature, you need to first understand their responsibilities and goals.
What Do Insurance Adjusters Do?
Insurance adjusters are hired to verify and assess insurance claims. They’re trained to be thorough, asking questions, collecting documentation, inspecting evidence, and identifying inconsistencies that may reduce the amount their employer has to pay.
During an investigation, they may:
- Request the accident report
- Ask for access to your medical records
- Offer quick settlements to avoid extended negotiations
- Analyze your past medical history for any “preexisting conditions”
- Suggest that your claim may be exaggerated or unjustified
It’s important to remember that these actions are not necessarily illegal. Adjusters are simply performing the job they were hired to do to benefit the bottom line of their employers, the insurance companies. That job just happens to include scrutinizing your story and finding ways to limit any compensation or deny your claim.
Are Insurance Adjusters on My Side?
In short: No.
Insurance adjusters work for insurance companies, not you. That means their duty is to protect the company’s financial interests, not to ensure you’re fully compensated.
While they may not be dishonest or intentionally manipulative, they are trained to control the situation and steer the narrative in a way that minimizes payouts. That includes:
- Framing your injuries as less serious than they are
- Misrepresenting or underplaying your statements
- Using your past health history against you
- Offering early, lowball settlements
Again, they aren’t doing this to be evil. Insurance adjusters are constantly looking for cracks and inconsistencies in any claim. Even innocent comments or quick answers can be used to justify reducing your compensation.
The Danger of Quick Settlements
One common tactic insurance adjusters use is offering a quick, low settlement in the days immediately following an accident. They may present this as a way to avoid “red tape” and speed up the process, but in truth, they’re hoping to catch you off guard before you understand the full extent of your injuries or speak with an attorney.
It saves them time and money, and while you do get something out of it, these settlements almost always fall short of what you actually deserve, especially when long-term medical costs, missed workdays, or subrogation claims are involved.
Once you accept a settlement, the claim is closed. You cannot go back and ask for more money if new symptoms arise or your condition worsens. This is why it’s crucial to avoid accepting anything without first seeking legal guidance.
How to Communicate with Insurance Adjusters After an Accident
The most valuable tool an insurance adjuster has is your own words. Whether it’s a recorded phone call, a written statement, or something casually mentioned during a conversation, what you say can be used to shape your claim and not always in your favor.
After an accident:
- You should notify your insurance provider that the incident occurred.
- You are not required to give a detailed statement.
- You are not obligated to discuss who was at fault.
- You should avoid discussing your injuries in detail until you’ve seen a doctor and legal counsel.
It is perfectly legal (and wise) to decline giving a recorded statement until you’ve spoken to a personal injury attorney. This isn’t about hiding the truth, it’s about protecting yourself from being misrepresented or misunderstood. You can bet the adjuster would not let you take a statement from their company’s insured.
Be Cautious with Medical Information
Many adjusters will ask for signed medical authorizations early in the process. On the surface, this may seem harmless—after all, they’re just trying to verify your injury, right?
The problem is that most authorizations are broad. Signing one may give the adjuster access to your entire medical history, not just the treatment related to the accident. They’ll comb through those records looking for anything that might be used to argue that your injuries were preexisting, unrelated, or not as severe as claimed.
Once again, this is not about truth—it’s about limiting compensation.
If you’ve been seriously injured, it’s in your best interest to have an attorney manage any communication regarding your medical treatment.
What Happens If They Deny Your Claim?
As we said earlier, denied and underpaid claims are a common occurrence:
- About 15% of all insurance claims are denied.
- 18% of adults have had a claim denied in the past year.
- Less than 0.2% of people pursue their denied claims.
Claims can be denied for many reasons:
- Delayed treatment
- Alleged preexisting conditions
- Insufficient evidence
- Conflicting statements
- Disputed fault
- Technical policy loopholes
- Any reason or no reason at all
A claim denial may seem like the end of the road. This is why most people don’t bother to pursue their claim beyond the denial. But the truth is, even if your claim is initially denied, you have options. You may, however, need some additional help…
When to Contact an Accident and Injury Attorney
The sooner you speak to an attorney, the better. Ideally, you should contact one before any claim is filed. However, if you’ve already filed a claim and it’s been denied, an attorney may be able to help.
This includes:
- What evidence to gather
- How to communicate with adjusters
- What tactics are commonly used to undercut claims
- How to negotiate or escalate if your claim is denied or underpaid
- And more
Even if you think your case is straightforward, things can change fast. A witness might alter their story. Medical issues may worsen. Paperwork may be delayed. Adjusters may change. These variables can affect your case in ways you may not anticipate. Meanwhile, you’ll be dealing with managing physical recovery, car repairs, emotional trauma, and more.
It can all get overwhelming very quickly, leaving you vulnerable for insurance adjusters to have their way.
But you don’t have to face all of this alone. An experienced accident and injury attorney doesn’t just make the process easier. They can help scare insurance adjusters and the companies they work for, ensuring you get what you’re owed without getting the runaround.
The Richards Firm Can Deal with Your Insurance Adjusters
The Richards Firm exists to make the legal system more accessible to those in need. With our law firm, you’re always more than just a number. From the beginning until the end, you’ll work directly with Rhys Richards, an Ohio native.
Rhys is here to listen to your story, help you understand your options, and take action on your behalf. He and his team will handle your insurance adjusters, gather the right documentation, and negotiate the settlement you deserve.
The Richards Firm works on a contingency fee basis, which means we don’t get paid unless you win your case or receive a settlement. There are no upfront or hidden costs, which means there is zero risk of reaching out. and no risk in reaching out.
If you’ve been injured in an accident in the Greater Cincinnati area, contact The Richards Firm today at 513-461-0084 or by visiting our contact page here.
Let us deal with the paperwork, the adjusters, and the stress, so you can focus on healing and moving forward.