John R. Gorman
Insurance Companies Exist to Take Premiums, Not to Pay Claims
Insurance companies begin defending against a motor vehicle insurance claim the moment that they learn of the collision. They will attempt to get early recorded statements from all occupants of the respective vehicles, particularly of the adverse driver. They want admissions about how the accident happened (“So, you weren’t looking at the road just before the collision occurred?”) and the claimant’s alleged lack of injury. That’s why a collision victim must immediately retain an experienced personal injury attorney after the collision.
Once the claim is established, the injury victim’s auto insurance companies try to limit the amount and type of medical treatment that its insured may receive. Without an experienced injury lawyer to push back, a collision victim may not get the medical treatment that they need.
The adverse driver’s insurance company will challenge causation for a motor vehicle injury, alleging that any abnormality on an X-Ray or an MRI represents a pre-existing condition. Or, the insurance company will blame a prior accident for the victim’s symptoms, even if the prior accident happened 10 years earlier.
After a lawsuit is filed, the liable driver’s insurance company will send the victim to a “doctor” who will likely deny the seriousness of the injuries. Many if not most insurance company doctors make more money writing reports and testifying that the collision victim suffered no or minor injuries that have healed than they do by treating their patients. Based on that biased information, the liable driver’s insurance company will make no or a nominal settlement offer.
The basic principle, enunciated decades ago, is that insurance companies exist to take premiums, not to pay claims. If you were injured in a motor vehicle collision, retain an experienced personal injury lawyer immediately.
Must-Know Process Of Claiming Car Accident Insurance
Like every business, every insurance company will do their best to pay less because the higher amount they pay, the lower profit they will have. However, as an insurance policyholder, here are some things you must know when filing an insurance claim, specifically car accident claim insurance:
What common scenarios occur during car accident claim insurance?
- The initial thing insurance companies will do is to undergo an investigation and make sure that the findings will be favorable on their side. They will make sure to make it as if the victim is to blame for the accident, so they would only pay a minimal amount.
How do insurance companies counteract the claims of the victim?
- They make things complicated. Like the filing process, getting evidence, and underestimating the effects of the accident on the victim’s health.
What do they do to reduce the compensation they have to pay?
- They will make sure it will take a longer time or make it as fast as possible to give a quick release (to pay smaller) or a more prolonged release (so the victim will be fed up and just forget about it).
- They will also advise you, the victim, not to seek legal support and promise to help you resolve the claim, because lawyers may discover more things covered by the insurance, which makes your claim higher.
When filing for a claim, do not rely solely on the insurance company. In my opinion, the best thing to do is to seek legal advice or, better yet, make sure you are knowledgeable on the coverage of usual car insurance. It will help you a lot during the filing of the claim, so you will get every penny that you should receive.
Several Ways an Insurance Company Counteracts Car Accident Claims
Typically, during a car accident claim, an insurance company will open a claim file. They’ll ask for copies of police reports, witness statements, and gather as much information as they can about what happened before, during, and after the car accident. Essentially, they’ll want to find out who caused the accident, who was at the accident scene, how it happened, when it happened, where it happened, what was damaged, and who was hurt and how badly they were hurt.
How do insurance companies counteract the claims of the victim?
If you have a legitimate claim, an insurance company should be working with you to resolve your claim and indemnify you—they should not be working against you. That said, what we have seen brought into question is whether you had coverage at the time of the accident.
If you were driving your car in Mexico—for instance—and your car insurance only covers you in Canada and the United States, then you might not be covered. When you applied for your insurance, were you honest about who drives your car, and if it is a work or personal vehicle?
If you weren’t honest, these could give the insurer reasons to deny your coverage. For example: if your live-in boyfriend or girlfriend is supposed to be the only driver of this personal vehicle, an insurance company might deny your coverage if they find out that you were the one driving the vehicle every day—not your partner.
Or if the vehicle was loaded with tools for your job, and you were towing a heavy work trailer loaded with explosive gas at the time of the accident. As the last example of reasons to deny coverage, if you made aftermarket modifications to your car that your insurance wasn’t made aware of—or you were committing illegal acts while you got into your accident… these could also be reasons to deny your coverage.
Speaking in extremes, if you got in a car accident while being chased by the police after robbing a bank—and your car had a nitrous system installed in a jurisdiction where such a system is illegal—those are all probable reasons for an insurance company to deny your coverage.
What do they do to reduce the compensation they have to pay?
So, once an insurance company agrees that you have coverage and they open a claim, there are often disagreements about how much they should compensate you. If your car was totaled and you had collision coverage, you might disagree with the insurance company about how much your car was worth. If you disagree with the insurance company’s valuation of your car, you can counter their number by looking up the Canadian black book value of your car or you can try to find cars almost identical to yours listed on Kijiji or Marketplace.
You should also remember to try to claim any other property that might have been damaged in the accident—your laptop that was in the backseat, for instance. That said, the property part of a claim is usually pretty simple compared to the injury part of a car accident claim.
First of all, how do you calculate what your pain and suffering from an injury are worth? What typically happens is that an insurance company or a claims adjuster will try to find some previously settled cases similar to your claim—but they’ll often pick the cases with the lowest settlement figures they can find.
That said, many other things about your injuries can be up for dispute: For instance, there might be a disagreement about whether your injuries or symptoms were caused by the accident. The insurance company might believe that you already had this injury before the accident or the injury happened well after the accident, or that you’re inventing or exaggerating your injury altogether.
They may ask for your medical records, or they might look for evidence of deception on your social media accounts. They might even hire a private investigator! An insurance company can also try to reduce your claim if they believe you haven’t done enough to try to recover from your injuries. For example, if you didn’t visit a doctor, physiotherapist, or psychologist, soon enough after the accident. Or perhaps you skipped all your follow-up physio appointments.
This is why it is very important to keep good personal records, to keep all your receipts, to see medical professionals right away, AND to not miss any medical or paramedical appointments after an accident. Many car accident victims don’t realize that they have an obligation to their insurance company to try to recover from their injuries as quickly as possible, and avoiding that obligation can cause your claim to be reduced or denied.
Other aspects of a personal injury claim can include your lost income, your loss of housekeeping capacity, and your out-of-pocket expenses as a result of the accident. Out of pocket expenses can include doctor’s bills, physio bills, medication—but it can even include things like taxi rides to and from the doctor’s office. Lots of people don’t know that.
At the end of the day, you should be able to tell the insurance company exactly:
- how much you spent on out-of-pocket expenses after the accident.
- how many days of work you missed.
- how long you were unable to help out around the house.
If you can’t back up these numbers with documentation, then they might reduce your claim. Lastly, if your injuries are long-lasting, you might also seek compensation not just for past lost income, but for future lost income as well.
Here, again, you and the insurance company might disagree. You might believe that you were going to get a promotion, win an Olympic medal, get tons of sponsorship deals, finish your Ph.D., and make lots of money in the future before retiring at the age of 70, but now the car accident has prevented all that.
An insurance company or claims adjuster might dispute that. They might say you weren’t going to get a promotion, or win an Olympic medal, and even finish your Ph.D. And they might say that you were going to retire at age 60. So, you need to be able to back up your claims.
Common Accident Insurance Claim Rebuttals
When dealing with a car accident insurance claim, here are a few of the most common scenarios:
- Dismissing the client’s injuries as insignificant or not serious and not warranting much, if any, treatment.
- Tricking clients into settling early when the pain has not entirely set in and hurt their ability to get more treatment paid by the insurance claim.
- Getting clients to make damaging statements regarding how the accident happened or that there were no injuries.
Typical actions taken to reduce the compensation include parts of what was previously stated plus the following: Paying the medical bills directly, revoking your right to negotiate the medical improperly and unilaterally. Also, using statements made before against you, holding you to them and that since you stated you were not hurt that it precludes you from hurting in the future. Using photos against you, claiming it is impossible to be injured when there is not much visible damage to the vehicle.
Claiming your current injury claim is from a previous personal injury or previous incident from your medical history. Stating the injury from the incident was due to your negligence in part or full and diminishing their liability responsibility. Other common scenarios include no police report corroborating your statement of how the incident occurred or contradicting witness statements disputing the facts of the incident.
When multiple vehicles are involved, the liability decision typically takes longer to decide or diminish or exclude responsibility and point the blame elsewhere. No cooperation from the adverse vehicle driver either delays decisions by the insurance or causes an insurance denial. Some of the ways they try to counteract the claims are to hire experts who have not met you or met your treating providers to try and diminish or dispute the treatment you received and the costs of the treatment as unreasonable or necessary.
All of the above are used to reduce the compensation. Here is one of the most common ways insurance companies try to counteract claims. They try to put you in a Catch-22 scenario by telling you how much it would cost to fight the case further versus potential recovery, catching you at your most vulnerable time and forcing you to make decisions without the assistance of counsel or time to consider the full consequences. These are only a few of the ways, and there many more that commonly occur. Therefore, it is truly in your best interest to contact competent legal counsel to help with your claim.
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