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Jerry Pearson Sept. 18, 2020

Dealing with Insurance companies when involved in a personal injury claim

In a personal injury claim, what should we know about insurance claims?

Although the overview of liability, causation, and damages (and burden of proof) is a helpful way to understand personal injury claims, it is also true that these legal distinctions do not address or anticipate the evolving roles of insurance companies.  Insurance is often based on contractual relationships, liens, reimbursement rights, state and federal statutory limitations, and a variety of factors that have become codified in the legal world.

Our perspective on the insurance industry sees that the corporate world as dominated by economics and indifference.  To the insurance culture, you are not a person. You are only a file, nothing personal…but the industry gets premiums on the front end and any claims that they have to pay they prefer to delay as long as possible and then pay as little as possible. Simple economics perhaps; but for many years I have viewed the industry as hostile, indifferent, and inhumane-most of which are still my opinions.  

But "it is what it is" as an industry. Most of the factors (indifferent claim evaluations) are generated from their computer system and their algorithms/software. They input metrics and factors of age, gender, pre-existing conditions, and the dollar value of property damage to the vehicles. This is their way to assess the physics of the impact and the potential for harm and injury.  My point here is this: there are many arguments that they make to defend their own evaluations, which are applied to tens of thousands of cases on a daily basis.

Again, as a person bringing a claim for harms caused by an insured, you are just a file and they want you to go away so they can close your file.

Here are a few of the standard insurance defense arguments (taken from both our experience and their claims manuals); and remember the injured person has the burden of proof to establish liability, causation and damages to defeat each of the following:

They Deny the event and then Blame you or others: The insurance company argues that this incident never even happened. This is all in an effort to create ambiguity and confusion, all of which ultimately help defeat the personal injury claim because the injured party has the burden of proof. By creating doubt or ambiguity the defense is focused on reducing the momentum of the injured person’s legal case, and diminishing value or causing confusion, which really just ends up serving the industry as a whole.

And if you can prove it did happen, then they argue it was not the fault of the negligent party, or that it was also partly your fault (this is called comparative negligence and reduces damages), or the fault of another party over whom they had no control…

They Deny that you were injured or that it was caused by the negligent party: Their game is always to deny that you were injured. If you can prove you were injured, they then challenge the severity of the harm and argue that the injury is not as bad as you claim.  They want to argue that you really suffer from a pre-existing condition (the natural progression of which would have led to this condition and treatment anyway) …and they will often claim your doctors and other providers are either biased or incompetent. They will hire insurance examiners (called IME doctors) to minimize any harm caused…. These arguments are made just to challenge your ability to carry your burden of proof. Again, they want to create ambiguity and confusion.

While the insurance industry relies on Deny, Delay and Distort, we proactively work on all issues, including harms and damages: Our approach in submitting claims for review, negotiation, and potential resolution includes calculating the treatment expenses that have been incurred due to the injury, separating those from any unrelated conditions, and providing a detailed timeline and chronology when needed. But, the insurance industry will always document gaps in care and will want to argue that if there was a gap in care it means the person was fully recovered or wasn't really hurt, or if they were hurt, then there must be something else that happened during the gap in treatment…. 

Our job is to help you through this insurance denial and blame game.