An Insurance Defense Attorney’s Perspective On Best Practices In Working With Insurance Claims Adjusters

In your law practice have you ever reached an impasse in trying to settle your case with an insurance claims adjuster? At times it can be frustrating. [1]  Working for two insurance defense law firms and three in-house insurance law departments over the past 33 years has given me some ideas on how to deal with insurance claims adjusters.  Here are five suggestions:

  1. Understand the environment the insurance adjuster works in

Most insurance adjusters, like attorneys, are busy people, and like most attorneys they respond well to civility. When you call or write, give them the time needed for them to respond to you. Instead of assuming that they are “out to get you,” visualize them wanting to help you resolve your claim while at the same time keeping up on the requirements which assure quality claim handling.

Threatening letters or harsh phone calls are usually not as effective as you think they may be, and they may well be counter-productive. Claims people are well trained. They are professionals doing their job in a highly structured environment. If you want to speed the process along, threatening them will likely not work. Proper file documentation, however, is extremely important to them and to the process you are trying to speed along. With the proper information they can accurately evaluate the case.  They may also need additional time to process information through the various levels of review within the insurance company.

  1. Understand the importance of insurance claim file documentation

As I just mentioned, proper claims documentation is extremely important to the process of settling claims. The California Department of Insurance regulates insurance companies doing business in California and per those regulations, consistency with internal insurance claims handling procedures is important. Settlement evaluations should be supported with medical or wage records of the injured person. Statements from witnesses or from the injured person may also be important. In property damage cases the company needs time to generate or collect property damage estimates. Much of this information can be gathered, with your help, before a suit is ever filed.  Records most often required after a suit is filed include: Responses to formal discovery; Deposition summaries; and Independent medical examination (IME) reports.

Delays in turning over the information or providing filtered or limited documentation may result in prolonging the eventual settlement. If you want to move the process along, give the claims adjuster what he or she needs and then give him or her reasonable time to evaluate the claim.

  1. Understand the value of a face to face meeting with the claims adjuster or field representative

Look for opportunities to place your client in front of the claims adjuster. Many companies have out of state claims departments. However, they still may have local field adjusters or representatives who can meet your client and attend mediations. Help the adjuster remember your case. Help him or her feel empathy for your client. This is particularly important when your client has a scar or other visible injury. Claims adjusters often find fulfillment in helping people through unexpected tragedies. Making your client and his or her story more personal and more human can only help your case.

The most common way to meet is during a formal or informal mediation. At the upcoming MCLE Spectacular on November 17, 2017, I will be participating in a seminar entitled “Solve Before You Sue” where we will discuss pre-litigation settlement opportunities. I hope you will come and listen to our ideas. If you have a chance to mediate your case (before or after you file suit) consider something “radical”- embrace the joint session as an opportunity to work together with your claims adjuster instead of something that you can’t wait to get out of. Resist any efforts by the mediator to quickly sequester you and your client in another room away from the adjuster. Spend as much time as you can talking together. The more pleasant you and your client are, the more inclined the adjuster will be to understand your case.

  1. Understand your ADR options including expedited jury trials

The Expedited Jury Trial program allows you to try your entire case to a jury in just a day or two. Effective January 1, 2016 almost all limited jurisdiction cases in California are subject to mandatory expedited jury trials. (See CCP 630.20-630.30).  This can be a cost effective and fair way to resolve your lower value cases.  Insurance companies and plaintiff’s attorneys have found these to be very effective.

  1. Understand ways to get beyond impasse

If you and the adjuster cannot agree on the value of the case, try presenting additional facts such as: how the injury has impacted your client’s life; the threat of your client losing income in the future; and the reasonable possibility that your client will have future medical expenses. Look for ways to develop and explain these new facts to the claims adjuster. After you present this new information use it as another opportunity to revisit settlement negotiations after the adjuster has time to reevaluate the case.

In conclusion, working with a claims adjuster can be a positive experience for both of you. The business of resolving cases with insurance companies is like any other business – the best results are achieved by treating others the way you would want to be treated.

[1] The views expressed in this article are my own and do not necessarily reflect those of my employer State Farm.