Why You Need an Attorney Who Knows How Insurance Companies Work

Working in the Insurance Industry

Prior to going to law school, I worked for one of the largest insurance companies in the U.S. I was taught how to investigate and evaluate claims from the insurer’s perspective and, as well as how to examine the facts of accidents to determine who was at fault. Initially, I had very little authority and settled relatively minor claims. As I gained experience, I began to handle larger and more complex claims, including commercial and litigation claims. I learned how to negotiate from the insurer’s perspective. Over time, I lost interest in working for a large insurance company and decided to attend law school.

Using My Law Degree and Past Experience to Help People

Why You Need an Attorney Who Knows How Insurance Companies WorkAfter graduating from law school, I decided to step in a different direction. I chose to represent people rather than using my education to benefit large insurance companies. I found more satisfaction in helping people who had suffered physically, financially, emotionally, or materially through no fault of their own. I found that I could use what I had learned from working in the insurance industry to turn the tables and aid my clients by providing a unique perspective. Today, I continue to use what I was taught in law school, what I learned in the insurance industry, and my experience as an attorney to bring justice to my clients.

How Adjusters Deal with Your Claim

When an adjuster is assigned a claim, they first perform a basic investigation to determine the following:

  1. Whether their policy covers the claimed loss
  2. Whether their insured party is at fault
  3. Whether the other party can be found at fault in any way
  4. What types of injuries exist
  5. How much the insurance company will have to pay

Make no mistake, an adjuster is looking to use any of these inquiries to minimize or flat-out deny your claim. That’s how insurance companies make money.

How Insurance Companies Use Comparative Negligence Laws to Make Money

Most states have comparative negligence laws. This legal doctrine allows a defendant or their insurer to hold the injured party partially liable for their own losses if their actions contributed to their injury. While significantly better than the old doctrine of contributory negligence, the comparative negligence rule is often a way to reduce a claim, even if only by a small amount. Insurance adjusters often use this “tool” to reduce what they are willing to pay. Even a small sum over a large volume of claims adds up to significant savings for the insurance company.

Investigating Claims and Protecting My Clients

When an adjuster tries to hold my client accountable to some degree, I take their investigation and begin deconstructing it, looking for incorrect assumptions or mistakes in logic. Whether it’s a car crash, a boating accident, drowning, a slip and fall or any other type of accident, I evaluate what truly set the chain of events in motion that injured my client. Most often, accidents don’t happen, and plaintiffs should not suffer the comparative negligence “penalty.”

How Insurance Companies Attack Claimed Injuries

The most often used strategy by insurance adjusters is to attack the claimed injuries. If the insurance company can successfully attack the severity, existence, or cause of the injury, the value of the claim can be greatly reduced. There are several ways adjusters can attack a claimed injury, such as:

Over Treatment

Insurance companys’ most frequently used tactic is arguing that the injured person sought too much treatment to inflate their claim. For example, adjusters often argue that a client went to a physical therapist too many times or that there was a gap in treatment, so the newer treatments must be from a new injury. This tactic leads to red-herring arguments.

Most people do exactly what their doctors and therapists tell them to do and follow the treatment plan prescribed. Adjusters are not medical experts and certainly have never examined my clients. It is not “overtreating” to do what your doctor advises.

Never let a claims adjuster overrule your doctor.

Minimizing Severity

Too often, adjusters look to minimize the severity of the injury or the pain that a client is enduring. Adjusters apply a “one size fits all” method to evaluate a claim, but not all people are the same. A broken arm or whiplash injury to an athletic, healthy 24-year-old does not have the same effect as it would on a 65-year-old retiree. The retiree will struggle significantly more with the injury, with a longer healing process and greater residual effects.

Preexisting Conditions – “Your Client Was Already Hurt.”

Insurance adjusters commonly argue that the injured person had preexisting conditions, most often in their neck or back. Therefore, their insured party did not cause the client’s injuries and pain. I hear this argument most often with older clients. Adjusters neglect to consider the client’s lifestyle before an accident as opposed to after. For example, many people enjoy skiing well into their 60s, but if a client can’t ski anymore after a collision due to newly developed back pain, they should be compensated for the loss of life enjoyment they suffered from the insured’s negligence.

How Insurance Companies Pay You Less So They Can Save More

I have worked in this field for 30 years and have experience on both sides. In evaluating my cases for settlement, I identify the area most likely to be attacked and the method the adjuster will use. Then, I develop a plan to successfully fight off the attack. It is essential to be aware of the ways an insurance company will attempt to pay a claimant less to save themselves money, some of which include the following:

Programmed Settlements

In the mid-1990s, many insurance companies started using computer programs to predetermine settlement ranges for various injuries. The most widely used program continues to be Colossus. Generally, Colossus works by evaluating types of injuries, like a herniated disk, and sets a baseline settlement range for that injury. Medical records are input into the system, and the program assigns a settlement range the adjuster follows. Most of the largest and best-known U.S. insurance companies use this system. The problem is that the range is only as good as the information the insurance company puts in or programs Colossus to consider. Insurance companies each set their own parameters and baselines. There are thousands of parameters, but insurance companies don’t use all of them. The insurance industry’s ultimate goal is to use Colossus to reduce claims costs and save money incrementally.

Colossus has caused problems for the insurance industry. In 2010, Allstate, arguably the biggest user of Colossus, agreed to pay $10,000,000 to 45 states for its misuse of the program and agreed to greater oversight. However, that didn’t stop them from continuing to use it.

One of the primary problems with Colossus is, like any computer program, it cannot account for the subjective nature of every claimant’s injury. Not every injury is the same, nor is every claimant. Additionally, many insurance companies tie the hands of their adjusters, giving them little to no authority to resolve a claim outside of Colossus’ range.

Low Ball Offers

Insurance companies are notorious for initially offering very little money to settle a claim, especially with an unrepresented party. They attempt to set a low settlement range by offering a claimant very little compensation and driving the negotiation closer to their number. This strategy can be defeated by an experienced Colorado Springs injury attorney who can recognize the negotiation style with skills learned over time. Never let an initial low offer intimate you into making large concessions to the adjuster.

Contact an Experienced Colorado Attorney: Don’t Fight Insurance Companies Alone

These are just some ways insurance companies attempt to pay a claimant less to save themselves more. If you’ve suffered an injury at the hands of another and are struggling with an insurance company to resolve it, you need an experienced attorney who understands insurance company tactics and knows how to fight back. Every claimant deserves just compensation, not a lowball, predetermined offer.

Call The Bussey Law Firm, P.C. at (719) 475-2555 so we can start protecting your future. I would appreciate the opportunity to discuss your case with you.


Philip Shadwick