I have been representing injured workers against workers’ compensation insurance companies for the past 20 years. My office has handled hundreds (if not thousands) of cases during this time. By representing hundreds and hundreds of work accident victims over the years, I began to see how the insurance industry deals with victims after they begin the claim process following the work accident.
I have found that most insurance adjusters are highly trained adversaries. Most people do not realize this, at least not in the beginning of the claims process. Most people understand that the insurance company’s job is to make money. One way it does this is by settling claims for less than the claim is worth. Yet, most people are unaware of how sophisticated, yet simple, the methods the carrier will utilize to help accomplish this goal.
I have broken this blog post into three parts. I know this is a bit long but I believe 100% that this is helpful information every injured worker in the State of Virginia needs to be aware of. Pay close attention, this information is crucial!!!
Here are some questions that will make the insurance carrier know that you are well informed. Now, they don’t like it when you ask these questions because they either cannot answer the question or worse, they don’t want you to have the answer.
QUESTION 1: Isn’t it true that if I use an attorney, I’m likely to recover more benefits and more money in settlement than if I try to manage or settle the claim on my own?
ANSWER: Don’t be surprised if the adjuster lies to you and says “no” to this important question. How do I know the answer is false? Because a study by the Insurance Research Council (a nonprofit group funded by major insurance companies across the nation) found that the average total payout on claims that have an attorney involved is 4.8 times greater than those claims where the injured victim settled on his or her own. This same study showed that individuals who use an attorney receive 3.28 times more money after the attorney’s fee is paid. Most insurance claims adjusters are very aware of this study. So, if the insurance company wants to maximize profits it will train its claims representatives to go to great efforts to dissuade people from hiring an attorney. Simply put, the insurance companies know that if you hire counsel you will likely get more money in settlement, even after deducting the lawyer’s fee. Second, since in workers’ compensation the injured worker has the burden of proof, they are not obligated to tell you if there are any additional benefits you could be receiving. Rarely have I had someone come to me who knew all of the benefits for which they were entitled from their insurance adjuster.
QUESTION 2: How can the insurance company verify that the settlement amount (or the allowed calculation or impairment rating, etc.) being offered to me is fair and reasonable?
ANSWER: It can’t and it won’t. Sure, the adjuster will tell you that the settlement offer is reasonable and fair but he can’t verify or prove to you that everyone with similar injuries never receives more. Unless you are in the business of negotiating and settling injury claims, there is little chance you will know whether the settlement amount that is being offered is fair. Therefore, by negotiating and settling the claim yourself without using the assistance of a professional, (i.e., a workers’ compensation attorney), you run the risk of accepting a sum that may turn out to be much less than what is considered reasonable for your type of claim.
QUESTION 3: Why do I have to give you a recorded statement when you can get information about the accident from the First Report of Injury?
ANSWER: Because the insurance company will try to use your own statements against you! In most accidents, a First Report of Injury form will be filed and the insurance company has easy access to this report (it just takes a phone call to your employer). So why is a recorded statement necessary? Most companies have written policies in place which require the adjuster to get a recorded statement to see if there’s any information the accident victim might reveal which could be later used to either deny the claim or pay out less money.
Check out the next posts for more tips to shed some light on the misinformation adjusters give to injured workers. It could mean the difference as to whether or not you are awarded benefits for your work injury!
If you would like more information on the Virginia workers’ compensation system, order my book, “The Ultimate Guide to Workers’ Compensation in Virginia,” or call our office today (804) 755-7755.
Michele Lewane, Esq.