My wife (and son) were involved in an auto accident in Oct. '14. The other driver was at fault, and her ins co paid to repair our vehicle (it was a lot of hassle, but they paid in the end). The medical portion is still not settled. The adjuster has given my wife the run-around at every turn (requesting medical bills to be faxed to him repeatedly, claiming he never received them, etc). A couple months ago, he made her a low-ball offer for pain and suffering. After much consideration, she told him what she thought she should receive (it was a very modest amount, considering what she went through). They have been negotiating back and forth, and were nearly in agreement today, when he told her that she would be responsible for paying her medical bills out of that money! He claimed that since she as not their customer, they can't pay the bills directly, so that amount was part of her settlement. Up until now, he had told her that the settlement was for pain and suffering, and the medical bills were separate. Today, he changed his story. He's clearly playing games. I'd appreciate advice from anyone who works/has worked in the insurance industry.
insurance adjuster
- Thread starter zrxkawboy
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I would say in this great country, a lawyer is always available.
A good lawyer will get you a fair settlement . This adjuster stooge has you in the category of one of the few cases where his insured is at fault but he can still jerk you around because you are unrepresented. These stooges never learn to pay a fair amount for a claim and thus avoid an attorney entering the case and jerking THEM around for a while before extracting what the case is worth.
I'd use the phrase, "bad faith"; it's feared by insurance companies.
Having been an insurance adjuster my strategy in your place would be as follows:
First, stop calling. It's obvious you are wasting your time.
Send certified mail to them with the medical bills, so you can prove they received them.
In the envelope, include a letter to tell your story above, that inside the envelope are the medical bills you expect them to pay since they have accepted liability. Then state the amount you need for her pain and suffering, as well as additional compensation for the additional time and suffering you have spent dealing with this because of their "bad faith" in failing to pay a clear claim in more than a year.
In the last paragraph, let them know you've contacted an attorney, and tell them you expect full payment within one week from the date of receipt or you will file suit.
Couple of points: First, there may be a statute of limitations on how long you can wait after an accident to file a lawsuit; I'd check this with an attorney right away, or with your own insurance company, maybe prior to sending the letter. Second, at this point and with the unfair way they've treated you, I would not write down "a modest amount" for her pain and suffering. Double or even triple it. During my time at insurance, I saw pain and suffering payments that were more than double the medical bills.
I would also say in the letter that you will only communicate via written means from now on, since they have given you the runaround on the phone.
Back all this up by NOT talking on the phone with him any more, by contacting an attorney to follow through in case they do not pay, and actually taking them to court.
This should have all been resolved within a month of your wife's final medical bill.
I'll welcome your PM with any questions.
Having been an insurance adjuster my strategy in your place would be as follows:
First, stop calling. It's obvious you are wasting your time.
Send certified mail to them with the medical bills, so you can prove they received them.
In the envelope, include a letter to tell your story above, that inside the envelope are the medical bills you expect them to pay since they have accepted liability. Then state the amount you need for her pain and suffering, as well as additional compensation for the additional time and suffering you have spent dealing with this because of their "bad faith" in failing to pay a clear claim in more than a year.
In the last paragraph, let them know you've contacted an attorney, and tell them you expect full payment within one week from the date of receipt or you will file suit.
Couple of points: First, there may be a statute of limitations on how long you can wait after an accident to file a lawsuit; I'd check this with an attorney right away, or with your own insurance company, maybe prior to sending the letter. Second, at this point and with the unfair way they've treated you, I would not write down "a modest amount" for her pain and suffering. Double or even triple it. During my time at insurance, I saw pain and suffering payments that were more than double the medical bills.
I would also say in the letter that you will only communicate via written means from now on, since they have given you the runaround on the phone.
Back all this up by NOT talking on the phone with him any more, by contacting an attorney to follow through in case they do not pay, and actually taking them to court.
This should have all been resolved within a month of your wife's final medical bill.
I'll welcome your PM with any questions.
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stop talking to the insurance company + Get a good Attorney ... they will pay medical in full and depending what the circumstances are with the pain and suffering and what she told the insurance company already a lot more money than you can get..Tell this bozo what you want and what they have to pay in medical and say he has 5 days or you are going to an attorney on the 5th day.
Hope everything you said does not come back and bite you..My wife always tells her clients Never speak to the insurance company thats what Lawyers are for and they know how to squeeze insurance companies. I dont know how long you have in your state but time may be running out!!! They want to play so the game is on..
Hope everything you said does not come back and bite you..My wife always tells her clients Never speak to the insurance company thats what Lawyers are for and they know how to squeeze insurance companies. I dont know how long you have in your state but time may be running out!!! They want to play so the game is on..
I've been here a few times. Kuato's advice is sound.
AZjeff
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Sir, you've let your wife be jacked around for 15 months by an insurance company jerk? Their job is to pay out as little as possible. The average person isn't equipped to deal with these guys. He wants her to wear down and finally give up.
Yes a PI lawyer will get paid, up to 1/3, but they level the playing field and you most likely end up better than trying to do it without one. If there's no doubt about fault it should be a no-brainer. Your wife won't more than the policy limits but with medical and pain/suffering that's the amount she's looking for.
Your wife needs a lawyer, one who specializes in this. Her next words to the guy should be "You'll be contacted by my attorney".
We suffered a terrible tragedy about the same time your wife was injured and have just been down this road.
Yes a PI lawyer will get paid, up to 1/3, but they level the playing field and you most likely end up better than trying to do it without one. If there's no doubt about fault it should be a no-brainer. Your wife won't more than the policy limits but with medical and pain/suffering that's the amount she's looking for.
Your wife needs a lawyer, one who specializes in this. Her next words to the guy should be "You'll be contacted by my attorney".
We suffered a terrible tragedy about the same time your wife was injured and have just been down this road.
In a case where all the fault is with the other party, between three and ten times the medical bills is the goal. Permanent loss of use if a limb raises it much more. Lost wages are included or the cost of domestic help for a housewife who can't take care of the home while she recovers.
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Originally Posted By: HerrStig
In a case where all the fault is with the other party, between three and ten times the medical bills is the goal. Permanent loss of use if a limb raises it much more. Lost wages are included or the cost of domestic help for a housewife who can't take care of the home while she recovers.
That sounds better than 2x. I DID work on the low end where the injuries were less severe.
In a case where all the fault is with the other party, between three and ten times the medical bills is the goal. Permanent loss of use if a limb raises it much more. Lost wages are included or the cost of domestic help for a housewife who can't take care of the home while she recovers.
That sounds better than 2x. I DID work on the low end where the injuries were less severe.
Originally Posted By: Kuato
I'd use the phrase, "bad faith"; it's feared by insurance companies.
Having been an insurance adjuster my strategy in your place would be as follows:
First, stop calling. It's obvious you are wasting your time.
Send certified mail to them with the medical bills, so you can prove they received them.
In the envelope, include a letter to tell your story above, that inside the envelope are the medical bills you expect them to pay since they have accepted liability. Then state the amount you need for her pain and suffering, as well as additional compensation for the additional time and suffering you have spent dealing with this because of their "bad faith" in failing to pay a clear claim in more than a year.
In the last paragraph, let them know you've contacted an attorney, and tell them you expect full payment within one week from the date of receipt or you will file suit.
Couple of points: First, there may be a statute of limitations on how long you can wait after an accident to file a lawsuit; I'd check this with an attorney right away, or with your own insurance company, maybe prior to sending the letter. Second, at this point and with the unfair way they've treated you, I would not write down "a modest amount" for her pain and suffering. Double or even triple it. During my time at insurance, I saw pain and suffering payments that were more than double the medical bills.
I would also say in the letter that you will only communicate via written means from now on, since they have given you the runaround on the phone.
Back all this up by NOT talking on the phone with him any more, by contacting an attorney to follow through in case they do not pay, and actually taking them to court.
This should have all been resolved within a month of your wife's final medical bill.
I'll welcome your PM with any questions.
This is very found advice.
I would add, that depending on the actual injuries a "modest" pain and suffering amount will not be what you could expect to receive in court. It may be a lot better to go to court, or move toward that (often they'll settle at the last minute). If the injuries are relatively minor it might not be worth it.
Litigation is very draining emotionally. Usually even after the lawyer gets their 33% or so, you're better off having one. The worse the accident and injuries, the more this is true.
One other poster also mentioned that adjusters get paid more by making claims go away for less money. Don't let them win.
I'd use the phrase, "bad faith"; it's feared by insurance companies.
Having been an insurance adjuster my strategy in your place would be as follows:
First, stop calling. It's obvious you are wasting your time.
Send certified mail to them with the medical bills, so you can prove they received them.
In the envelope, include a letter to tell your story above, that inside the envelope are the medical bills you expect them to pay since they have accepted liability. Then state the amount you need for her pain and suffering, as well as additional compensation for the additional time and suffering you have spent dealing with this because of their "bad faith" in failing to pay a clear claim in more than a year.
In the last paragraph, let them know you've contacted an attorney, and tell them you expect full payment within one week from the date of receipt or you will file suit.
Couple of points: First, there may be a statute of limitations on how long you can wait after an accident to file a lawsuit; I'd check this with an attorney right away, or with your own insurance company, maybe prior to sending the letter. Second, at this point and with the unfair way they've treated you, I would not write down "a modest amount" for her pain and suffering. Double or even triple it. During my time at insurance, I saw pain and suffering payments that were more than double the medical bills.
I would also say in the letter that you will only communicate via written means from now on, since they have given you the runaround on the phone.
Back all this up by NOT talking on the phone with him any more, by contacting an attorney to follow through in case they do not pay, and actually taking them to court.
This should have all been resolved within a month of your wife's final medical bill.
I'll welcome your PM with any questions.
This is very found advice.
I would add, that depending on the actual injuries a "modest" pain and suffering amount will not be what you could expect to receive in court. It may be a lot better to go to court, or move toward that (often they'll settle at the last minute). If the injuries are relatively minor it might not be worth it.
Litigation is very draining emotionally. Usually even after the lawyer gets their 33% or so, you're better off having one. The worse the accident and injuries, the more this is true.
One other poster also mentioned that adjusters get paid more by making claims go away for less money. Don't let them win.
I had a similar problem. They were at fault. Medical bills etc.
I decided their guy was jerking me around.
Next time he didnt take my call and called me back when I told him I would be unavailable at work. I answered and told him my attorney would be contacting him soon and not to contact me again.
It was so worth it not to deal with those time wasting sobs.
I decided their guy was jerking me around.
Next time he didnt take my call and called me back when I told him I would be unavailable at work. I answered and told him my attorney would be contacting him soon and not to contact me again.
It was so worth it not to deal with those time wasting sobs.
I should've updated this a long time ago, but forgot. Shortly after I posted, the adjuster stopped responding. My wife was able to get ahold of other people at the co and was told the adjuster was out on sick leave. She pushed, and finally was given the adjuster's supervisor's direct number. The supervisor seemed pretty surprised that this had been going on so long, and apologized to my wife. Within a few days, she had a check for the amount she had requested plus medical bills! So, all is well! Thanks for the replies.
Originally Posted By: zrxkawboy
I should've updated this a long time ago, but forgot. Shortly after I posted, the adjuster stopped responding. My wife was able to get ahold of other people at the co and was told the adjuster was out on sick leave. She pushed, and finally was given the adjuster's supervisor's direct number. The supervisor seemed pretty surprised that this had been going on so long, and apologized to my wife. Within a few days, she had a check for the amount she had requested plus medical bills! So, all is well! Thanks for the replies.
I should've updated this a long time ago, but forgot. Shortly after I posted, the adjuster stopped responding. My wife was able to get ahold of other people at the co and was told the adjuster was out on sick leave. She pushed, and finally was given the adjuster's supervisor's direct number. The supervisor seemed pretty surprised that this had been going on so long, and apologized to my wife. Within a few days, she had a check for the amount she had requested plus medical bills! So, all is well! Thanks for the replies.
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