When someone gets into an accident, people often say: “I hope they have insurance!” This implies that the insurance company will help the injured person fix the situation. But whether it’s car, home, or health insurance, you should always remember that insurance companies are not a victim’s friend.
Insurance companies are for-profit businesses; they make money when they don’t pay out benefits. This is a fundamental misalignment of incentives, if the goal is to make sure you are protected and made whole after an accident.
Insurance companies will go to great lengths and use almost any means necessary to avoid paying you. These are 5 common tactics insurance companies will use to deny you the compensation you deserve.
- Making lowball offers very soon after an accident,
- Delaying and dawdling in hopes that you will give up,
- Denying your legitimate claim to make the process take longer,
- Getting “expert” opinions that downplay your injuries,
- Using deliberately confusing language in contracts and settlement offers.
Tactic #1: Quick, Lowball Offers
One of the first things an insurance company might do after an accident is contact the injured parties fairly quickly and make an (insultingly) low offer. The adjuster might present this offer as a way to “get paid quickly” or “put the accident behind you,” but know that their aims are entirely self-serving.
No matter how nice the insurance adjuster or representative sounds on the phone or even appears in person, they use this façade of concern to their own benefit. Accident victims should never fall for the insurance company’s trick.
Remember, insurance adjusters are trained negotiators and their job is to protect the interests of the insurance company. They will prey on your pain and dismay in the immediate aftermath of an accident to push you to settle quickly for an unfair amount.
Moreover, you may not know the full extent of your injuries at first. By settling early insurance companies avoid paying additional expenses on car repairs, future medical bills, or lost wages.
Tactic #2: Delay, Defer, Dawdle
A tried and true tactic to avoid paying insurance benefits is to delay, defer, and dawdle—especially if you did not accept the initial settlement offer. Insurance companies will move slow, put you off, or ask for “more paperwork” all with the hopes of running out the clock on your patience. This is fundamentally a stalling tactic, and the insurance companies bank on victims growing restless and ultimately giving up.
Purposefully throwing up obstacles such that only the most dedicated and tenacious victims get properly compensated is not only harmful to victims, it’s highly unethical and deceitful. We know this tactic happens and that it’s successful based on the raw statistics for insurance payouts. Despite the massive profits raked in by the $300-billion insurance industry, premiums continue to rise and payouts continue to drop.
Pro Tip: Florida is the state with the highest number of uninsured drivers in the country (26.7% in 2015). It also boasts the third highest average insurance cost ($1,356 in 2017). The first fact is a good reminder that adding uninsured motorist (UM) coverage is a smart idea. The second fact helps to explain why so many drivers in Florida go uninsured or opt to buy only the state-mandated minimum coverage.
Tactic #3: Denials of Legitimate Claims
But you have a contract with them, so that means the insurance company is obligated to pay your legitimate claims, right? Wrong. That just means insurance companies have to find a “reason” to deny your claim. They will use a variety of tricks and ploys to justify their denial or, at the very least, the lowest payment possible.
Every year there are hundreds of stories (and many more that don’t get national coverage) of giant insurance companies denying claims. These customers are in real pain and are reaching out to their insurance company for help, only to receive a nonsense denial of a legitimate claim, which adds stress to an already stressful situation.
Pro Tip: Denials of genuine claims are just another delay tactic. Insurance companies hope to gaslight you into thinking that you don’t have a legitimate claim. You will stop pursuing compensation, you won’t talk to a personal injury lawyer, and the statute of limitations will expire, at which point you won’t be able to file a lawsuit. Don’t let this happen to you!
Always remember that your insurance company’s sole focus is its bottom line. Cutting costs, pinching pennies, and increasing revenue outweigh your valid pain and suffering.
Tactic #4: Using Their Own “Experts”
Another mechanism insurance companies use to deny your claims or reduce your compensation is to refer to their own experts. This takes many forms:
- Independent Medical Exams by insurance company–hired doctors
- Sending you to a “recommended” body shop
- “Totaling” a vehicle and low repair estimates
First off, if you are claiming medical benefits in Florida from your PIP coverage, your insurance company may request an Independent Medical Examination (IME), which will be conducted by a physician hand-picked by the insurance carrier.
Although the exam is obligatory, it is rarely “independent.” These insurance-hired physicians are expected to find evidence that contradicts your story: For example, the injuries are less severe than claimed or the injuries were actually caused by an earlier accident.
Pro Tip: We prefer to record these examinations on behalf of our clients. By taping the examination, we can compare the conclusions of the IME physician to your treating physician to identify any red flags.
Second, your insurance carrier may play fast and loose with the repair costs of your vehicle to save money.
On the one hand, totaling your vehicle may be the best option for the insurance carrier. The insurance company usually will “total” vehicles if repair costs are 70% or more of the fair market value (FMV). You will then get a check for the FMV amount rather than what it would cost to repair your vehicle.
But the insurance company often bases the FMV on a list of “comparable” vehicles for sale in the area rather than more-objective measures like Kelley Blue Book. And, yes, the insurance company decides what counts as “comparable” and what vehicles to include (or not include) on the list!
On the other hand, if the damage is well below the 70%-value threshold, it’s in the insurance company’s interests to downplay the damage to your vehicle. You may receive a low repair estimate, and your insurance company may try to send you to one of their recommended body shops. These body shops are in cahoots with your insurance company and may use cheaper parts or cut corners on repairs to keep costs low.
In both cases, you have rights: You can appeal your insurance company’s offer if it totals your vehicle. You also are not obligated to use the insurance company’s body shop.
Tactic #5: Deliberately Confusing Language
Finally, linguistic complexity is one of the most widespread means to deny injury victims the compensation they deserve. Unfortunately, since this usually involves victims signing legally binding documents or contracts, it is also one of the most effective.
Most injury victims are not lawyers, and the average person is not well-versed in the impenetrable legalese that pervades most contracts (nor should they have to be!). Insurance companies know this and use it to their advantage to get you to sign documents that include provisions that you don’t fully understand.
Whether it’s the insurance policies themselves or settlement offers after an accident, companies use confusing terminology, length and formatting, and misleading euphemisms to ensure they protect themselves and avoid paying your claims. They know the average person is unlikely to read a 100-page policy and, even if they did, that they won’t understand all the nuances of every single provision.
Pro Tip: Make no mistake, the insurance companies made a deliberate choice to write their contracts and agreements in a way that discourages policy holders from reading and understanding. Courts have repeatedly agreed that policy language must be “conspicuous, plain, and clear.” And yet, insurers still bury critical information on page 30 of a 125-page contract amid a wall of all-caps text.
Protecting Yourself and Your Rights
These are only five of the many tricks and tactics that insurance companies will use to deny you the compensation you deserve. You shouldn’t be expected to be a lawyer before being able to get fair compensation from an insurance company.
If you have been injured and your insurance company is playing tricks, delaying, lowballing you, or anything else that you think might be off, call the trusted and experience lawyers at the Personal Injury & Accident Law Center. We will take on the insurance company for you so you can focus on healing and recovering.
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