Here’s How Insurers Can Compromise Claims & How to Push Back to Protect Your Rights
Insurance companies profit from not paying claims. That’s no secret, but it also may not be totally obvious when insurers present themselves as being “like a good neighbor,” “on your side,” or “here to help.”
- Insurers will NOT prioritize you or your rights after a crash: Insurance agents are not on your side after a crash, even if they’re from your own insurance provider. Instead, they are looking out for the insurance company and its interests.
- Insurers are NOT obligated to explain or protect your rights: Really, it’s up to you to know and protect your rights. If you mistakenly rely on insurance companies to do this for you, you could be misinformed and misled into making choices with your claim that serve the insurer at your expense.
You can avoid giving the insurance company the upper hand — and you can take effective steps to safeguard your rights and your claim — by knowing what tactics insurance companies typically use and how to respond to each of them.
10 Tactics Insurers Use to Sabotage Claims
When you’re filing a claim after a car accident, a work accident, a slip and fall, or another incident, stay alert to these insurance tactics as you move through the claims process. If you anticipate that insurance agents will be working against you and your claim, you can be better prepared to spot the subtler tactics, and you can be ready to react with an appropriate, decisive response.
1. Pressuring you for an “official” statement
Official means “recorded” for many insurance companies, and these recorded statements can be used to fight your claim. That’s more likely to occur if:
- An official statement includes incorrect details, assumptions, or misstatements.
- An insurance adjuster can trip you up with questions as you make an official statement.
In other words, official statements are typically used to help insurance companies, not you, when you’re asked to provide them. And insurance companies will usually be looking for any errors in what you’ve said as opportunities to reduce or deny your claim.
TIP: Don’t give an official statement until you are 100% ready to do so. Also, remember that there aren’t deadlines for giving these statements and you can talk to an attorney for advice before you sit down to provide any “official” statement to an insurance company.
2. Pointing out reporting or treatment “gaps”
Reporting accidents to insurance companies can be required as a term of coverage for certain types of insurance. For instance, auto insurance providers commonly require motorists to report any traffic collision within 24 to 72 hours of a crash. Missing that reporting deadline could trigger certain consequences for claimants, like reduced coverage, according to an insurance company.
Similarly, foregoing medical care for the injuries associated with a claim could give insurance companies room to argue that:
- You’ve contributed to your own trauma.
- You are not entitled to as much (or maybe even any) compensation due to gaps in medical treatments.
Whether insurance companies point to “gaps” in reporting an incident or receiving medical care, this tactic is generally used to try to:
- Negate or play down your injuries
- Blame you, rather than the negligent party or parties, for your injuries
- Allege that you may have overstated or exaggerated your injuries
Whatever angle they pursue here, this insurance tactic is all about limiting coverage and undercutting the losses involved.
TIP: Get ahead of this tactic by closing the gaps. That means reporting injuries or injury-causing events to the insurance company ASAP. It also means seeking immediate medical attention after getting hurt and following through with all medical treatments, as well as all doctors’ orders related to activity and work limitations.
3. Prolonging the investigation or claim
If you’re hurt and you see a doctor, you’re going to have medical bills — and those expenses can add up FAST, especially if you’re treating more serious injuries.
Insurance companies know that. And they know that injured folks usually need money for medical bills and maybe living expenses too.
That’s why insurers may take their time with claims, dragging them out to:
- Put more financial pressure on claimants.
- Increase the chances that claimants will accept the first or any lowball offer because they need money immediately.
- Get them to accept less than they deserve or convince them that a denial of their claim is the final word on the matter.
So, if you’re injured, waiting on an insurance company to process a claim for compensation you need, you could feel like you’re at the mercy of the insurer — and that you may be victimized again.
Keep in mind, however, that Texas law requires insurance companies to:
- Acknowledge claims within 15 days of receiving notice of them and request any additional information needed at that time.
- Approve or deny your claim within 15 days of receiving all requested information.
- Notify you if the deadline needs to be extended, explaining why if so.
TIP: If you think an insurance company is giving you the runaround or if you feel like they’re purposefully dragging their feet, call a lawyer. You can get free, confidential advice related to your claim, along with helpful guidance about your options for moving forward and how to protect your rights as you do.
4. Faulting you for the injury-causing event
Victim blaming is a common tactic insurance companies use to avoid paying compensation for injury and accident claims. Generally, this strategy is more likely to be invoked when:
- You may have admitted at some point to causing an accident.
- There’s unclear or insufficient evidence to definitively establish fault at an early stage of an investigation and a claim.
If you give an insurer any room to make these (or other) arguments blaming you for your injuries, there are good chances they will. And if you don’t know how to subvert these arguments, you could end up being wrongfully blamed for an accident — and your claim could get reduced or denied.
TIP: Never accept blame if you weren’t actually at fault. Even if an insurance company is telling you they have evidence that you caused an incident, there could be other evidence that refutes their arguments and establishes liability more clearly. That’s why it’s prudent to retain an attorney if you’ve been wrongfully blamed for an accident. A lawyer can help you determine and present the best possible counterarguments and evidence to protect your claim and your rights.
5. Downplaying your injuries and/or losses
Your injuries were pre-existing, or you didn’t do enough to avoid or mitigate the losses involved — those are a couple of ways that insurance companies may try to gloss over the damages associated with a claim. They could also allege that some incident after the injury-causing event caused the injuries or losses in question.
Again, this comes back to the bottom line, and it’s just another strategy insurers may use in an effort to pay you as little as they can.
TIP: Be prepared to prove the physical trauma, the financial damages, and other losses caused by the event associated with a claim. Pictures, videos, police reports, and medical records are just some items that may help establish the actual extent of the injuries and losses — and insurance companies can have a more challenging time arguing against losses that are backed up by concrete evidence.
6. Using standardized formulas to calculate payouts
When insurance adjusters are calculating what to offer to settle a claim, A LOT of unknowns can come into play, raising questions like:
- What formulas or equations were used?
- What numbers were plugged in?
- Were any mistakes made in the calculations?
- What assumptions were used to complete the calculations?
You may not get straight answers to these questions from the insurance company, but you CAN:
- Run your own damage calculations.
- Come to the negotiating table ready to present a more realistic offer, with evidence to back it up.
- Retain an attorney to help you with compensation calculations, settlement negotiations, and more.
TIP: Never accept an offer without understanding the details. All too often, initial and subsequent offers fall short of providing the full compensation a claimant deserves.
7. Requesting another medical opinion
Even if you’ve already been to a doctor, insurance companies can request another medical opinion, asking you to see another physician of their choosing. If they do:
- This is generally a one-time visit to assess or verify your injuries.
- Don’t expect confidentiality with this doctor.
- It’s generally safe to assume that the doctor has a relationship — and likely aligned interests — with the insurance company.
TIP: Be honest and tell the truth when talking to the insurance company’s doctor, but do NOT disclose details that you would not want the insurance company to know. Also, try to bring someone you trust with you to this appointment. This person can be an important witness later if there’s any discrepancy regarding what happened or what was said during the visit.
8. Watching you
You could be the target of insurance company surveillance after you file a claim, with an insurance investigator following you around and recording your activities. This surveillance is usually done to:
- Verify whether your statements to the insurer were true.
- Try to catch you doing things that could be used to undermine your claim, like engaging in activities that go against doctor’s orders (e.g., lifting a heavy item when you have a back injury and doctor’s orders not to lift anything over 10 lbs.).
Additionally, this may include surveillance cameras, with or without the presence of an investigator, outside of your home, your work, and/or other places you routinely visit.
TIP: Expect to be surveilled after you file a claim, and keep a lookout for anything out of the ordinary. Also, take special care to follow all doctor’s orders, and don’t do anything you shouldn’t be doing, given any physical limitations you may have.
9. Mailing a check with a release of all claims
Getting a check in the mail can seem like a step forward with a claim, but it may not be. In fact, if an insurance company sends you a check and you cash it, you could be unwittingly:
- Accepting that check as your settlement
- Closing the claim, with a release of all future claims related to that incident
And once that check is cashed, there may be no going back to reopen the claim and negotiate better compensation.
TIP: Carefully read and examine everything the insurance company sends you. NEVER cash any checks or sign and return any documents to the insurance company without fully understanding what that action entails. Better yet, consult an attorney when you receive these items, so you can make more informed decisions that better serve your interests.
10. Bringing in the big guns
Insurance companies usually have teams of highly experienced lawyers who only focus on fighting claims. So, if your claim results in a dispute:
- The insurer will be ready to go to battle in court, backed by experienced attorneys dedicated to protecting the company.
- You could have to stand up to these experienced legal eagles, trying to fight for what’s right in a David versus Goliath-type fight.
TIP: Don’t fight insurance company lawyers alone. Retain an experienced attorney who can help you level the playing field, fight back, and assert your rights in and outside the courtroom.
Filing a Claim? Talk to an Attorney First
With insurance claims and companies, you could be facing more of an uphill battle than you realize — and any mistakes you make along the way could diminish the strength of your claim, possibly making it more difficult to recover full, fair compensation.
The good news is that you do not have to face or deal with insurance companies alone. An experienced injury lawyer can counsel and represent you, providing important advice before you file a claim while guiding you at each step going forward. That advocacy can be crucial when it’s time to prove liability, advance claims toward the best resolution possible, and make insurance companies pay what victims truly deserve.