If the at fault party has liability insurance, then when you file a claim with their insurance company you have a 3rd party claim.

I have read quite a few articles that give a lot of bad information about adjusters. The thing I have noticed most about those articles is that none of them were written by an insurance adjuster! I'd be willing to bet that if you have not been an insurance adjuster, then you believe they are almost as bad as used car salesmen or attorneys, hehe. It is a common view.

What Is The Norm?

I can't speak for every single insurance claims office out there, but I can say that I have worked for 5 different non-standard companies as an adjuster, and I have worked on contract for many standard companies as a recovery specialist with a firm.

I have never been instructed to deny any valid claim, nor have I been advised to "low-ball" claimants. This might happen at some companies, but it is definitely not the norm.

Insurance adjusters (if they care about their license) will usually try very hard to fairly resolve claims. I will say that I have definitely dealt with some companies that have some "questionable" practices. I won't name names, but some of these companies simply attempt to cut costs by hiring inexperienced adjusters and giving them a "rule-book". It is the inexperience of the adjuster in interpreting the "rules" that causes the majority of the issues.

One common unwritten rule at these companies is "deny claims with conflicting statements". An adjuster that doesn't understand when they can and when they can't deny a claim makes it very frustrating for a claimant to successfully negotiate a fair settlement. In my opinion, adjusting takes an inordinate amount of common sense, but the test to get a license (at least in Texas) doesn't really test for common sense. An adjuster can know all the rules and still be a really crappy adjuster. Believe me, I have dealt with some adjusters that give a terrible name to the profession. I'm not trying to defend those adjusters. I have heard conversations between inexperienced adjusters and claimants, and it is appalling. I have overheard adjusters just confidently misinform claimants of their rights, or confidently base their coverage or liability decision on misinformation, or just poor investigation.

Just realize that is not the norm.

Common Sense and How To Use It To Resolve Your Insurance Claims Issues

An Example

With that previous rant off my chest, let me tell you a practice that falls into that category of having a "no common sense" adjuster and that is (in my opinion) unethical and inappropriate. The main scenario that causes a claimant to be "screwed" is when the damages are not very severe. For example, let's say you were rear-ended, but since you are a good person, you are not claiming any injury even though you may be sore for a while and could possibly incur some therapy bills.

Now let's also assume that coverage has been accepted. Since you are such a good person, you didn't call the police so there's no police report. Now it is up to the other person (let's say they are an unlicensed 15 year old kid) to admit that the accident was their fault, or, in the alternative, it is up to the insurance adjuster to make a judgment call (based on common sense) on whose fault the accident was.

Seems simple, right?

You were rear-ended, you have damages to the rear of your vehicle and the other person has damages to the front of their vehicle. It should be clear, right? Well, let's add a common twist that I saw all the time. The kid lies.

First of all, he/she wasn't supposed to be driving the vehicle. Next, they had a few friends with them (that's why they rear-ended you, they were distracted), and they weren't supposed to be hanging with friends on a school night. So instead of just telling the truth and saying they rear-ended you, they try to avoid further "trouble" at home and they lie and say that you had pulled out into the intersection a little and then backed up into them. At least the accident wasn't their fault (I have heard it before, really).

When the adjuster calls you and tells you this, you can't believe it!

The adjuster has three options:

1. Believe the kid

2. Believe you

3. Just pay for your damages

What do you think will happen? I'll tell you.

If the adjuster is inexperienced and has a supervisor or manager that is immoral, they will deny your claim based on conflicting statements. This is a perfectly valid denial that they can get away with. They can play dumb and try and act like they really can't tell whose fault it is. It's valid because there is not any evidence to support either side of the story. It is word against word. They will deny the claim saying that they can't determine liability.

Now surely if you filed suit, they would pay the claim because, I mean, come on....what jury is going to believe a 15 year-old who says they got backed into at an intersection?  Especially if they had three other 15 year-olds in the car with them? The problem is that your damages are only $1200.00, and it is going to cost you to file suit.

So what can you do?

If you are really sharp, you could use a small claims court to force the matter, but even the rules for small claims can be complicated, so most people end up just getting mad and bad mouthing the insurance company (rightfully so in my opinion).

The insurance company counts on this type of issue.

They play the numbers game.

Quite a few companies (even the big ones) take this approach. They have inexperienced adjusters who don't think for themselves, and just ask the manager what to do. Once they have been told to handle it that way once, they just think that is how it works. Nobody ever seems to figure this out until they have been in the business a while. A manager is not going to explain it like I just did - they will just say "Well, deny the claim, you can't tell whose fault it was!". The adjuster is none the wiser. The manager knows they will pay if a suit is filed, but what the manager knows is that most people will give up and not fight because they don't know how and the claim is not worth enough for an attorney to take the case.

In this case, the insurance company wins! They can deny these types of claims because they have inexperienced adjusters to thwart off common sense and they won't make that judgment call to pay the claim.

Fight Or Be Taken Advantage Of

Here's the cold hard fact: If you don't fight, you will get taken advantage of. You can avoid this type of issue if you know what evidence to secure at the scene, but how many of us are claims specialists and think to get a written statement from the kid at the scene?

You as the claimant have to learn how to fight for yourself when the claim is a small amount (say under $7500.00). I tell you, I never did this to people when I was handling 3rd party insurance claims. I used my head and I paid the claim because common sense told me the accident was the fault of the 15 year-old. I have always thought for myself. The story of someone backing into somebody at an intersection doesn't hold much water for me unless there is some really good evidence or a witness that can confirm the story.

If you find yourself in this situation, you have a choice to make.

You can either accept the denial, or you can fight until you are blue in the face for what is right! If more people utilized the small claims court system, some of these "questionable" practices would be less profitable and we would all see a little higher quality adjuster on the front lines so that those judgment calls could be made with some common sense. It is up to the adjuster to decide if you are serious about suing or not, and if they don't believe you have what it takes to get your money, then you will get a denial.  Period.

P.S.

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