Adjuster Relations: Health and Disability Claims

ADJUSTER RELATIONS: Health and Disability Claims

THIS ARTICLE IS ABOUT HOW TO COMMUNICATE WITH ADJUSTERS ON THE FOLLOWING CLAIMS:

• health insurance
• disability insurance
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GENERAL DISCUSSION

When a personal injury or wrongful death occurs, health insurance adjusters and disability adjusters may need to work with you.  A health or disability “claim file” is opened and an insurance adjuster for the health or disability insurance company is assigned to you.  This insurance adjuster does not work for you, but is an employee of the insurance company.  This insurance adjuster speaks and acts for the insurance company.
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FIRST CONTACT WITH THE ADJUSTER

Introduce yourself and exchange basic contact information.  Ask the adjuster for the steps you need to take and what you need to provide the adjuster.  Be sure to get the claim number to the adjuster's claim file.

Keep notes on:

1. who you talked to
2. the date you talked
3. what you talked about
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GIVING A RECORDED STATEMENT

If the adjuster requests your recorded statement or asks you to release your medical records, tell the adjuster you would like more information about what the adjuster intends to do in your claim.  Any statement you give the adjuster is usually recorded and binds you to the words you use.  There are times to cooperate and give a statement, but there are also times you want to decline giving a statement.  If you need help sorting this out, contact me, and kindly advise the adjuster you need more time before giving a statement.
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KEEP THINGS ORGANIZED

Keep all your paperwork organized.  My office can provide you with manila file folders at no charge.  Keep the adjuster updated by sending any relevant documentation.  This maintains contact with the adjuster and helps the adjuster stay on top of your claim.
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GETTING THE RESULTS YOU WANT

The adjuster wants to close out your claim for as little money as possible and as quickly as possible.  But the adjuster may need your approval and sometimes, your signature, to close out a claim.  So, you want to provide the adjuster what the adjuster needs to pay your claim.  So, step one to getting what you want, is to decide what you want.  Make a fair and reasonable demand to settle your claim.  Support your claim with documentation and statements from witnesses when necessary.  Ask the adjuster lots of questions and be patient with the adjuster.  If an adjuster is rude, ask the adjuster if you have said something wrong, that you want to resolve this quickly and need the adjuster to explain. Above all else, document your claim.  Nothing moves an adjuster faster than strong documentation.

The adjuster, by law, must act in good faith to settle your claim honestly and free of misrepresentation.  But, you and the adjuster will probably have differing ideas on how your claim should be settled, so do not ever, ever, ever get mad at an insurance adjuster.  It is a waste of time and hurts your chances to resolve your claim.  Most adjusters, if treated with respect, will treat you the same way.