Red Flags That Insurance Claims Adjusters Look Out For

If you are trying to collect on an insurance policy due to a personal injury, you may have to convince the insurer as to the validity of your claim. It is the job of the insurance claims adjuster to decide whether the policy applies to your case and then decide the validity of specific items in your claim. Naturally, the adjuster will be skeptical of anything that doesn’t seem right given the facts presented, and, depending on his experience, the claims adjuster will make further inquiries into things that need further explanation or seem suspicious. An Irvine personal injury attorney may be able to help you present your case in the most favorable light and satisfy the adjuster. Here are some telltale signs that claims adjusters often look for regarding medical treatment:

The adjuster’s responsibility is to verify and articulate, in monetary terms, the amount of loss or damage sustained by the claimant. The adjuster may look at your detailed list of medical expenses and evaluate whether the treatments you are receiving are justified by what is in your medical reports. The adjuster may also look at the type of doctor treating you (if you are only seeing a chiropractor, your case may invite more inquiry than if you saw a neurosurgeon as well). Additionally, the adjuster may look at the frequency and amount of your treatment to see if you are showing any signs of improvement.

Adjusters are particularly skeptical of claims of soft-tissue injuries (sprains or strains) for which you claim chronic pain and disability but which no medical test supports. If you claim medical bills that seem excessive to the injury sustained (inordinate amounts of physical therapy, for example), or claim treatment that does not seem directly related to your injury (psychiatric treatment for low-impact accidents, for example), that will seem suspect as well.

Adjusters look out for certain personal injury attorneys and doctors who often refer clients and patients to one another and who may be “in cahoots” with one another to create a network of referrals. The adjusters will scrutinize those doctor’s records more closely and possibly give them less credibility. If you use one of these red flag doctors, the insurer may request an independent medical examination.

If you have further questions about how to deal with your insurance company, contact experienced Irvine personal injury attorney Samer Habbas for a free consultation.