The Truth About Automobile Industry Insurance Claims
By John Cooper, Virginia Car Accident Injury Lawyer
As an experienced Virginia personal injury attorney specializing in automobile wrecks and insurance claims, I know how the system works. The insurance companies make their money by taking in as much as they can charge for premiums and paying out as little as they can to injured people. That business model for insurance companies is the same for every single insurance company whether it's the big ones like State Farm, GEICO and Progressive or the newer or smaller ones like Elephant Insurance, the Hartford or USAA.
They will do whatever they can do to get away with paying an injured person the minimal amount necessary to get that release. They will lowball you and treat you poorly even if it's your insurance company that you're dealing with. The insurance company doesn't care that you are a Nationwide insured even when the at-fault driver who rear ended you also has the same Nationwide insurance. You are just a number to them. You are going to get treated no better as a result of having been paying your premiums to Nationwide for 20 years.
The insurance companies realize that it's all a matter of dollars and volume. If they can get away with paying $1,000 less on 100 cases, they have just saved themselves $100,000. In fact, the volume of injuries from automobile accidents is a huge number and the stakes are often much bigger than just $1,000. However, the accountants and lawyers who run the claims departments for Allstate, MetLife, and Liberty Mutual all do the same thing. They try to come up with excuses to not pay for the full extent of the harms and losses caused by the carelessness and mistakes of the people they insure. Every dollar saved is a dollar that they can bonus out to their CEO or increase their stock price with.
The various games and techniques that insurance companies use are a long list. Over 25 years of handling this kind of case I've seen lots of different arguments, most of them unfair or even silly, used by insurance claims adjusters to try to pay people a few dollars less than they should have gotten for a harm which was no fault of their own including the following:
- These bills are too high and are not reasonable so instead of treating this emergency room bill as correct for $2,000, we're going to only give you credit for half of that because we think the bill should have been lower. The silly thing about this is that the patient the person who was sent by ambulance from the scene of a wreck to the emergency room has no control over what the bill is from the emergency room. The emergency room doctor is the one who is going to decide whether a CAT scan of their head is necessary and what parts of their body to take an X‑ray of. The patient has to pay the full original amount of the hospital bill and the emergency room physician's bill and the radiologist bill. The injured person doesn't get to go back to the emergency room and say oh I don't want to pay so much for this service because the insurance adjuster doesn't think that your services were worth that much.
- Your client deserves less money because they have all these gaps in treatment where they didn't treat for a week so they must not have been seriously hurt. The insurance company makes this argument all the time ignoring such things as the fact that it was Christmas when the person got injured and therefore not only did they have family obligations but no doctors' offices were even open during much of that time. The insurance company doesn't care that you didn't have health insurance and were worried about running up a bill that you couldn't pay for and that's why it took you some time to get an appointment with a doctor. The insurance company claims representative doesn't care that you were trying to be conservative and not run out to get treatment until you were sure that you were really hurt and that it wasn't going to just go away all the while taking over-the-counter medication to try to self-treat the injury. The insurance companies spend lots of money and time developing these theories and arguments that they use to save themselves money in every single case that they can which multiplied times the millions of claims a year means lots of money that the insurance company doesn't have to pay out regardless of whether the gaps in treatment argument is really true or valid in any one person's case.
- Our medical records review doctor says you shouldn't have treated after six weeks because all back injuries heal after six weeks. This argument ignores the reality that a certain percentage of the patients who suffer a back injury are not going to get better in six weeks. The insurance company and their hired gun backroom doctor have not pinpointed the day when you were miraculously cured, and your back went from hurting to not hurting. They don't really care whether your back was hurting or not. They're just saying they don't want to pay for it anymore after six weeks because their insurance company thinks they can get away with that in a certain number of cases. The human body is a mysterious thing, and medicine is still as much an art as a science particularly when it comes to dealing with injuries caused by the trauma of something like a car wreck. Some people will heal up fast and well with a standard amount of physical therapy and others won't. However, by making this one-size-fits-all-type argument, the insurance company gets away with forcing many people to settle their case for far less than it's really worth even though there may be chronic and potentially permanent injury to a person's body that they're just going to have to live with for the rest of their life.
The truth about automobile accident insurance claims for injury cases is that it is very much not a fair fight. The insurance companies have millions of dollars to spend on claims agents, investigators and paid doctors to fight against your claim. You are lucky to have one good experienced personal injury attorney fighting on your side.
The insurance company knows that an attorney specializing in accident and injury cases is about the only way that you're going to be able to balance the power between you and them. So the insurance companies will do everything in their power to get you not to go to an attorney. They will mislead you about how they are going to treat you in the future to get you to wait and see until it's too late. They will sometimes be extremely pleasant and nice making false promises hoping to get you not to get an experienced practitioner on your side. Sometimes they'll be hassling you and pestering you to take a quick low dollar settlement before you even know what's wrong with you. The truth is that you are generally going to be better off with an attorney than without one in any significant automobile accident with injuries that's not your fault.
At a minimum, you should talk to an attorney for a free no-obligation consult to find out what your options are and to get some initial impressions from an experienced plaintiff's side personal injury lawyer to make sure that you aren't being taken advantage of by the big insurance company. Call us at (757) 455-0077 today if you have been hurt in a car crash due to the fault of another person.