Insurance Adjusters in Auto Claims

Dealing with Insurance Adjusters

There are many auto insurance claims at ICBC annually. The number of crashes reported to ICBC is 260,000 per year, based on a 5 year average. The insurance adjuster is your ICBC point of contact to help you with injuries and health problems as a result of an automobile accident, including the inability to work. An outline of the adjuster’s roles and responsibilities and what he or she is not responsible for may help you to gauge how you wish to handle your insurance claim.

Role of Adjusters in an ICBC Claim

The adjuster’s role is to manage your accident claim file from beginning to end and he or she has the goal of processing and closing the file as quickly and efficiently as possible. The more claims the adjuster processes, the better his or her employee record. Further, the adjuster obtains a percentage of the settlement money saved from each insurance claim through a bonus scheme.

To manage the file, the adjuster will need to collect information about you and the accident. He or she will ask you questions about the accident and your injuries and may arrange for a mobile adjuster to come to your home to provide a signed statement of facts. The adjuster will also obtain medical records from treating professionals, and facilitate discharge planning. Upon receipt of information, the insurance adjuster will assess the merit of the claim and assign a possible cost to it based on the available information. He or she may provide any reason to deny your claim.

Where there is sufficient medical evidence provided to ICBC, the adjuster will coordinate assessments, arrange in-home attendant and convalescent care as needed, arrange therapy and rehabilitation, and co-ordinate return to work plans. He or she seeks to have you return to work as soon as possible in order to close the claim.

One of the ways in which an adjuster will seek information to justify closing the file is by hiring private investigators to follow and watch you, which they are legally allowed to do. The investigator may appear harmless, but will seek to obtain information that can be used against you by asking questions of neighbours and professionals at work.

An adjuster is also responsible to coordinate and share information with stakeholders on a continuous basis throughout the file duration. Stakeholders include you, family members, employers, legal counsel, hospitals, treating specialists and healthcare providers. The adjuster is also required to regularly report the status of the open file to his or her supervisor and explain why it is still open.

If the adjuster has not been able to close the file within the targeted time period, the adjuster will arrange for “independent” medical examinations as a second opinion to that provided by your own physician. Commonly, the doctor hired by the adjuster to provide independent examinations will write a report stating that you don’t need the treatment your own doctor recommended and that you are ready to return to work. Doctors who provide these reports may give a professional opinion that there is nothing wrong with you or that your problems are minor and being exaggerated by you. Sometimes the insurance company will pay more for this second opinion than the treatment that your physician ordered would cost.

These assessments paid by ICBC are hardly impartial and help to keep the costs of insurance down for the benefit of all policy holders by closing the file earlier than otherwise.

At the same time that the adjuster seeks to terminate accident benefits quickly, the adjuster will seek to delay or avoid paying a significant tort claim. Rarely are the funds offered by the adjuster based on a fair assessment of the circumstances. The adjuster might also tell you that you only have a few weeks to accept the offer, when the law states that you have two years from the date of the accident to make an insurance claim. There is no need for you to rush into accepting a settlement offer and doing so will thwart your ability to recover additional compensation later if complications from your injuries arise. It is best not to sign anything without having it first reviewed by a lawyer.

There are additional benefits besides settling the claim cheaply for ICBC when the file is not settled fairly. One of the benefits of delay for ICBC is that they can invest the principal of the policy payment for longer with their firm without having to pay interest to you at settlement. Another advantage for ICBC is the time value associated with healing your injuries; typically over a longer period of time claimants with disabilities are able to resume some form of employment, which then reduces the need to provide funds for future loss of earnings.

A further benefit to delaying reasonable settlement payment of a tort claim is that ICBC’s bargaining leverage increases when the injured accident victim and/or his or her legal counsel has incurred legal and medical expenses and needs the funds. The adjuster is well aware that you are worn down, in pain and inexperienced at dealing with litigation lawyers. The adjuster is aware that the more serious your injuries the less likely you will have the physical stamina and/or intellectual capacity to try and protect yourself and the more vulnerable and susceptible you are to bad faith handling practices.

What Adjusters Are Not Responsible For

Knowing what adjusters are not responsible for can help you determine how to proceed with your claim. Adjusters are not obliged to ensure that you have a copy of the details of your insurance policy or that you read and understand it or interpret it in a way that benefits you most. Adjusters are not obliged to educate or inform you even though insurance policies can be vague or written in a way that makes their interpretation very difficult for the layperson to understand. They do not work for you and have no incentive to help you access benefits you are entitled to even though you are a policy holder. The insurance adjuster works for ICBC, which has a mandate to keep, protect and promote the company’s interests and keep costs down for the benefit of policy holders.

How to Succeed with Adjusters

Your best option in dealing with adjusters is not to deal with them directly and to hire a lawyer to represent you instead. Insurance adjusters have a legal background, access to in-house ICBC lawyers at any time and are well trained to work efficiently to protect the interests of ICBC. Hiring a lawyer to represent you will help to level the playing field with ICBC. The success of your claim and the amount of claim rests on your decision about whether to try and deal with the insurance adjuster yourself or obtain professional legal representation.

If you have been in an automobile accident, contact a lawyer at Kenneth Cristall Law Corporation to represent you against ICBC. We have offices in Burnaby, Vancouver, Coquitlam, Langley, Richmond, New Westminster and Surrey. We will review your insurance policy terms with you and can identify the coverage you are entitled to. Contact us today at 604-654-2250.

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