After you’ve been injured by the negligent acts of another person in Massachusetts, you have a right to seek compensation from them. In most cases, the person will have liability insurance and you’ll have to deal with the insurance company’s point of contact, called an insurance or claims adjuster. They are also called claims examiners, claims analysts, and claims representatives.
Before you file a lawsuit, it’s customary to seek a settlement with the insurance company and the adjuster’s job during settlement talks is to make sure you get as little money as possible to cover your losses. Your attorney’s job, of course, is to get you as much as possible. Peter Ventura has been doing this since 1985. Every now and then, an adjuster will say or do something inappropriate if they think they can get away with it.
Here are some statements that should raise a red flag.
“The accident is your fault.”
First of all, Massachusetts is a no-fault state in terms of auto accident cases, meaning that an injured person can be compensated for limited losses, such as lost wages and medical costs, up to a limited amount, even if the injured person is at fault, and your own auto insurance company will cover you. However, in cases where you seek additional compensation, for pain and suffering for example, compensation from another person’s insurance policy will be required and you must show the other driver was at fault. Most insurance adjusters are not lawyers and their opinion as to who’s at fault for the accident is not final. Don’t let it dissuade you. In these situations, you most certainly need a lawyer to help.
“The insurance policy’s limits won’t cover your claim.”
When an adjuster says this, it may very well be true, but that doesn’t mean you can’t be made whole. Massachusetts law only requires that motorists have $20,000 of coverage for bodily injury per person, $40,000 for total bodily injury per accident. If the costs for your losses go beyond this, and the insured has only the required minimum coverage, you may very well have to look to the insured’s assets for compensation or look to see whether your own auto insurance policy covers you for underinsured motorist claims. A competent attorney could help you with this.
“Your story contradicts the police report.”
Is it true that your version of events actually contradicts the police report or would it be more accurate to say that the police report merely fails to confirm your claims? There’s a big difference. Police are almost never there during the accident and they reach conclusions based on observations and speculations after the fact. Just because a police report can’t confirm what you know, doesn’t mean you’re lying.
“You need to send more medical records.”
Be careful here. You should send the adjuster all records that pertain to your injuries caused by the insured, but you should not send records that pertain to past injuries or illnesses. Often, the adjuster is looking for pre-existing conditions or embarrassing information to undermine your claim.
“You need to get another medical examination.”
When the adjuster doesn’t believe that your injuries are what you claim, they may suggest going to an “independent medical examiner” (IME). This happens most often when you’re claiming long term future harms or chronic pain. The thing is, these IMEs are hardly independent. The reason the insurance companies use them again and again is because the doctors hardly ever find anything wrong with the injured parties.