Maybe you’re a few days out of the hospital, just getting back into something resembling your old routine. Or you’re at the kitchen table, recovery still ongoing, with a stack of bills in front of you. Or you’re opening the mail to discover an insurance company has denied your claim after your car accident. What was the point of filing? What comes next?
The denial appears final. It may even say words to that effect right under the company letterhead. But it doesn’t have to be. You can choose to fight the insurance company, challenge the denial and get the money you’re owed. But fighting insurance companies isn’t something you can do on your own. The insurance companies have teams of lawyers to defend their denials. When dealing with insurance companies one thing is clear—you need to tip the scales back in your favor and the experienced attorneys at Montlick are here to help.
Putting a personal injury attorney on your side puts the insurance company on notice that you won’t stand for the denial. But you don’t have to wait until they deny your claim to get legal help. If you aren’t able to contact an attorney right after an accident, then you should as soon as possible and it is particularly important if you notice any of the common insurance company tactics we outline below.
Insurance Companies Owe a Fiduciary Duty, But Not to Everyone
Before we can get into how to fight an insurance claim, it helps to know where shady insurance company tactics spring from. We often expect insurance companies to do right by us, and bitterness becomes a natural reaction when these companies fall short. We expect a certain degree of care because these companies insure the things we hold most dear. Our homes, our transportation, our health, and our very lives. How could they coldly deny coverage or play dirty?
Insurance companies will try to wrestle their way out of paying a claim entirely or as little as they can possibly get away with because they have a fiduciary duty to their shareholders, owners, or members. A “fiduciary duty” is a requirement that one party act on behalf of, and in the best interest of another party. This duty is rarely owed to you as an insured customer, but it’s always owed to insurance companies’ owners.
The Fiduciary Duty and You
How does this duty affect you? If an insurance company must act for the best interest of its owners, that means one thing—maximizing profit. For many companies, performing their fiduciary duty to shareholders by maximizing profits involves creating great products and services that customers love using. But insurance companies have a more complicated business model.
One way an insurance company could maximize profits would be to collect premiums and never pay out any claims. But that insurance company probably would not operate very long. Besides the legal implications of the practice, people would refuse to become customers of such a company. On the other extreme, an insurance company that approved every claim for the maximum amount could face retaliation from their shareholders for not fulfilling their fiduciary duty.
Insurance companies know the duty they owe to shareholders and fear the power they possess. Insurers also know they typically don’t owe any similar duty to their customers. The insurance companies run very simple calculations: there’s a certain amount of claims they’ll have to deny or minimize to keep shareholders happy.
To achieve this goal, some insurance companies turn to all manner of tricks, tactics, and bad practices. Their hope is that the person on the other end of the denial doesn’t know their rights or is too desperate to fight for what they’re owed.
Common Insurance Company Traps
So how do insurance companies see to it that they pay as few claims as possible for as little as possible? Their strategies revolve around the assumption that you don’t have any other options and don’t know your rights. They believe they can either deny altogether, wait you out, or pay less than what’s owed. Fortunately, the lawyers at Montlick are experienced at recognizing, and helping our clients avoid, these traps.
Insurance Company Tactics to Deny or Minimize Your Claim
Insurance companies should conduct a reasonable investigation of your claim, as laws like O.C.G.A § 33-4-7 require for first-party property damage. Those investigations aren’t entirely for your benefit, though. If an insurance company can find a reason to deny a claim, they will. Insurance investigations need to be approached with caution, whether you’re dealing with your insurance company or the responsible party’s policy.
1. Beware of the Amicable Adjuster
Thanks to countless media depictions, we’re all familiar with the “good cop/bad cop” routine during criminal investigations. We’re far less familiar with how insurance companies use friendly claims adjusters to drop our guard and get information out of us. The adjuster may appear to be trying to help you out and just need to ask some questions as a formality. In truth, the adjuster is looking for facts and information they can use to minimize or deny the claim.
They may ask you about the context surrounding the accident or claim event, like whether you were speeding or distracted. If you want to know how to fight insurance claim adjusters that hide their true intentions, you should consider refusing to give any statement to the insurance company and bringing an attorney into any conversations with the insurance company. A seasoned attorney will recognize the tactic for what it is and dissuade you from answering any potentially harmful questions.
2. Don’t Provide Recorded Statements
Unfortunately, not providing recorded statements is easier than it sounds because Georgia is a “one-party” state for recording. According to O.C.G.A. § 16-11-66, you can record a conversation if you are a party to the conversation, meaning only one party in the conversation needs to give consent to record. Effectively, an insurance company can record your conversation regardless of your personal wishes.
Armed with your recorded statements, insurance companies can use them to deny your claim. GA R&R 120-2-52 requires insurance companies in first-party motor vehicle claims to provide the specific details of why they’re denying your claim. They can match your recorded statements to policy provisions to justify a denial. They can also use your recorded statements as a way to reduce your claim’s worth, arguing that injuries aren’t so serious or that you don’t have that much pain and suffering.
3. Approach Forms With Caution
In the wake of an accident and claim, there’s seemingly a mountain of paperwork insurance companies need you to fill out, sign, and send back. The tedious complicated task becomes mind-numbing—by design. Read the forms carefully and watch out for any form asking you to release your medical records to the insurance company.
The insurance company wants you to give them access to your medical records and treatment to build a case against your claim or against paying what the claim is worth. They may be looking to argue that your injuries weren’t as damaging as you claim, or that you wouldn’t have suffered such injuries were it not for pre-existing conditions. Remember that HIPAA provides protections that require the insurance company to get your consent to access your medical records. If you don’t give that consent, they can’t get that information.
4. Insurance Companies Must Provide Some Time For Recovery
In addition to providing you with a mountain of forms, insurance companies may also try to get you to sign forms at inconvenient times. If you were hospitalized or are in a health care facility, Georgia law, O.C.G.A 51-1-35, provides a 15 day window from the date of the accident that insurance companies and their agents cannot talk to you in order to try to settle your claim and/or obtain a waiver or release of liability.
What happens if they do, though? And what happens if you agree to waive liability, release and/or settle your claim within that time period? The good news is that O.C.G.A § 51-1-35 prevents insurance companies from using any waiver, release or settlement discussions as evidence in a lawsuit. However, in order to fight an insurance company’s attempt to use this information, you need to hire an experienced attorney.
But what if your injuries are more extensive? If you don’t fully recover within 15 days, the protections Georgia law provides no longer apply. That means insurance companies could still try to catch you off-guard as soon as day 16. Getting legal support as soon as possible can help you protect yourself from these practices.
5. Watch What You Post
Insurance company investigations can be thorough. If the insurance policy suspects your claim may cost them up to the full limits of the policy, they will ramp up efforts to avoid that outcome. That could include looking at your social media and online presence. Insurance companies will scour your posts for evidence that your injuries or damage aren’t as much as you’re claiming so they can justify paying less than what you’re owed.
Insurance companies may even hire a private investigator for invasive research into your life to justify a denial or lower settlement amount. You should be cautious when dealing with insurance companies, and assume they’ll be looking at everything you post online. Even if you make your account private, they may have unassuming accounts follow you to report back. A good practice is to not post about your accident or injuries and to be mindful of what you do post to social media after your accident.
6. Insurer May Question a Delay In Treatment
The time between the accident and treatment provides insurance companies with another tactic to undervalue or deny your claim. Insurance companies may attempt to argue one of two things. First, that the injuries are not related to the accident because there was a day or more between the accident and the first attempt at getting treatment.
Second, they may argue that the injuries are not as serious as claimed because the injured victim waited to seek treatment. They argue that if the injuries were serious, a reasonable person would have gone straight to the hospital. Or, they may argue that the injuries wouldn’t be as serious if treatment had been received straightaway.
Attorneys with experience fighting insurance companies recommend that victims seek treatment as soon as possible, even if first responders give an all clear. Emergency services can detect certain injuries, but may fail to recognize internal injuries caused by items like seatbelts or hidden or delayed onset injuries and pain.
7. The First Offer Isn’t Final
If the insurance company used all those above techniques but couldn’t find a reason to deny your claim, they may fall back on offering you far less than it’s worth. If they find information they believe can support paying you less, they will try to offer less. If you want to know how to fight an insurance claim offer that’s lower than expected, you need a sense of how much your claim is worth.
This is where contacting an attorney can clarify the situation. While no two cases are alike, veteran attorneys can draw on their experience and dedication to begin calculating the expenses you already have and costs that may arise as a result of the accident. With this estimate in hand, you can accurately compare the insurance company’s offer with your estimated expenses. If it doesn’t add up, you don’t have to accept it.
Insurance companies cannot threaten or bully you into accepting these offers either. If they attempt to pressure you into accepting their offer under threat of a counter lawsuit or criminal prosecution, it’s time for assistance. While laws like O.C.G.A § 33-6-34 target practices like this, they only do so when it becomes so frequent that it’s considered that insurer’s general business practice. Insurance regulators in those cases may fine the company, but you need legal counsel to get justice of your own.
Insurance Companies May Try To Delay a Fair Settlement
In addition to the slew of tactics insurers resort to above, insurance companies may also look for other ways to extend the process in their favor. They may feel they can get an injured victim to settle for less if the victim’s situation becomes dire.
In the aftermath of an accident, charges for treatment and repairs stack on top of regular monthly bills. Insurance companies fully understand that the longer the claims process or settlement negotiations take, the greater the financial pressure can be on the victim – you. They believe that you will accept any offer once you have to deal with late charges on bills or the possibility of eviction.
While GA R&R 120-2-52 states that your own insurance company has a duty to you to resolve your property damage claim timely, what if you’re dealing with the insurance company for the at-fault party for your property damage and injury claim? Georgia rules and regulations are less clear on how timely an insurance company for the at-fault party has to be, creating challenges when a negligent actor injures an innocent victim. Insurance companies for the at-fault driver may feel they can deny or refuse to settle within the policy limits, so they can drag out negotiations until you feel like you have no better option but to accept whatever offer is currently on the table. Don’t succumb to this tactic, especially if you suspect that your claim is worth more than the limits of the at-fault party’s insurance. An experienced attorney can evaluate your claim and, under certain circumstances, help you potentially hold the at-fault insurer in bad faith and achieve compensation for you that exceeds the insurance limits.
How to Fight Insurance Companies’ Traps
You don’t have to settle for less or accept shady insurance company tactics. Before the insurer resorts to these tricks, contact a trusted personal injury attorney. Insurance companies use many of the strategies above because they believe they’ll be able to get away with it. When they see you represented by experienced legal counsel, their confidence can plummet.
Attorneys know how to fight an insurance claim denial, delay, or low offer—and that makes insurance companies nervous. When you retain a seasoned personal injury attorney, they’ll get to work investigating the claim on your behalf, not the insurance company’s. They won’t subject you to trick questions and lay traps for you to fall into. Instead, they’ll work to collect as much evidence of the accident as they can. That may include camera footage, eyewitness statements, and collision analysis.
In addition to gathering evidence to support your claim, an attorney can help you navigate the claim and settlement processes. They can walk you through the complicated forms, explain the road ahead, and keep you informed of your claim’s progress. They can also keep you from common mistakes that could reduce your claim.
When you’re fighting insurance companies with an attorney at your side, you put someone in the room with your best interest at heart. We know that insurance companies typically don’t have a fiduciary duty to their insured clients, but attorneys do. Your attorney should spend their time diligently working to advance your best interests, whether at the negotiating table or in the courtroom.
Hate Dealing With Insurance Companies? Call Montlick.
If you’re tired of fighting insurance companies alone, turn to Montlick. Our experienced personal injury attorneys passionately pursue justice on behalf of our clients. We know how to fight insurance claim denials and delays because we’ve seen all these tricks before. We give our clients peace of mind as we fight for justice on their behalf.
Contact Montlick today to see how we make a difference in our clients’ lives. Your initial consultation is always free.
