How Insurance Companies Operate

Steven Schwartzapfel Feb 10, 2016

Insurance companies are in business for one purpose and one purpose only — to make profit for their shareholders. The insurance companies are not in existence to pay you one penny more than they have to.

Thirty years ago, I worked as an attorney representing the insurance company defending personal injury claims. I can tell you, having firsthand knowledge, that the insurance company will do everything within their power to stall, delay, or deny your claim. The insurance company knows that their tactics will further delay your case and increase their likelihood of success. Having experienced counsel by your side can make all the difference between your success and theirs. The insurance company representatives and lawyers will strive to make a simple accident ambiguous, confusing, and complex. The longer the case drags on, the more money the insurance company makes earning interest on their money. The insurance company also knows it will cost you or your lawyer money to prosecute or try the case.

Insurance Companies Will Avoid Paying Limits as Long as Possible

In New York State, the minimum policy limit is $25,000 dollars. Rarely, if ever, is there any incentive for the insurance company to offer $25,000 early on regardless of how badly injured or disabled you are. The insurance company knows the insurance policy limit is the highest amount they will ever have to pay anyone. There is absolutely no reason for the insurance company to have to pay you early on when they can pay you years later and earn interest on the money. If the injured person is elderly, the insurance company will never admit it, but they actually hope the person dies before the case ever gets to trial.

They Will Go to Extreme Lengths to Limit Your Claim

Stalling, delaying, and denying claims works for the insurance company’s benefit, not yours. The insurance companies have highly experienced and skilled lawyers and investigators to protect their interests, to minimize their exposure, and to pay you as little as possible. They train their insurance adjusters to take advantage of claimants who have not yet retained an attorney and have no idea of how much money their claim is worth. The insurance companies and corporate wrongdoers have tremendous resources and have spent countless dollars figuring out every possible trick, trap, and tactic not to pay out money in claims. Whether it is spending hundreds of millions of dollars on lobbyists, public relation firms, think tanks, and political action committees (PACS), or simply running ads and articles to distort the facts, poison the minds of American consumers and juries, push their anti-consumer tort reform agenda to limit consumers’ access to the civil justice system, or limit trial by a jury —make no mistake about it — insurance companies and corporate wrongdoers do not want to be held accountable.

They Will Try to Reach You Early

The insurance companies have also learned that the sooner they can investigate and begin processing the claim, the less money they will have to pay out. Many insurance companies now have a twenty-four-hour rule. It is their goal to make contact with the claimant and take statements within twenty-four hours of the accident. Some insurance companies even have adjusters in vehicles on standby, waiting for a call from their insured notifying them of an accident. The adjusters now drive right to the accident scene or even to the hospital to
begin defending the claim. These insurance company investigators and adjusters are highly trained. They act concerned, compassionate, friendly, and helpful. They may be neighbors, belong to local churches or temples, coach little league or soccer, belong to the same civic group or business networking group, and they may appear to be wonderful people. Don’t be fooled — their sole purpose is to protect the insurance company, not you. The insurance company is under no obligation to tell you your legal rights. Often they will falsely tell you that you must give a written or recorded statement or fill out a form if you want the insurance company to pay for your property damage or anything else. Then they use the statement against you as grounds not to pay. Do not speak with any insurance company representative until you have spoken to a lawyer.

Do not Give in to Misinformation and Intimidation

Insurance companies will often tell you not to hire a lawyer, that you don’t need one. They are well aware of the studies done that prove that a person with a lawyer receives, on average, three-and-one-half times more money than a person without a lawyer. Even after paying attorney fees the claimant often receives more than double the amount of money he or she would have otherwise received. Most recently, we have noticed insurance company representatives also showing up at the hospitals and accompanying clients to doctor visits, demanding to be present during examinations. The latter are nurse practitioners whose purpose is to intimidate the client, the doctor’s office, and staff. Their mission is to cut off and deny benefits as quickly as possible and then to testify against the client if the case proceeds to trial. They never tell the client that they have no legal right to even be there! One of the insurance company’s primary goals is to obtain a written or a recorded statement as soon as they can. They know the quicker they get a statement, the better they can defend or deny a claim. Unless you have been involved in an accident, you can’t imagine how stressful, surreal, and upsetting the whole thing is — especially if family members were hurt, injured, or killed. Your entire body, system, and mind may be in a state of shock. The accident may have knocked you out or caused you to black out. We have had clients who have broken their legs, had their bones sticking out, and have tried to get up to walk. Even if you are seriously injured, unconscious, suffering from a concussion, or are in shock, it does not stop the insurance company from calling or showing up at the hospital or your home and demanding a statement.

Not All Injuries Are Immediately Obvious

The insurance companies know the importance and value of immediately investigating and processing the claim. The insurance company is also aware that immediately after the accident, not only is the client often dazed, confused, and in a state of shock, but that many injuries have a latency period whereby the neck, back, shoulder, and/or knee gets progressively worse, not better, as days, weeks, and months go by.

Medical research proves that the full extent of certain injuries is usually unknown at the time of the accident. The insurance company also knows that when a person is lying in bed in excruciating pain with broken bones that they usually are not focusing or aware that other parts of their body are bruised, sore, battered, swollen, and injured. The adjuster has training in basic psychology on how to phrase questions to get you not even to mention or to minimize the nature of injuries, pain, or impact of an injury. For instance, the insurance company adjuster or investigator typically asks questions and writes out “your” statement for you to sign. The adjustor may ask you, “No other parts of your body hurt you at this time?” However, the adjuster may only write down “no other injuries or complaints” and omit from your statement “at this time.” In addition, adjusters will do everything within their power to phrase questions to make it appear that you are fully or partially at fault for the accident.

Despite What They Say, You Do not Have to Say a Word

Remember, you are under no obligation to give any statement. The old adage is true, “Anything you say can and will be used against you.” Also, remember you are under no obligation to answer any questions. You are under no obligation to fill out or sign any forms. Do not allow anyone to intimidate you into making any decision or doing anything without first speaking to a lawyer. It is not uncommon for insurance company adjusters to tell you they will not pay your medical bills or property damage once you get a lawyer. This is simply not true.

Before Accepting or Signing Anything, Talk to a Lawyer

Worst of all, do not, under any circumstances, accept any money from the insurance company without speaking to a lawyer. Do not enter into any agreements with the insurance company. Do not sign anything or settle your claim without first speaking to a lawyer. Insurance companies are notorious for telling clients they are going to give them a check for property damage and/or miscellaneous expenses, and then have the clients unknowingly sign a general release, releasing the defendants and forever giving up all rights, including the right to past and future medical expenses, lost wages, pain, and suffering. We have had clients, especially our Spanish-speaking clients, told by insurance company adjusters that they are receiving money for their car and miscellaneous expenses. Only later did they find out that they gave up their right to sue for serious personal injuries.

Contact Schwartzapfel Lawyers P.C. Today

At Schwartzapfel Lawyers P.C., we have extensive experience working with insurance companies, and we know the truth about your rights – regardless of what they claim. If you have been involved in an accident, you should consult with an attorney before accepting any settlement or signing any agreement. Contact an attorney at Schwartzapfel Lawyers today by calling 1-877-737-4806 or by filling out our online contact form. We will fight for you!

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