The Law According to Insurance Adjusters
Being an insurance adjuster is a hard job. They have to know a lot about medicine, law and insurance. Most adjusters also have a staggering caseload and are under fairly strict instructions on what they can and can’t pay from their company.
I often get responses from adjusters on why they can’t pay a claim. Some of them are valid. Sometimes they need further documentation. However, sometimes adjusters decide they can’t pay the claim based on reasons where they just make stuff up. They quote law that’s wrong, fallacious and sometimes just plain ole made up.
Depending on my mood and how it’s done, it either annoys me, amuses me or really pisses me off. The main issue is to help the client and resolve the case. Most of the time, I will give them the right law and if they don’t want to accept it, or at least take the information and check into it, I’ll tell them. Okay, so what you’re telling me is that you just don’t want to pay the claim. You don’t have a valid reason for it, but you’re not going to pay the claim. We’ll accept that decision and move forward from there.
I was going to pull together a big list of ‘adjuster law’ claims, but instead, I’ll just add a category and add them as they happen. If you’ve experienced any ‘adjuster law’ claims, send them in and I’ll be more than happy to post them.
Great idea.
Recently, a State Farm adjuster in the Upstate cited their insurance policy in regards to a 3rd Party Workers Compensation setoff vis-a-vis Uninsured benefits.
There was actually case law directly on point stating otherwise (no set off). Ironically, the case was Ferguson v. State Farm Mut. Auto. Ins. Co., 261 S.C. 96, 101-102 (S.C. 1973)
Welcome to my world. Or rather, welcome me to yours. You've been practicing longer than me. One of my favorites is an adjuster telling me the only reason my client is still hurt (other than being rear-ended at 40 miles per hour) is because he's fat. He's 6 foot, 185.
