South Carolina Trial Law Blog

When I was relatively new as a Plaintiff’s attorney, I received a call from a GEICO adjuster stating that at the beginning of December, that they wanted to take all of their cases and wrap them up for the year’s end. That a super adjuster was coming in from Atlanta and would take care of all the cases at once.

What a great idea, I naively thought. The big day came and I had 5 cases with GEICO at that time. She didn’t even read the demands and medical records:

• Too Young – I can’t believe that such a young girl has such serious injuries and won’t recover. She’s young, she’ll get better.
• Too Old – I can’t believe that she’s having such problems from the car wreck. She has to have a ton of pre-existing conditions.
• Too Much Treatment – It’s clear she’s ‘milking it’.
• Too Little Treatment – She’s obviously not hurt.

Let’s play this ‘game’ a little more.

• If a person goes directly to the doctor – She ran to the doctor. Why is she doing that?
• If a person waits a day, to see how they’re feeling – They must not be hurt. If they were hurt, they’d go immediately to the doctor.

It took me awhile to realize that to a very large degree, the facts don’t matter to the adjuster. They’ll find anything they can to poke. After awhile you learn to document your case and if the adjuster won’t listen, then you just file suit, and move the case forward. The best way to settle a case is to prepare for trial.

This seems like the name of the game in any matter involving a negotiation like influence. Whatever one side says, there is an opportunity to defend it from the other side. Facts are less important than convincing arguments.

I tried a case on Tuesday where the argument was that treating doc was biased because he was the doctor's patient. Who on earth would then be qualified to speak to the injuries? Someone we hired? Same problem you are speaking about: they will spin it some crazy way no matter what the facts are, even at trial.

Verdict was about 20 times the offer a week before trial.

I enjoyed your post that said "The best way to settle a case is prepare for trial". As an agent I have bitter sweet feelings regaarding this. As a policy holder I enjoyed your committment to fighting. My blog isn't as developed but I'm working on it.

Thanks for the info

My wife, who is an insurance defense attorney, laughed hysterically when I read her your blog. She queried if you were given the "Quick Response Cheat Sheet"?

Before 04/23/09, as an insurance professional I trusted that PIP Adjusters would treat well substantiated claims as automatic benefits to which Claimants would be entitled. How wrong and naive was I!

I have not had any problems with [Progressive] the Insurer of the negligent driver who caused my injuries. So far they have paid for my Property Damage and other expenses to which I am entitled.

However, my own Company's PIP Adjuster as well as the Insurer's PIP Manager, on behalf of the President of the Board (to whom I had complained for Adjuster's multiple violations of the "sacred" Rule of INDEMNITY) have unsuccessfully attempted to set up malicious snares attempting to defraud me by denying the Wage Loss Benefit of $9,000.00 to which this victimized claimant is inconstestably entitled. You may contact me for incontestable data.

The Adjuster and the Officers of the Company he represents perfectly know that Medicare would have taken over as the primary insurer after my No-Fault Benefits had become exhausted, but Adjuster elected to pay medical bills instead, in spite of the fact that my Wage-Loss Claim and the Medical Certificates of Disability were presented to him long before he received any medical bills.

I feel that this is a nasty act of Prevarication and of other transgressions which include but are not limited to lack of good faith. Is this not a clear-cut case of violation of the spirit of Indemnity because the Adjster's mathematical formula clearly works out in my financial detriment?

This is why I have already reported (in my own representation) the multiple irregularities to the Florida Department of Financial Services.

In addition, Adjuster and Insurer's PIP manager have failed to respond my numerous demands (for answers) within the Department's statutory time limit of 20 days.

In view of so many obvious acts of bad faith, I have already certified (in my own representation) a Petition for the Commissioner to aknowledge that Insurer has conceded by failing to respond.

Regretfully, average claimants are not trained to do research and much less to clearly understand insurance regulations or case precedents. Consequently they tend to trust "claims experts" and so become easy preys of so many well calculated coercive tactics from some unscrupulous adjusters who usually get away with tort while enjoying complete impunity.

Therefore I trust that the Departmet of Financial Services, as an administrative government agency, may want to set an example to prevent that other naive Floridians are victimized by similar unethical practices.