Dealing With Insurance Adjusters

Within a day or two of a crash, your phone will ring. The caller will be an insurance adjuster, and the first thing to understand is which insurance company they work for, because that changes everything about how you should treat the call.

This chapter of The Ohio Personal Injury Guide explains what adjusters do, what they will ask you for, what to say and not say, and the duties Ohio law places on them.

The adjuster's job

An adjuster is a claims professional employed by an insurance company to investigate a claim and decide what, if anything, the company will pay. Adjusters are trained, they are measured on how much they pay out, and they handle hundreds of claims a year. You are handling one.

The adjuster for the at-fault driver's company (the "liability adjuster") owes you nothing. Ohio law does not generally let you sue the other driver's insurer directly, as our post on suing the other driver's insurance company explains; the adjuster's duty runs to their own insured and to their employer. Their goal is to close your claim for as little as possible, and every technique below serves that goal.

The adjuster for your own company is different. Your insurer has a contract with you and owes you a duty of good faith, which we discuss at the end of this chapter. You have a duty to cooperate with your own company. You still should not volunteer more than is asked.

Recorded statements

The liability adjuster will ask for a recorded statement, usually framed as a routine step to "get your claim started." Decline it. You have no legal obligation to give one to the other driver's insurer, and nothing good comes from it. The questions are designed to get you to minimize your injuries ("so you're feeling okay today?"), fix details you are not sure about ("how fast were you going?"), and say something that sounds like an admission. The recording will be transcribed and used against you a year later.

Say this: "I'm not going to give a recorded statement. I'm still treating for my injuries. Please send anything you need in writing." Then end the call. If you have a lawyer, say that and give the lawyer's number. The First 72 Hours covers this moment in more detail.

Your own insurer may require a statement under your policy's cooperation clause. If so, give it, keep it factual and brief, and if you have a lawyer, have the lawyer on the line.

Blanket medical authorizations

The adjuster will send a form authorizing the release of your medical records. Read it carefully. The typical form is a blanket authorization: it covers every provider, every condition, and your entire lifetime. Signing it hands the insurer your complete medical history to search for anything, a decade-old back complaint, a counseling visit, a prior crash, that can be used to argue your injuries are "pre-existing."

Do not sign a blanket authorization. The insurer is entitled to records relevant to this injury, and a lawyer will provide those, limited by provider and date range, at the appropriate time.

Quick "nuisance" offers and releases

Some adjusters make a fast, small offer, often a few hundred to a few thousand dollars, within days of a crash, before you have been fully diagnosed. The pitch is that you can "wrap this up" and get a check this week. The offer comes with a release.

A release is a contract in which you give up every claim arising from the incident, known and unknown, forever, in exchange for the payment. Once signed, it cannot be undone because your "sprain" turned out to be a herniated disc requiring surgery. The insurer knows this; the quick offer is a bet that you do not. Never accept a settlement or sign a release before you have reached maximum medical improvement and had the offer reviewed by a lawyer.

The property damage claim and the injury claim are separate

It is fine, and usually smart, to resolve the damage to your vehicle early. You need a car, and the value of the car is easy to establish. Settling the vehicle claim does not settle the injury claim, as long as the paperwork is done right.

Read the property damage release before signing. It should refer only to property damage and nothing else. If it says "all claims," "bodily injury," or "any and all damages arising from the accident," do not sign it. Insurers do not always do this on purpose, but it happens, and the consequences fall on you.

Three property-damage points people miss:

• Diminished value. A repaired car is worth less than one that was never wrecked. In Ohio you can claim that loss in value against the at-fault driver's insurer. Get a diminished-value appraisal if the car is newer or the damage was significant.
• Rental. The at-fault insurer owes you a comparable rental for a reasonable period while the car is repaired or until a total-loss payment is made. Push back if they cut it off early.
• Total loss. If the car is totaled, the insurer owes its actual cash value, and you can challenge a low valuation with comparable listings. Make sure your own vehicle's black-box data and photographs are preserved before it is released to salvage.

MedPay and your own coverages

Your own auto policy may include medical payments coverage, or MedPay, which pays medical bills from a crash regardless of fault, up to a limit such as $5,000 or $10,000. Use it. It is coverage you paid for, and it keeps providers paid while the injury claim proceeds. Your policy may also include uninsured and underinsured motorist coverage, which is the claim you make against your own insurer when the at-fault driver has no insurance or too little. See Using Your Own Insurance, our UM/UIM page, and our post on MedPay and bad faith.

What Ohio requires of insurers

Ohio regulates how insurance companies handle claims. The Ohio Department of Insurance's rule on unfair property and casualty claims settlement practices, Ohio Adm.Code 3901-1-54, sets minimum standards. Among other things, an insurer must acknowledge a claim within 15 days, respond to communications within 15 days, decide whether to accept or deny a claim within 21 days of receiving proof of loss (or explain in writing why it needs more time, with status updates every 45 days), pay an accepted, undisputed amount within 10 days, and give written notice 60 days before a statute of limitations expires. The rule prohibits denying a claim without citing the policy provision relied on, making offers so low they force people to sue, and concealing policy benefits that apply.

The rule does not give you a lawsuit against the other driver's insurer, but it does set the standard the Department of Insurance enforces, and it is useful to know when an adjuster is stalling.

Bad faith: the duty your own insurer owes you

Your own insurance company owes you more than the regulations require. Under Ohio common law, an insurer owes its insured a duty of good faith in handling a claim. The Supreme Court of Ohio has held that an insurer breaches that duty when its refusal to pay is "not predicated upon circumstances that furnish reasonable justification therefor." Zoppo v. Homestead Ins. Co., 71 Ohio St.3d 552, 1994-Ohio-461, paragraph one of the syllabus. The court made clear that an insurer does not need to intend to cheat you; an unjustified denial, or a one-sided investigation that ignores the evidence in your favor, is enough. An insurer that acts in bad faith can be liable for the damages the bad faith caused, and in egregious cases for punitive damages and attorney fees.

This matters most in uninsured and underinsured motorist claims and MedPay claims, where your own company is the one deciding whether to pay. Your insurer cannot treat your claim the way the other driver's insurer would.

What to say and what not to say

Say: your name, contact information, the date and location of the crash, the fact that you were injured and are receiving treatment, and that you will communicate in writing or through your lawyer.

Do not say: anything about fault, speed, or distance; anything that minimizes your injuries ("I'm okay," "just sore"); anything about prior injuries or conditions; anything about your income or your health insurance; or anything about settlement numbers. Do not guess. "I don't know" is a complete answer.

Be polite. Adjusters are people doing a job, and rudeness never helps. But politeness does not require cooperation beyond what the law requires.

Surveillance and social-media monitoring

On larger claims, insurers hire investigators. They may sit outside your house with a camera, follow you to the grocery store, and film you carrying a bag. They will review every public social-media post you and your family make. The goal is a single clip or photo that can be shown to a jury as proof you are exaggerating.

You do not need to hide; live your life within your doctor's restrictions. But assume that anything you do in public may be filmed, and keep your accounts private and quiet. Social Media and Other Mistakes That Hurt Your Case covers this in detail.

Key takeaways

• Know which insurer is calling: the other driver's adjuster owes you nothing; your own owes you good faith.
• Decline recorded statements to the at-fault insurer and do not sign blanket medical authorizations.
• Quick offers come with releases that end your claim forever; never settle before maximum medical improvement.
• Settle the car separately if you like, but read the release, and claim diminished value and rental.
• Ohio Adm.Code 3901-1-54 sets claims-handling deadlines; Zoppo makes your own insurer liable for unjustified denials.
• Say less, guess never, and assume you may be filmed.