Insurance adjusters are not there to represent your interests. It’s not being negative, that’s just the reality. Knowing how insurers are taught to value your claim, and what their strategies are during the early days following your accident is the best defense against losing out on fair compensation, or even worse, giving up your legal rights unintentionally.
The adjuster’s actual mandate
When an adjuster opens your file, their mission is not to arrive at a fair settlement. It is to close the claim for the smallest amount of money possible. Many major insurance companies even rate their adjusters based on how much less they pay than the computer model predicts they should. This is known in the industry as “claim leakage”. It gives the adjuster a financial reward for questioning the extent of your injuries, disputing liability in every possible way, and moving quickly before you know what hit you.
And if you think the insurance adjuster is trying to get you to settle quickly for a low amount, you are right. Many large insurers use computer software programs to evaluate the value of your claim. The best-known of these is the Colossus program. The computer program asks for specific information and then calculates that information based on diagnosis, injury explanation, and billing codes. This information may be coded with a number or a letter, and that is what the adjuster will use to “determine their settlement range”. The adjuster will use the amount given by the program as the lowest amount they will offer and probably the only amount they will offer.
The insurance company also reserves a certain amount of potential cash for your claim. This is known as a “claims reserve” and the adjuster also stands to personally gain by minimizing this amount. So even before the adjuster opens your file, the computer is set to conclude it with the smallest possible amount of money. The adjuster will then begin reviewing your file.
How PA and NJ law shapes your options
What happens after a crash? It all depends. And it’s influenced heavily by decisions you’ve been prompted to make well in advance of having an accident of your own – namely, the choices you made when buying insurance.
In PA you chose either Full Tort or Limited Tort. Full Tort, you can sue for pain and suffering no matter how slight or how severe your injury. Limited Tort, you pay less for your premium and you gave up the chance to recover compensation for your significant disability, your lost opportunity in life, the impact your injury has had on your marriage or relationship with your children, and usually for the increase in your insurance premium caused by the tort election. Most people pick Limited Tort without realizing what they’re giving away.
New Jersey works in much the same way except that PIP always pays your medical bills regardless of your fault but the ability to sue for pain and suffering is controlled by the tort election you made when you bought your policy. Under what is often referred to as the “verbal” or “AICRA” threshold (the Limitation on Lawsuit Option) you can only recover for pain and suffering if you meet one of the objective thresholds listed in the policy – death, dismemberment, loss of a fetus, displaced fracture, permanent injury, significant disfigurement or scarring.
Both states also apply a modified comparative negligence rule with a 51% bar. If an adjuster can get you assigned 51% or more of the fault for the crash, you recover nothing. Even getting you assigned 30% of fault significantly reduces the value of your claim. This explains why adjusters push so hard to frame your conduct as contributory in their incident reports.
The 48-hour settlement offer
One of the easiest strategies for a claim adjuster to employ is to get you to settle as quickly as possible. This is their job – to make sure claims get closed as cheaply as possible. The earlier they can close your case, the more tempting their offer is likely to be. (And conversely, the more unlikely they are to ever offer you full value down the road.)
Too often, crash victims are willing to accept this quick, but very low-balled offer. And who can blame them? It’s money in the hand at a time when medical bills – and maybe even new car payments – are due.
Here’s the hitch. With that money in your hand, you’re going to need to sign a release that closes your claim. There’s no coming back for more, after you accept the $500 offer to close your $50,000 case.
Talk to a lawyer first. Find out your rights. If your lawyer tells you that after these few weeks your case may still only be worth $500 and that the $500 settlement offer is more than fair, you can always settle then. But if the lawyer thinks you’re looking at anything more than a few hundred dollars, you can probably guess why the adjuster wants you to settle so quickly.
Documenting the scene like you’ll need it in court
The evidence obtained from the scene of a crash is frequently the most important evidence you will ever have. By the time lawyers and adjusters become involved, the vehicles are fixed, the witnesses are gone, and the physical evidence has likely been altered.
Photograph your vehicle from all sides, including close-ups of damage and broader shots that show your location in relation to the other vehicle. Do the same for the other vehicle, the roadway, any skid marks, traffic signage, and the surrounding area. If you have a dashcam, lock the footage in place now – many dashcams record over footage on a looping basis. Identify any commercial properties, ATMs, or traffic cameras in the vicinity that may have recorded the crash. That evidence is frequently recorded over within 24 to 72 hours and needs to be specifically requested soon.
Obtain the name and phone number of every witness before they leave the scene if you can. Witness statements are considerable evidence in a disputed liability claim, and an adjuster that is aware of the existence of witnesses will handle the case differently than one who believes there are none.
Obtain the police report’s case number and, when it is available, secure a copy of the report itself. The standard Pennsylvania crash report is Form SP 7-0015, the New Jersey crash report is the MV-104 (sometimes referred to as the WR-362). This report memorializes the preliminary objective facts concerning the crash and will be referred to repeatedly in the claims settlement process.
Medical documentation and the “gap in treatment” problem
Insurance adjusters are trained to find or create gaps. If two weeks pass between the car crash and your first doctor visit, the adjuster writes: “claimant did not seek treatment for 14 days following alleged incident.” The term “alleged” is then used to question whether the crash caused your injuries.
Do not give the insurance company the chance to plant those seeds. If you are hurt in a crash, see a doctor as soon as possible. If you continue to experience pain, keep going to the doctor. If you are referred to physical therapy, go to physical therapy. If you are told to come back in a week, or a month, or three months, do it.
If you do not attend recommended medical appointments, the adjuster may interpret this to mean one of two things: first, that you were not hurt badly, because you didn’t go to the doctor or physical therapist who could have made you better; or second, that you have recovered.
Each of these assumptions is used against you, by the insurance company, to reduce the amount of money they may have to pay.
Anything you write on social media is fair game. If you post a photo from your weekend with friends and comment you had such a good time at the game, camp, museum, park, or the beach, don’t be surprised if the adjuster mentions this during your deposition. They will claim that, if you were really in pain, you wouldn’t have been able to do those things.
Create a file and keep notes on every appointment, prescription, every out-of-pocket expense, and every day of work you missed. If you don’t play with your kids, if you are not sleeping, if you had to hire help to do things you once did yourself: write it down when it happens. Courts and adjusters are impressed by what is written down far more than what is remembered.
Why you should never give a recorded statement to the other driver’s insurer
The other driver’s insurance company will ask you for a recorded statement. Likely, they’ll frame it as standard procedure. It is not standard for you.
Adjusters are interviewers for a living. They are well aware of the questions that produce answers which can be used to suggest comparative fault. Responses like “I didn’t see them until the last second” or “I was attempting to change lanes” – spoken innocently and accurately – can be taken out of context and used against you in a dispute. You are not required to give a recorded statement to the other driver’s insurance company, and in nearly all cases, you should refuse to offer one until you’ve sought legal advice.
This is a point at which cases can be weakened before they are ever filed in court. When you’re facing pushy adjusters in the Mid-Atlantic, working with a litigation firm like Rand Spear means you have someone representing you during those discussions – someone who fully understands how those statements can be manipulated and can help protect your comments from being taken out of context.
How disputed fault works in multi-vehicle crashes
When more than two vehicles are involved in a collision, or if certain circumstances put the liability into question, multiple carriers will typically collaborate in the background to parse out blame in a manner that protects each insurance company’s financial exposure. This process doesn’t necessarily take what truly occurred into consideration.
Because of the 51% bar rules in both Pennsylvania and New Jersey, the potential benefit to insurers of shifting fault to a plaintiff in order to clear the 51% bar is substantial. If they can succeed in shifting just 40% of the fault onto the plaintiff, they slash the value of the claim by 40%. The financial incentive is clear, and adjusters understand it.
In multi-vehicle wrecks, each insurance carrier performs its own investigation and comes to its own conclusions, all of which tend to support the self-interest of their policyholder. In the absence of independent evidence like dashcam footage, eyewitness testimony, or accident reconstruction analysis, you’re taking the word of individuals who have a strong financial motive to slant the facts in their favor.
When to get a personal injury attorney involved
You can submit minor claims to insurance companies. If you’re in a fender bender with no injuries and a police report clearly puts the other driver at fault, that’s a different scenario from being rear-ended on the highway and suffering a back injury that puts you out of work for six weeks. If you’re in any of the scenarios below, hire a lawyer:
- You’ve suffered serious injuries.
- Liability is contested.
- The other party was driving a commercial vehicle or work car.
- Multiple defendants could share fault for the crash.
- You’re in a dispute with the defendant’s insurance company over “unnecessary” medical treatment. The insurer may argue this; it can be a way to reduce your claim.
These are the scenarios with the most money on the line and in which you’re most at risk of doing something that will cost you a lot of money. The averages show it. People in auto accidents who hire a lawyer get settlements, on average, 3.5 times bigger than those who don’t (Insurance Research Council), and lawyers don’t cost you any more money in your pocket for a personal injury case because they work on contingency. If you don’t get paid, they don’t get paid.
And remember that, in Pennsylvania and New Jersey, the statute of limitations is two years. If you let that run out without a settlement, you’ll wind up with nothing and the attorney won’t be able to help you.
After the crash: keep a timeline
One of the most neglected tools in a claim is a timeline following the accident. From the day of the crash, document forward with a brief daily or weekly log of your symptoms, your limitations, your appointments, and any communications with the insurance company. Include dates, names, and what was said or offered.
This document becomes invaluable if the claim is disputed. It shows continuity of pain and treatment, rebuts the “gap” argument, and gives your attorney something concrete to work with. It takes five minutes to maintain and can be worth far more than that.
The insurance company is running a professional claims operation focused on managing claims efficiently and controlling costs. Your job is to make sure the record reflects reality – what happened, what it cost you, and what it continues to cost you. Every piece of documentation you control is a fact they can’t rewrite.
