Tactics That Allow Insurance Companies To Reduce Size of Payout

Insurance companies fight injury claims in hopes of decreasing the size of the anticipated payout. There are certain tactics that have proven effective, if an insurance company has chosen to fight an injury claim.

Questioning one of the 4 elements of negligence

Since no claimant can present an effective claim without proof of the opposing party’s negligence, the adjuster in the defendant’s insurance company might allege that the defendant did not have a duty of care towards the plaintiff. That tactic works best in cases where the plaintiff has signed a waiver, before taking part in a risk-filled activity. The signature on the waiver allows the defense team to claim that the plaintiff had assumed a known risk. The evidence of that assumption would threaten to erase any claim that the defendant had undertaken a duty to protect the plaintiff.

Question nature or extent of reported injuries

By using this tactic, an insurance adjuster might be able to delay the time when it must admit the need for a payout. In order to acknowledge proof, concerning the extent of a victim’s injuries, an insurer would request more evidence. If the victim had not collected sufficient evidence, then the adjuster might schedule an independent medical examination (IME). Even if the examining doctor were to say that the patient/victim was in good health, that same patient/victim would have a right to challenge that decision.

The entire procedure would fill a large block of time. That would delay arrival of the time when the insurance company had to compensate the injured party, the claimant.

Even without ordering an IME, an insurance company could allege that the claimant had failed to produce a suitable amount of evidence. Claimants can work to weaken such an allegation by saving all the information on obtained treatment, and by taking photographs of the untreated and treated injuries.

The above tactics get used when someone has submitted a 3rd party claim. There are also strategies for fighting 1st party claims.

Attempt to introduce provisions of policy’s exclusion phrase

Every policy has an exclusion phrase. An insurance company could allege that the circumstances surrounding a given claim have caused that same claim to qualify as one that should be excluded from coverage.

Your own insurer might claim that the injured victim was partly responsible for the extent of his or her reported injuries.

Alternatively, the adjuster could claim that the injured victim was partly to blame for the severity of the reported injuries. That tactic might be tried, if a policyholder/claimant had been hit by an uninsured driver, while carrying an uninsured motorist option, and the option holder had purchased that coverage from the recipient of the 1st person claim.