(This information came from Mike Cerf (prairielaw forum))
The Inside Game
Investigation, Chapter 3, 12/14/99
Now that you are past the PD and opening the file, going on at the same time is the adjusters investigation. In general what will occur is as follows:
Mikes Rule: The investigation is not done to favor you, it is done to develop a defense for the insured, or more plainly speaking to minimize that loss payment, or to compromise and/or deny your claim.
1. Statements: You are under no obligation as a third party claimant to provide a statement. The typical drill, is we just want to record an interview of what your version of the accident is. However, it is really not your version, it is the adjusters statement guide version. Granted, you can tell your story, but keep in mind the statement is not done to help you. Point: Just tell the adjuster you will send him your version in a few days, so all you really have to do is just send a very basic written story. Be careful in each and every step, tell the truth, but keep it simple and to the point. Also, keep in mind the adjuster wants to use any statement you make, that you are not hurt, as evidence later that you were not hurt, keeping in mind that often soft tissue injury starts to manifest after a loss.
2. Scene investigation: The field adjuster in some cases will be dispatched to do a scene investigation, this is photos and diagrams of an intersection with a witness canvass if applicable. Do your own if there is a question of liability or demand that your carrier do one to protect the PIP subrogation.
3. PD photos: Will photo your car all four sides and three of point of impact. May not be what an expert would want, but the adjuster will use it to argue that the impact could not have caused injury.
4. Witness Statements: Will take witness statements to support their position
5. Police Report: Obtain for further documentation
6. Interview police officer: Will do this to clarify officers comments
7. Use of experts: If there is a serious injury experts move in immediately to help the adjuster such as reconstruction experts, bio-mechanics, etc.
Note that the adjuster will want to find out such things as where you were coming from, this assist to know if you were working for your employer, where were you going, how long had you been up, do you wear glasses, had you been drinking, using drugs or medication, who was in your car, how fast were you going, when did you first see other car in feet or car lengths, what did you do when you saw the car, what was your speed at that moment, where was the impact, what happened after the impact, where did the cars end up, where were the impact points on the cars, lighting conditions, weather conditions, street conditions, obstructions to vision, how often do you travel the area, prior accidents, prior injury, etc.
8. Medical authorization/Wage Authorization, the common approach is to simply say we need to look at your medical and wage loss so we can pay you. Now this is often asked even when they are going to deny liability, but keep in mind you are under no obligation to provide one. Best approach just tell the adjuster, when I am done with treatment I will send you everything, or my attorney will.
9. You medical records: Tell your PIP carrier or Med Pay carrier and do it in writing that they are not to provide any information whatsoever to the carrier who caused the accident, that is the third party.
10. Communications: Each and every discussion with any adjuster is to be confirmed in writing as to the exact nature of the conversation and any and all agreements.
In summary keep in mind that the purpose of the investigation is to find facts, but under all of this it really is to find a way to:
(1) compromise any payment, (2) deny payment.
Investigations should not be delayed, be familiar with your states Unfair Claims Practices Act, in the act it is clear regarding time frames for completion of investigation and response to correspondence and demands for payment.
At the start of the investigation if you feel your claim is owed demand they comply with the act and make that demand in writing, hold them to the terms of the act.
The most important aspect of the investigation however is to establish a basis to pay the claim if they owe it.
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CHAPTER
4
Mike Cerf
Expert Witness Insurance Claims
Sherwood, Oregon
mcerf@teleport.com
Truth and Justice will prevail! Promote it for all you are worth, or your worth will be nothing!
PR CRAP!Please don't believe "You're in Good Hands", or that "A Good Neighbor" will deliver "A Piece Of The Rock", if you buy their Insurance!
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