Insurance adjusters investigate claims on behalf of car insurance companies. They ultimately determine how much money the insurance company pays following an accident. In addition to vehicle damage inspection and injury evaluation, an insurance adjuster also reviews police reports, interviews witnesses, and may speak to you, the claimant.
Florida is one of 12 no-fault states in the country. Florida requires drivers to carry Personal Injury Protection (PIP) car insurance. PIP insurance offers certain benefits to drivers injured in accidents. For example, PIP insurance provides Florida drivers up to $10,000 in coverage. It covers 60 percent of lost wages and 80 percent of medical costs after deductibles.
So, if you were in a wreck, you might have to deal with a couple of adjusters: the PIP insurance adjuster from your insurance company and an adjuster from the at-fault driver’s insurance company who is handling your liability claim against the other driver.
How Does the Adjuster Determine Payments?
The insurance adjuster’s objective is gathering information and lowering costs for the insurance company. This applies to the PIP adjuster at your insurance company and the adjuster at the at-fault driver’s insurance company. So, as you field requests from the insurance adjuster to submit documents, we strongly recommend consulting a lawyer before you send any documents or okay the release of your records.
After you submit your claim to the insurance company, the adjuster reviews the written accident report and may call you directly for a firsthand account. However, adjusters may assume that not everything you say is factual, and thus investigate the accident, your injuries, and your damages.
You should prepare to produce the following:
- Police reports
- Medical records
- Lost income
But before you produce any documents, we recommend consulting a lawyer. Your lawyer will advise you regarding which requested documents you should send.
Florida state law requires filing accident reports following car accidents. And this may be the first thing an insurance adjuster retrieves when investigating your claim to confirm the accident and, in the case of the liability adjuster at the at-fault driver’s insurance company, to evaluate fault. The adjuster takes notes, measurements, and pictures and compares the findings to the accident report.
You may have to give the okay to send medical records to the adjuster. Pertinent documents include bills from ambulance service, hospital stay, and physical therapy. You may also provide documentation from your primary care physician as well. This demonstrates your level of health prior to the accident.
But again, please do not send any medical records to the insurance adjuster before you first consult a lawyer.
Florida’s PIP laws cover claimants for up to 60 percent of lost wages following an accident. And if you file a liability claim against the at-fault driver, you may qualify to recover all your lost wages. The adjuster may request pertinent information regarding employment and salary history as well.
If an accident leaves you unable to work, request a document detailing the following from your employer:
- Rate of pay
- Job title
- Hours worked per day or week
- Days of work missed
PIP covers your injury-related damages regardless of fault, so you won’t have to prove fault to your PIP adjuster. But the adjuster on the at-fault liability claim will require proof of fault.
While insurance adjusters often take their own photos, providing your own may be helpful. Photos increase your claim’s legitimacy beyond itemized lists of damages. Also, photos of your car prior to the car accident illustrate your vehicle’s damage. And if you suffered injuries, photos of your injuries may help too.
What Is the Difference Between a PIP and Liability Claims Adjuster?
The main difference between PIP and liability claims adjusters is that PIP adjusters do not have to investigate fault. PIP adjusters evaluate your claim to ensure it meets a few requirements such as:
- Did you get initial medical care within 14 days?
- Did you have an emergency medical condition? If not, you are limited to $2,500 in medical reimbursement.
- Are you claiming massage therapy and acupuncture? PIP does not cover these treatments.
The PIP adjuster is concerned about your damages alone, while a liability claims adjuster must evaluate your damages as well as fault for the accident. If the adjuster finds evidence you are to blame for the accident, it may jeopardize your liability claim.
Do I Need a Lawyer to Help Me Deal With an Insurance Claim?
There is no law requiring you to hire a lawyer. But we recommend it. We represent people hurt in car accidents caused by other parties, and we even help injured drivers with their PIP claims.
Insurance adjusters may attempt to contact claimants directly. The adjuster may try to extract damaging information from the claimant to hurt their case or reach a quick settlement. Adjusters often ask claimants to prematurely sign documents or make recorded statements.
Adjusters use recorded statements to suggest that a claimant’s story is contradictory their previous account. If filing a claim, decline to give a statement or provide documents and direct all correspondence to your lawyer or inform the adjuster that you must consult your lawyer before giving a statement or sending documents. Also, do not sign any documents without consulting your lawyer.
Are you dealing with insurers and adjusters seeking to pay you less than what you deserve? Contact the Law Office of Anidjar and Levine for experienced, reliable representation. Call 800-747-3733.