Do Insurance Companies Investigate Injury Claims?

By August 28, 2023Personal Injury

Insurance companies investigate injury claims all the time. Why? Because they must confirm their obligation to pay a claim, and they have a strong, profit-driven incentive to find ways to minimize their financial obligations.

If an accident injured you, you should count on an insurance company investigating your claim. And to protect your rights to compensation for the harm you’ve suffered, contact an experienced personal injury lawyer who can handle your claim, negotiate with insurers on your behalf, and get you the most money possible.

The Role of Insurance Companies in Injury Claims

The purpose of insurance is to provide financial protection against unexpected losses or damages. In the case of an injury claim, an insurance company’s role is to reimburse the injured party for their losses, usually as defined by the policy terms.

Different types of insurance coverage can come into play when an injury occurs. The injured person may have their own health or auto insurance that covers some of the costs. The at-fault party, if there is one, may also carry liability insurance that covers damages they have caused to the injured person.

Insurance companies, therefore, can be legally responsible for compensating injured parties for a variety of costs, depending on the details of the policy and the circumstances of the accident. This compensation can cover direct medical expenses, loss of earnings if the person cannot work, and sometimes, non-financial damages such as pain and suffering or loss of enjoyment of life.

The amounts paid can vary greatly depending on the severity and effects of the injury, the evidence available to support a claim under an insurance policy, and the maximum amount (or limit) of coverage the policy provides.

Do Insurance Companies Investigate Injury Claims?

Why Insurance Companies Investigate Injury Claims

An insurance company collects premiums from a large pool of customers, then uses that money to cover the costs when a customer files a claim. This business model necessitates evaluation and investigation whenever a claim is made.

The investigation of an injury claim serves a few critical purposes. Firstly, it confirms the insurer’s contractual obligation to cover the claim, which could either be a first-party claim by the insured individual who is injured or a third-party claim by an injured party under the at-fault party’s liability insurance coverage. Obviously, the insurer wants to avoid paying a claim that isn’t covered according to the terms of the insurance contract (policy). Investigation serves to ensure the insurer only pays covered claims.

Secondly, the investigation aims to verify the nature and severity of the injury in question and determine the amount of compensation due to the injured party (claimant). The insurance company has a vested interest in paying what it contractually owes and not a penny more. By investigating, the insurer confirms that the claimant’s requested payment is accurate and supported by evidence.

Thirdly, insurance companies conduct investigations as a deterrent to and detection mechanism for fraudulent claims. Fraudulent claims could potentially drain the resources of an insurance company, leading to financial instability and higher premiums for all policyholders.

Finally, a sizable driving force behind an insurance company’s investigation of an injury claim is its desire to protect its bottom line. The company can maximize its profits by scrutinizing and minimizing the amount paid to the injured person. While this may seem unfair to the injured claimant, it is an unavoidable fact that most insurance companies are businesses committed to generating returns for their owners and shareholders.

How Insurance Companies Investigate Injury Claims

The person typically responsible for an injury claim investigation is known as an insurance adjuster. Adjusters work on behalf of the insurance company to assess the value of your claim and determine how much the insurance company should pay.

An injury investigation almost always involves reviewing accident reports and medical records. It can also encompass interviewing witnesses, law enforcement officers, and the parties involved in the accident.

Insurers scrutinize this information for details that may affect their contractual obligations, the amount they must pay, or their ability to undercut the value of a claim or reject it altogether.

Insurers may not disclose their mixed motives when investigating an injury claim. For example, an adjuster may attempt to contact the injured claimant directly soon after receiving notice of a claim or potential claim (that is, before a claim is even filed).

In reaching out, adjusters often act supportive or claim to be the claimant’s advocate. An adjuster protects the insurance company’s bottom line. If the claimant agrees to talk, the adjuster may record the conversation and ask loaded questions to gather statements that could undermine the injury claim.

Insurance companies may also employ surveillance to investigate the claimant’s level of injury and physical limitations. For example, an insurer may send an investigator to take a video of the claimant or review social media posts to check if the claimant is involved in activities inconsistent with the injuries claimed. This is why experienced personal injury lawyers advise their clients to be careful and consistent about what they post online when they have a pending injury claim. (See below)

The outcome of an insurance company’s investigation can influence the value and viability of an injured person’s claim for compensation. If the insurer determines that the claim is valid and the injury is as severe as stated, it may offer to pay the claim in full or nearly in full.

But if the adjuster identifies any evidence suggesting fraud, overstating of injuries or losses, or that the insurance policy doesn’t cover the claimant, the company may either deny the claim outright or offer a drastically reduced payment. In those cases, you may have to take legal action to secure the money you deserve for your injuries. 

Reasons to Hire a Lawyer Handle Your Injury Claim

When you’ve been injured, the last thing you want to deal with is complicated paperwork, conversations with adjusters, and the stress of ensuring you’re being treated fairly by the insurance industry. 

A personal injury is a vulnerable time in your life. It’s easy to make mistakes that can hurt your claim. You may unintentionally provide inaccurate information to an adjuster or fail to provide the necessary details to support your right to payment.

But there’s no need to carry that burden or run those risks. A personal injury lawyer can handle all interactions with any insurance company that might owe you money. The lawyer serves as your representative and is tasked with protecting your interests.

By hiring a lawyer to handle your injury claim, you can ensure you never receive another unwanted call from an insurance adjuster demanding to talk to you about your accident.

Lawyers are also well-versed in the language of insurance and the ins and outs of insurance law. They know how insurers operate, including the investigation strategies they deploy and how to shield you from them. For instance, hiring a personal injury lawyer ensures that you never get tricked into saying the wrong thing to an aggressive insurance adjuster or falling for demands to allow the insurer to review medical records they should never get to see.

Personal injury lawyers also know how to negotiate with insurers from a position of strength. Armed with a thorough understanding of your injury, the related costs, and the relevant law, they can force the insurance company to acknowledge liability and compensate your damages adequately. This often translates to a significantly larger settlement than the insurer might otherwise offer to pay.

Hiring a Lawyer for Your Injury Claim is Affordable

One common misconception is that hiring a lawyer to handle your injury claim will be expensive. In truth, you can afford to hire a lawyer no matter your financial circumstances.

To begin, most personal injury law firms offer free consultations for injury victims like you. In a meeting with a qualified legal professional, you get the opportunity to discuss your case, understand its potential value, and determine whether the law firm feels like a good fit. Free consultations ensure you can make an informed decision about your legal representation without taking any financial risk.

If you decide to move forward with legal representation, you’ll also find that most personal injury lawyers work on a contingent fee basis. That’s an arrangement where the lawyer does not charge you upfront or by the hour. Instead, the lawyer’s fee is a percentage of any money they recover for you, such as through a settlement or a court judgment. In other words, you pay nothing unless the lawyer wins for you.

Contingent fee arrangements make hiring a lawyer for your injury claim affordable, as the financial risk is placed on the law firm, not you. They also align your interests with your lawyer’s since the lawyer benefits by securing the most favorable recovery possible for you.

Tips for Avoiding the Pitfalls of Insurance Claim Investigations

Navigating the world of insurance after an accident can be confusing and stressful. The most reliable way to manage it is to hire a skilled attorney immediately to handle your injury claim. In the meantime, following these tips can also protect you from the insurance company’s investigation tactics.

Be Careful Talking with Your Own Insurance Company

If you carry insurance that covers your losses, you’ll likely have to notify your insurer of your potential claim. It’s important to keep these conversations straightforward. Stick to the facts and avoid getting drawn into discussions about fault. Remember that certain comments that might imply fault, such as “I should have seen the accident coming” or even an innocuous “I’m sorry.” Casual remarks can sometimes be misinterpreted and used against you.

Avoid talking to someone else’s insurance company

The at-fault party’s insurance company may contact you before you’ve even filed a claim, asking to talk about the accident and your injuries. In most cases, you’re under no obligation to agree. And even if you must speak with an at-fault party’s insurer, you can almost always wait until you’ve first consulted a personal injury lawyer. Never agree to a recorded conversation with an insurer without first seeking legal advice.

Beware of Direct Settlement Offers

Insurers sometimes make settlement offers directly to injured accident victims like you before a claim has been filed. Be careful if it happens to you. The amount offered almost always falls far short of what you deserve for your losses, and accepting it could mean you lose your right to full compensation. In virtually all cases, having a skilled lawyer to negotiate a settlement on your behalf is a far better bet.

Stay off or Limit Social Media

As mentioned, insurance companies have learned that social media can be a fruitful source of information about an injured claimant. Today, adjusters routinely scan social media for information about a claimant, hoping to find information contradicting a claimed injury or disability.

For that reason, personal injury lawyers encourage their clients to stay off social media entirely, if possible, while healing from an injury and, if they must post, to exercise extreme caution about what they say or show to the world. Even something as simple as a picture that shows you smiling could end up being twisted into evidence that your injury isn’t as bad as you claim.

Contact an Experienced Injury Claim Lawyer Today

Insurance companies routinely investigate injury claims. And in doing so, they employ strategies and tactics designed to minimize their liability and the amount they pay.

The most beneficial step to protect yourself in an injury investigation is to hire a knowledgeable personal injury lawyer to handle your claim. A skilled attorney can handle all interactions with an insurance company on your behalf, avoiding their tactics and negotiating for maximum compensation.

Don’t let the confusing and intimidating world of insurance claim investigations discourage you or hinder your pursuit of rightful compensation. Contact an experienced injury claim lawyer in your area today for your free consultation.