Monthly Archives: October 2019

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Pushing Back Against Aggressive Insurance Claims Adjusters

Insurance companies are in the business of risk management, which means they go to great lengths to avoid paying more than they have to on a given claim. Claims adjusters are the foot soldiers of this process. They investigate the merits of claims and determine the amount that an insurer will pay. To improve their own performance ratings, some adjusters will use aggressive or even underhanded tactics to reduce their employers’ exposure. People who are faced with disputes with insurers may need to pursue litigation to overcome an adjuster’s strategies.

What does an insurance adjuster do?

A claims adjuster can be thought of as an investigator. They tend to have specific skills that qualify them to review evidence and determine the value that should be paid under the applicable insurance policy. Adjusters do a number of things on behalf of the insurer, including protecting it against fraudulent claims and acting as the insurer’s “eyes and ears” to evaluate the specific facts of the claim. An adjuster will often examine the physical evidence related to a claim, such as damage to an automobile or an individual’s physical injury. They may also conduct interviews with the parties and witnesses. Adjusters may also be directly involved in negotiating settlements with covered individuals, and will also be involved in any litigation that may ensue if the injured person disputes the insurer’s findings. Among other things, an adjuster may be the individual who pressures an injured person to accept a “quick cash” settlement after an accident.

Contesting an adjuster’s conclusions

Ultimately, an insurer has a legal obligation to treat each claim in good faith. Few adjusters will make it easy for an injured person to build a case of bad faith. When an adjuster’s conclusions don’t fit with the facts, the injured person needn’t accept inadequate coverage. Disputing a denied or under-compensated claim doesn’t necessarily require jumping straight to a lawsuit. The first step is often simply to reach out to the adjuster to discuss the rationale for the adjuster’s decision. In some cases, the adjuster may not have a complete set of information, or may have missed an important fact that could change how the insurer handles the case. In any dispute with an insurer, an injured individual who goes without legal assistance will be at a significant disadvantage. An adjuster’s job is to be an insurance expert. The role requires developing a sound basis for the insurer’s decisions. An individual who lacks the adjuster’s sophistication may do more harm than good while making arguments in favor of coverage. An attorney can help the claimant ask the right questions and present evidence in a manner that will give the claim a better chance of being approved. For over 40 years the law firm of Greenman Goldberg Raby Martinez has helped clients in the Las Vegas area recover compensation in personal injury, auto accident, and workers’ compensation cases. If you have been injured please don’t hesitate to reach out to discuss your case with an attorney. Our initial consultations are free. Call us today at 702-388-4476 or contact us through our website.

How Social Media Use Can Endanger a Workers’ Comp Claim

A workers’ compensation claim can begin a complex and lengthy process. Especially when the injury is severe and involves high costs, an insurer’s claims adjusters will constantly search for ways to reduce their employers’ liability. Injured employees’ social media accounts are one way an insurer can investigate the merits of an employee’s claim. It’s important for the injured employee to keep their pending workers’ compensation claim in mind when they post to social media.

Insurers examine the merits of every claim

Bear in mind that an insurance adjuster’s job is to ensure that the insurer only pays for expenses that are rightfully covered under a policy. Adjusters are insurance experts. They know the cracks in a policy that might allow a claim to be partly or entirely denied. Adjusters therefore examine every claim to ensure that they tell an accurate story of the injury, its diagnosis, and how it is likely to be treated. Every insurer is vigilant against potential fraud. An employee who files a fraudulent claim will have the claim denied and may face other significant consequences, like a lost job and even criminal prosecution. Criminal fraud involves an intent to deceive the insurer, which may not be the case in many circumstances where an employee has made honest mistakes. But even an accusation of fraud can leave an injured employee without coverage.

Social media posts are a form of evidence

People who routinely use social media platforms like Facebook, Instagram, or Twitter can easily forget that their posts can reach a wide audience. Even if a user studiously controls their privacy choices, for example by not allowing “public” access, social media posts can become the focus of legal disputes, including administrative conflicts over denied workers’ compensation claims. What once was “private” may lose its privacy protection as a consequence of obligations in discovery or a subpoena. Social media posts can also reach coworkers and managers. Do not discount the possibility that a manager could alert an HR department about a social media post that they believe raises concerns. Cases of true fraud—where an employee is caught posting pictures of herself running a marathon two days after claiming to have a broken leg—are more common than one might expect. But social media can create hazards for injured employees in more subtle ways. Anything that contradicts the facts included in claim documents could create doubts in the mind of an insurance adjuster. In the social media world, which places a certain premium on keeping up appearances, a photograph or casual comment could cast doubt on the severity of an employee’s injury.

Call the GGRM Law Firm for help with your workers' comp claim

For over 45 years the law firm of Greenman Goldberg Raby Martinez has helped clients in the Las Vegas area pursue workers’ compensation claims. We offer free attorney consultations to new clients. To schedule an appointment call us today at 702-388-4476 or send us a request through our site.

Nighttime Risks to Las Vegas Pedestrians

Las Vegas is a famously bright city at night. Yet being a pedestrian at night is considerably more dangerous than during the day. According to statistics compiled by the National Highway Traffic Safety Administration, 74% of nation-wide pedestrian fatalities in 2015 took place at night. The same report found that 76% of pedestrian deaths occurred in urban areas, and 72% happened to pedestrians who were not in an intersection. Nevada had 2.28 pedestrian deaths per 100,000 residents, placing it on the high end of that dubious statistic when compared to other states. There are several reasons why the night is especially dangerous for urban pedestrians:
  • Drunk drivers are more common at night than during the day. In the NHTSA’s analysis, about 60% of pedestrian fatalities were associated with alcohol. Pedestrians themselves may also be under the influence of alcohol, which can impair judgment and reduce reaction times.
  • Bright lights from buildings and other cars can, ironically, make less well-lit features of the roadway, including pedestrians, harder to see.
  • Night worsens the effects of environmental factors, like rain and roadway debris, that can affect a driver’s control of a vehicle, visibility, and other factors that can contribute to accidents.
  • Many drivers experience reduced acuity of vision at night. Compromised depth perception, blurry vision, and trouble with differentiating light and dark, can all reduce a driver’s ability to quickly respond to changing conditions.
When accidents happen at night, the at-fault driver may not have a clear idea of what happened. Even a driver who wasn’t under the influence of drugs or alcohol can have failed to see a pedestrian in the roadway. This can lead the two sides in the accident to have different accounts of what happened. As the driver’s insurance carrier examines the case, it may adopt the at-fault driver’s story of events as its starting point, forcing the injured person to prove the case in other ways. Today’s auto accidents tend to have a wide range of potential evidence that the plaintiff can rely upon in a legal case. Modern cars have memory. Cameras are ubiquitous, both on the car itself and around many urban spaces for security purposes. And of course, in a busy city like Las Vegas there are often other people who may be able to serve as witnesses. The attorneys at Greenman Goldberg Raby Martinez have represented clients in the Las Vegas area in personal injury and auto accident cases for over four decades. If you have been injured in an accident in Las Vegas, we can help you examine your legal options for recovering compensation. For a free attorney consultation about your case call us today at 702-388-4476 or send us a request on our contact page.