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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.

What to do if an Insurer Denies Your Personal Injury Claim

Insurance companies are in the risk management business. They help their clients manage risk by taking responsibility for keeping costs under control in the event that a claim is made against a policy. In turn, an insurer’s claims adjusters work hard to make sure that claims are valid and not, in the opinion of the adjuster, overbroad or outside the scope of the policy. In some cases, an insurance company takes an aggressive approach, denying claims in hopes that the injured person doesn’t appeal the decision or sue. Fortunately, there are options for people who find themselves in this circumstance.

Insurance companies have a legal obligation to be honest

When someone makes a claim against an insurance policy, the insurer has a legal obligation to conduct an honest assessment of the claim and pay for damages that are covered under the policy. The assessment process needs to be concluded and payments made within a reasonable time. At the same time, insurers also have an obligation to protect their clients, the policyholders, against claims that are invalid, unsupported by the facts, or fraudulent. An insurer that acts in bad faith can be sued. An insurer acts in bad faith if it tries underhanded methods of delaying or avoiding its obligations under a policy. Imposing huge volumes of paperwork, making a lowball offer, or misleading people about a policy question are all examples of potential bad faith. A claim of bad faith may be brought by the policyholder, such as an at-fault driver in an auto accident who is not getting the coverage that a policy promises, or by a beneficiary of the policy, such as someone who has made a claim against the at-fault driver’s policy. Between honest dealing and unambiguous bad faith is a large grey zone where a lot of confusion and conflict can arise. An insurer may in good faith believe that the facts of an injury place it outside the scope of a policy. An adjuster may in good faith review the costs associated with an injury and conclude that they are significantly lower than what the injured person has claimed. A lack of bad faith doesn’t mean that the insurance company escapes responsibility, but it does mean that the injured person may need to take more aggressive steps to protect his or her interests.

Contesting denied claims

When a claim is denied or only partly honored, the beneficiary should consult with an attorney to determine next steps. An insurance company is unlikely to put aside a claims denial without a rigorous consideration of the issues underlying the claim. Those issues may be purely legal, such as a conflict over interpretation of policy language. They may be purely factual, such as questions about how an accident occurred or the extent to which the policyholder is at fault. Or they may involve a mixture of legal and factual issues. The appropriate solution for the problem of a denied claim will depend on the particular policies of the insurer and the nature of the dispute. Some insurers may offer an in-house appeals process to help reduce the risk of litigation. But many insurers will need to be sued to bring them to the negotiating table. Once there, an insurer will have an adversarial position and will need to be countered with strong legal arguments.

GGRM can help you resolve your insurance disputes

For more than 45 years the law firm of Greenman Goldberg Raby Martinez has served clients in the Las Vegas area in personal injury cases. If you are struggling to recover what you are owed in a personal injury claims dispute, contact us today for a free attorney consultation. We may be able to help you reach a better settlement. Call 702-388-4476 or contact us through our website.

How an Attorney Can Help Your Workers’ Comp Case

People often make workers’ compensation claims without talking to an attorney about their rights. This can be the right approach for relatively minor injuries that can be resolved with one or two visits to a doctor and don’t raise disability or other long-term issues. But in many cases proceeding without an attorney’s help can be a serious mistake. An attorney can help a workers’ compensation claim in a number of important ways:
  • Gathering all the facts. Someone who doesn’t handle workers’ compensation claims all the time may not know what information can be important over the lifetime of a claim. An attorney works with the client to gather all the important facts of the injury or disease, with special focus on documenting information in such a way that it can be used in any future appeals process. Evidence is always important but can be especially critical if there are potential grounds for denying the claim, such as questions about whether or not the injury was truly work related.
  • Managing the insurer relationship. Workers’ compensation insurers would much rather deny every claim if they could. Their adjusters are hired to find every excuse to discourage, discredit, or deny claims. Having an attorney on the case does more than just help keep an eye on the insurer. It also can discourage the insurer from using wrongful methods that an attorney will catch. For example, insurers sometimes don’t provide clear notice of deadlines or required next steps. An attorney can ensure that such errors don’t leave the client without options or give the insurer an inappropriate opportunity to make the claims process more difficult.
  • Keeping an eye on the medical examination process. Someone who has been seriously injured at work will need to submit to one or more medical evaluations by a physician selected by the insurer. The doctors who make these evaluations often have conflicting interests: to win repeat business from the insurer, an evaluator may have an incentive to scale back an initial diagnosis to something that will cost the insurer less. Patients can request that their attorney be present for most types of evaluation exams. The attorney’s job in these cases is to verify that the doctor is following prescribed procedures, and to ensure that the client can protect his or her interests during the exam.
These are just a few of the reasons for working with an experienced workers’ compensation attorney to resolve your claim. For over 45 years the law firm of Greenman Goldberg Raby Martinez has helped clients get the most from their workers’ compensation claims. If you would like to speak to an attorney about your case, please call us today for a free, confidential consultation at 702-388-4476 or ask us to reach out to you through our contact page.

How Greater Transparency Can Improve the Workers’ Comp Claim Process

People who are injured at work can sometimes be frustrated by the complexity of the workers’ compensation claims process. Elaborate rules and tight deadlines add stress to an already difficult situation. And in many cases it can feel like powerful forces are working against the employee, as insurers and employers take steps to protect their own interests. Greater transparency at each stage can improve the claims process.
People who are injured at work can sometimes be frustrated by the complexity of the workers’ compensation claims process. Elaborate rules and tight deadlines add stress to an already difficult situation. And in many cases it can feel like powerful forces are working against the employee, as insurers and employers take steps to protect their own interests. Greater transparency at each stage can improve the claims process. The object of workers’ compensation systems is to ensure that people injured on the job get the care they need without being driven into financial hardship. Ideally, injured employees receive personalized care that gets them back to work as soon as possible. Employers, who are required to carry workers’ compensation insurance, benefit from liability protection and, in many cases, from having workers restored to productivity. The workers’ compensation claims process is full of technical pitfalls for injured workers. Some are to preserve fairness for employers and insurers, who need to account for their risks. But others can feel arbitrary and unfair. In a transparent system the employee knows about the pitfalls before they arise, so they can be avoided or overcome. Here are some examples showing why transparency matters:
  • Missed deadlines can invalidate claims, leaving employees stranded. Perhaps the simplest and most frustrating problem an injured worker can face is a missed deadline. Deadlines are present in every step of the claims process. Initial claims for compensation must be made within 90 days of the employee becoming aware of an injury or illness. Workers also have 90 days from their claim to exercise their right to choose a different doctor from the one selected by the insurer. Although employers and healthcare providers are required to provide notice of these deadlines to employees, many either fail to give notice or bury them within paperwork in hopes that the employee will unwittingly give up rights through inattention.
  • Conflicts of interest create moral hazards for employers and insurers. Although the workers’ compensation system is designed to protect employees, its mechanisms are weighted heavily in favor of employers and insurers. An employee with a clear understanding of the competing interests involved at each stage of the process can better protect his or her own rights. This is especially true for decisions about health, from diagnosis to choice of treatments, but can also feed into the kinds of financial benefits an employee receives.
  • Workers need to understand their options if injury prevents them from resuming their old job. In serious cases where an injury leaves an employee temporarily or permanently disabled, insurers and employers will sometimes try to avoid their legal responsibilities by not offering required accommodations, mischaracterizing the employee’s disability, or other tactics. In a more transparent system, not only does the employee better understand the options available, but employers also avoid potentially costly litigation and regulatory action.
Because the claims process is often not as transparent as it ought to be, an injured worker can benefit from working with an experienced workers’ compensation attorney who has only the employee’s interests in mind. For over 45 years the attorneys at Greenman Goldberg Raby Martinez have helped injured workers in the Las Vegas area protect their rights to workers’ compensation benefits. If you have been injured at work, call us today for a free attorney consultation at 702-388-4476, or request a call through our website.

Legal Options When Injured Helping Friends or Family

Legal Options When Injured Helping Friends or Family
Personal injury lawsuits shouldn’t be on our minds when we’re lending a hand to a friend or family member. But some kinds of help involve real risk of injury. Whether an accident happens while cutting down a tree, repairing a roof, or clearing brush, it can result in massive medical bills and substantial lost earnings. When helping out leads to a serious injury, sometimes a lawsuit is necessary to recover benefits under an insurance policy. In these situations, understanding how the law treats injuries suffered while doing voluntary work.

Negligence and the homeowner’s duty of care

Whether a guest is a friend or family member, a homeowner or renter has a general duty to take reasonable care that his or her property is safe. Although a homeowner is not expected to actively watch out for new hazards that might develop on a property, there is an obligation to warn guests about known dangers. For example, not warning a guest about an ankle-breaking gopher hole wouldn’t necessarily breach this duty, but leaving a deep ditch unmarked probably would. Personal injury lawsuits usually focus on two questions: whether the defendant was negligent, and whether the defendant’s negligence caused the plaintiff’s injury. To make a successful negligence claim, the plaintiff must establish that the defendant owed a duty of care, such as the one owed by homeowners to guests, the homeowner breached the duty, and the breach caused the plaintiff’s injury. In the case of injuries like the ones we’re discussing, chances are that the injured person will feel reluctant to sue a family member or close friend for negligence. But these cases often involve an insurer that is on the hook for injuries to a homeowner’s or renter’s guests. Even when a case involves other issues, like breach of (insurance) contract, the merits of the negligence question will probably play an important part in determining who is financially responsible for the plaintiff’s injuries.

Negligence cases focus on facts

The merits of each case come down to the specific facts surrounding the plaintiff’s injury. Whether the homeowner acted with reasonable care and whether the lack of care caused the injury are tricky, legally technical questions. A host of factors may be involved. For example:
  • Were tools involved? A badly maintained chainsaw or mower can be significantly hazardous.
  • Was anyone involved a professional in the activity, or was everyone an amateur?
  • What did the defendant know about the hazard, and what steps were taken to make it safe?
  • Did contributing factors, like alcohol use or inclement weather, influence the events leading up to the injury?
  • Could other parties be responsible? For example, if a tool caused the injury, perhaps the tool manufacturer is at least partly responsible under a products liability theory.

Don’t hesitate to talk to a lawyer

Even if you think that suing your friend or family member may be more trouble than it’s worth, exploring your legal options is always a good idea after an accident. After a serious injury costs may continue to accumulate for months or even years. For over 45 years the attorneys at the law firm of Greenman Goldberg Raby Martinez have helped clients in the Las Vegas area work through difficult legal challenges. For a free attorney consultation, call us at 702-388-4476 or send us a request through our site.