Dealing with insurance claims can quickly become frustrating if you feel misled or under-compensated. Most claims get resolved fairly, but some adjusters misrepresent policy details, allege questionable causes, or claim exaggeration to reduce your compensation. You may even start to question, “Do insurance companies lie about policy limits?”
When you get hurt, you just want the incident to end and move on. However, insurance claims can become a hassle as they start to say the claim is not within your limits or some other excuse. An Atlanta insurance claims lawyer can help you through the process.
What an Insurance Adjuster does
Insurance adjusters play a key role in assessing and resolving claims on behalf of insurance companies. An adjuster’s primary responsibility is to investigate claims, determine fault and liability, catalog damages, and negotiate a fair settlement of claims for their insurer. They serve as the main point of contact for claimants throughout the process.
For claims involving injuries or major damage, adjusters may also work with external experts to analyze reports, estimate repair costs, and determine long-term prognosis. They leverage this information when making settlement determinations and offers. Adjusters work to settle claims fairly and efficiently out of court. However, their ultimate loyalty lies with the insurer’s bottom line interest.
Having the insurance adjuster looking out for the insurance company more than you can lead to tense negotiations with claimants seeking maximum compensation. You will likely not get the settlement you want without skilled legal representation from a personal injury attorney.
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Why and How an Insurance Agent May Lie to You
Most insurance adjusters act ethically. However, incentives and pressure can motivate dishonesty in some cases. Understanding common falsehoods helps protect yourself when you are filing a claim.
Adjusters may misrepresent policy exclusions or provisions to avoid payments the insurer actually owes. They may fabricate alternate causes for damages besides the covered incident to deny claims. Some downplay the extent of your injuries or suggest pre-existing conditions so they can limit payouts.
Lies may also help adjusters negotiate lower settlements, such as understating repair estimates, exaggerating deductibles, or claiming inadequate proof of loss. They leverage inflated demand for documentation to ultimately delay and stonewall payment. Outright falsehoods violate codes of conduct, but more subtle deceit sometimes happens with adjusters.
Common Techniques an Insurance Adjuster May Use
While adjusters should handle claims fairly, some rely on falsehoods to limit payouts. Watch for common questionable claims. Some of the ones you should watch for are the following:
- Adjusters may state a policy exclusion applies when it does not or that damages arose before coverage started. They may falsely allege preexisting conditions unrelated to the incident cause current symptoms.
- To lowball claims, adjusters might lie about local repair costs being lower than reality or requirements for compensation proof. Predicting very short recovery periods for major injuries is another tactic.
- If an adjuster says your policy prohibits lawsuits or makes threats about claims denial, get advice, as these misleading statements often lack legal grounds when pressed.
You should always question claims and address them against facts. An attorney can help if you suspect exaggerations or lies to reduce your compensation. You can push back on questionable denials firmly while still remaining professional.
Types of Trouble the Insurance Adjuster Could Get into for Lying
While some dishonesty cannot be proven, insurance adjusters can face consequences if deceptive practices are uncovered. For example, intentionally providing false information to claimants violates industry codes of conduct and the insurer’s internal policies. If this is found, it typically warrants termination since trustworthiness is vital.
Unethical behavior like routine exaggerations or misrepresentations to reduce settlements risks significant fines and sanctions from state insurance oversight bodies. Fraudulent reports or falsified documentation could trigger criminal fraud charges with hefty penalties. However, criminal liability is less common.
Though not all lies lead to disciplinary outcomes, the potential is there. If you suspect intentionally misleading conduct, you should document interactions. You can also consider reporting suspicions to the Georgia Department of Insurance (DOI).
Documenting Interactions with Insurance Adjusters
Strong documentation protects you from potential dishonesty and establishes a record of events. Consistently document all communication. Here are some ways to document all interactions:
- Keep detailed notes of every conversation, including dates, names, statements made, and details discussed about the claim. Save all physical and email correspondence, too.
- For phone calls, request to audio record the conversation to prevent conflicts later. Some states require adjuster consent, while others permit secret recording.
- Request copies and keep thorough files of all reports, photos, estimates, bills, letters, and other materials sent between you, the adjuster, and the insurance provider.
Thorough documentation avoids relying solely on memories or hearsay. Detailed records also provide proof of any suspicious misrepresentations and critical timeline verification later on. This is one important fact your lawyer would need to help you.
Getting Legal Help When Dealing with Dishonest Adjusters
If exaggerations or misinformation from an adjuster raise red flags, working with an Atlanta insurance claims attorney lawyer can help. An attorney with insurance claim expertise can analyze policies, documentation, and correspondence to identify any factual misrepresentations by adjusters. They also negotiate forcefully for proper claim valuation and challenge unfounded denials.
A lawyer will compile strong evidence showing your losses and damages. They can file official complaints on your behalf if systematic bad faith seems evident. Having legal representation applies pressure to the insurance company.
Avoiding unnecessary litigation is ideal. However, a credible threat of a lawsuit backed by an assertive attorney often brings unfair adjusters to the table for fair negotiation. An experienced lawyer can help maximize your compensation.
Get the Compensation You Deserve with Legal Experts on Your Side
If you feel an insurance adjuster exaggerates or misrepresents facts to deny reasonable claim compensation, you do not have to go through it alone. At John Foy & Associates, our team of compassionate attorneys can provide the strong advocacy you need. We understand this complex process and how to respond strategically when adjuster claims seem questionable.
With diligent documentation review, assertive negotiation, and comprehensive claim valuation, our lawyers have a proven record of securing the compensation our clients deserve. We know that pushing back on denials professionally can resolve issues versus when legal escalation becomes necessary. Contact us today for a free consultation to discuss your situation and options.