The Process of Insurance Claims for Slip & Fall Injuries

The Best Premises Liability Injury Law Firm

Learn the strategies insurers use when handling slip and fall accident claims. Gain the knowledge you need to boost your injury compensation.

More than a million people go to the hospital yearly because of slip and fall injuries, costing the healthcare system a hefty sum.

If you were hurt in a slip-and-fall accident that was someone else’s fault, they should cover your medical bills and other costs. In most cases, you will have to deal with the insurance company for the property owner.

It’s not uncommon for people to hurt themselves by slipping and falling, and the resulting medical bills can add up quickly. Insurance companies deal with slip and fall claims daily, and they will do anything they can to minimize the victim’s payout or deny the claim altogether.

Slip and fall victims, do yourself a favor, and get checked out. Consider a slip-and-fall injury claim from the point of view of an insurance adjuster. What you discover about insurance firms can increase payouts for you and your loved ones.

The Financial Impact on the Insurance Firm

Insurers prioritize three main factors when it comes to claims for injuries sustained from slips and falls.

In order of importance, their goals are:

1. Save Money– Adjusters won’t pay you any more money than they have to. Lower payouts mean greater profits for the insurance company and bigger bonuses for the adjuster.
2. Save Reputation– Insurance companies are obligated to protect their insured. If you fell at a restaurant or retail store, they have to protect the business’s reputation.
3. Save Time– Time is money, and adjusters can have hundreds of claim files to handle. They don’t want time-consuming claims that take away from their other responsibilities.

The adjuster has three objectives, and while all are important, they are frequently prepared to waste time to safeguard their financial and professional standing. In a pinch, the adjuster will jeopardize the insured’s reputation to safeguard the insurance company’s bottom line.

To comprehend the adjuster’s perspective, you need to know the insurance company’s priorities.

Now that you know this information, you can begin negotiations with the insurance company.

Careful preparation and review of fundamental settlement negotiation skills could help you persuade the adjuster that a reasonable settlement offer would result in:

• Reduce negative publicity for the responsible insurer
• You may spare the adjuster a lot of trouble and effort by

The claims adjuster will immediately see that you have a solid case and are a legitimate victim of an accident. Instead of taking the chance that you’ll win a bigger award in court, the adjuster will offer you a reasonable settlement.

REDUCE YOUR INSURANCE PREMIUMS WITH THESE STRATEGIES FROM AN ADJUSTER

A dedicated adjuster will handle your injury claim once you’ve notified the insurance company of your plan to file a claim. The adjuster will settle your claim as soon as feasible and for as little as possible.

As with any other profession, claims adjusters might earn bonuses for going above and beyond the call of duty. There is a chance that the adjuster’s career advancement and end-of-year bonus hinge settling your claim for less than it’s worth.

Adjusters at various insurance companies each have their approach to managing slip-and-fall claims and employ a wide range of tactics.

PLAN NO. 1: PUT ON A FRIENDLY FRONT.

There is no friendship between you and the adjuster. Since the insurance company employs them, adjusters must defend the at-fault party.

Be wary of the claims adjuster who seems too nice to be true and assures you they’ll “take care of everything.” They will look you in the eye and insist you do not need legal representation.

A small injury claim can be settled without involving an attorney if you’re well-prepared. Personal injury attorneys are your best bet when filing a claim for a serious injury or one that involves a lot of legal wrangling.

Adjusters will often try to “buddy up” to get a recorded statement from you. If you give in without thinking, you may say something that can be used against you later.

The adjuster can twist an independently recorded statement; hence lawyers advise against it.

PLAN NO. 2: TACTIC IS TO JUST REFUTE YOUR CLAIM.

Refusing a claim outright, regardless of its validity, is a strong tactic for discouraging future claims. The insurance adjuster is counting on you to give up and withdraw your claim.

Your slip-and-fall claim could be rejected by the insurer because:

• You are to blame for your wounds.
• No injuries have been reported.
• You already have those injuries.
• You didn’t immediately notify anyone of the fall.
• A legal violation did not occur on the part of the property owner.

Please don’t give up hope. While the insurance company can make up any reason it wants to to avoid paying out on your claim, that doesn’t mean you should give up on getting paid.

PLAN NO. 3: MAKE LOWBALL OFFERS.

A lowball settlement offer substantially below the value of your claim is expected if your claim is not outright refused.

The insurance adjuster may say:

• For your specific type of claim, it’s the best they can do.
• It’s not a bad exchange.
• This deal is a win-win for all parties involved.
• To do otherwise would be beyond their remit.

Insurance companies are interested in making low offers, just as they deny claims outright. They want you to give up or accept their cheap offer so they may move on to easier prey.

The adjuster will have the upper hand if you show signs of anger, anguish, or sound desperate for additional compensation.

Please don’t take the lowball offer personally. Maintain composure, decline the low offer, and proceed with the dialogue.

PLAN NO. 4: DELAY

Unless it helps their financial line to stretch out, insurance firms prefer to have claims resolved as quickly as possible.

To delay, you could use techniques like:

• Not returning your calls
• Ignoring your counteroffers and continuing to negotiate at a lower price
• To not respond to your inquiries.

There is a risk that if you delay, you will lose faith in your claim. If the adjuster knows you have expenses to pay or a costly event, this could make you more receptive to a lowball offer.

It’s also possible that you were assigned an adjuster who is either too busy to help you out or too lazy to care unless an attorney calls.

If you want to negotiate successfully, you must be patient and persistent. Be patient with the insurance company if you file a claim for injuries sustained in a fall; the process might be lengthy.

PLAN NO. 5: MAKE A DANGEROUS STATEMENT

Even though they initially act like your “friend,” not all adjusters will remain that way. Overly aggressive adjusters may try to intimidate you into accepting their “last offer.”

Adjusters who are overly eager to settle may make it seem like a favor. They might warn you that they’ll deny your claim if you don’t respond quickly.

The time restriction for settling an injury claim or filing a lawsuit varies by state, but they won’t tell you that. When a deadline for filing a lawsuit passes, a person’s ability to seek monetary damages is barred.

Adjusters sometimes use strong-arm tactics, such as threatening to arrange an independent medical examination (or “IME” for short) if a claimant does not cooperate with their investigation. Talking to an attorney now is a good idea if you handle your claim.

Insurers often employ medical professionals known as IMEs to treat their patients. Independent medical examiners (IMEs) are paid to cast doubt on the seriousness of your injuries and the value of your treatments, even though they are required to maintain objectivity.

The adjuster can threaten to take you to court if you reject their offer, so be prepared to meet them there. When someone is hurt, the last thing they want to do is go to court and deal with the costs, delays, and unknown outcomes that come with it.

But once they learn you intend to sue their client, adjusters’ attitudes frequently shift. When you hire your lawyer, they immediately increase their settlement offer.

HOW TO DEAL WITH ACCIDENTAL INJURY CLAIMS

After getting over any minor injuries sustained in a slip and fall, you may want to deal with the insurance company’s adjuster on your own.

The insurance company’s response to your claim filing will be either a denial or a settlement offer.

If you get a lowball offer, you probably shouldn’t take it. Instead, you should plan how to negotiate with the insurance company’s adjuster and arrive at a settlement that satisfies both parties.

The following are some guidelines for developing a winning negotiating stance:

Don’t skimp: It’s important to be prepared before negotiations. The evidence, including your notes, should be reviewed and organized.

Everything you have helps, including:

• Medical bills
• Witness statements
• Wage statements
• Photographs and video

Try to estimate how much money you will need to settle your slip and fall claim before you call the insurance company. The following are examples of acceptable compensation requests:

• Insurance Costs
• Expenses that patients must pay themselves for treatment, such as prescription drugs
• Loss of Income
• Expenses associated with getting to and from medical visits
• Negative feelings and discomfort

Hard expenditures, such as medical bills and lost income, can be more easily defended because you will have documentation in the form of invoices and pay stubs to back them up.

Emotional suffering is not quantifiable in the same way physical injuries are. An adjuster’s resistance is expected, but there are strategies for negotiating compensation for injuries sustained in a fall.

Avoid the common pitfall of grossly exaggerating the amount of anguish you endured. You lose bargaining power if you make a claim that is too high.

Just wait for things to develop, and don’t intervene too soon. For instance, you shouldn’t start bargaining until you’ve calculated all the expenses related to your claim, such as medical charges. Waiting until you’ve fully healed to consider settlement is recommended.

Being patient as you get ready will give you time to gather evidence, educate yourself on the subject of negotiations for slip and fall cases, and possibly even consult an attorney.

Talks between parties usually take some time. Take your time before accepting the adjuster’s initial offer. To get what you deserve, you need to be ready to stand firm.

Know the most compelling aspects of your case and argue for them with all your might. Just because an adjuster dismisses your arguments does not mean they are not valid.

You may want to instruct the adjuster to “pound sand” at some point during the negotiations. Don’t give in to the urge.

Keep your cool and focus on the evidence’s strongest points. Polite and well-mannered claimants are more likely to receive a “bargain” from their adjuster.

Keep a level head; every argument has its proponents and detractors. You should be unwavering in supporting the strongest parts of your argument while being flexible about the weaker parts.

If you want to strengthen your argument, you need to first identify its flaws. These skills will be less useful than you think if you can’t confidently answer inquiries about them. For talks to succeed, both parties need to be willing to compromise.

If negotiations break down, you must know what other options you have. However, there are other avenues you can explore besides filing a lawsuit.

If you can convince the insurance company to participate, alternative dispute resolution (ADR) methods like mediation or arbitration could be useful.

• Mediation is similar to negotiating, except that instead of you and the insurance company directly communicating, a “neutral” third party (the mediator) acts as a go-between.
• Arbitration neutral party is required in arbitration as well. Arbitration is like mediation, except the neutral third party, termed a judge, makes the final decision.

You and the insurance adjuster may find ADR preferable to going to court due to the high-risk level, high cost, and long duration of a court action.

PAYOUTS FOR SLIP AND FALL ACCIDENTS MIGHT BE INCREASED WITH THE HELP OF AN ATTORNEY.

In a case of a slip and fall, the insurance company has various advantages over the injured party. Insurance companies employ expert negotiators known as “adjusters.” They have access to evidence that would be difficult for you to find on your own, and they have many more tools at their disposal. Moreover, they have lawyers on staff who constantly research changes to personal injury laws in each state.

Consultation with an accomplished personal injury lawyer is the best approach to safeguard your legal rights and obtain maximum compensation after suffering serious injuries in a slip and fall accident.

A lawyer should be consulted for even the most minor harm claims when:

• The claims adjuster is placing the blame for your injuries on you.
• Your insurance provider treats you unfairly, you say.
• The adjuster or the party at blame destroys the evidence.
• An unreachable adjuster who ignores phone calls and emails
• You feel the adjuster is dishonest or unfair in handling their claim.

Your lawyer will speak with the insurer on your behalf and try to settle before your injury claim goes to court.

If a lawyer gets involved, most adjusters will increase their settlement offer. The insurance company’s worst nightmare is having one of its insureds identified as a defendant in a lawsuit.

Most personal injury attorneys will offer free initial consultations to people injured in slip and fall accidents. It won’t cost you anything and won’t commit you to anything to find out what a good lawyer can do for you.