http://www.seattlepi.com/local/122105_colossus15xx.html

The following article discusses a computer program called Colossus, which is a computer program that was designed to help adjusters evaluate injury claims. Views regarding the Colossus program varies. My view on programs like Colossus is that no matter what opinion an insurance adjuster has on the case it is always held in check by a qualified personal injury attorney on the otherside. If an adjuster is unreasonable than the attorney, and the injury claimant, has the right to request that a judge or jury to award a fair amount. As long as those “checks” are in place, I do not believe that injury claimants are in danger of being regularly short changed by insurance adjusters. The key here for the injury claimant is to make sure they are represented by an attorney who can properly evaluate there claim and make sure they are getting a fair result.

Although I do not necessarily believe in the contents of the following story it is an interesting viewpoint into the injury claim industry and the role of plaintiff’s attorneys, adjusters, and the injured claimants in the continual evolution of this area of law.

Here is the article taken in full from the above link:
Does insurance company ‘low-ball’ pain and suffering?
Industry’s use of Colossus, a service to judge the worth of claims, comes under fire
By CANDACE HECKMAN
SEATTLE POST-INTELLIGENCER REPORTER

Since her car was rear-ended by a speeding SUV four years ago, Barbara Martin’s life has dissolved into a drug-induced daze — prescribed to mute a crippling cycle of back and neck pain, blinding migraines and depression.

ALSO SEE:

Low-ball offers nothing new in insurance industry

Which auto insurers get the most complaints?

Earlier stories:

Insurer wants to silence 2 ex-staffers

Judge recuses himself in insurance whistle-blower case.

The accident changed the Redmond woman more than she could have imagined. A promising career in tourism marketing was ruined. She could barely function as a wife and mother.

Martin’s insurance company of 15 years never sent an adjuster to interview her. Farmers Insurance processed her claim through Colossus, an insurance industry computer program shrouded in secrecy.

The computer’s call: Don’t compensate Martin for “pain and suffering” — her lost career, inability to have another child, continuing emotional and physical pain.

“I didn’t understand why they wouldn’t offer me anything,” she said in a recent interview. “They didn’t even come out to see me. How could they know me or what happened to me?”

Yesterday, the family filed a lawsuit against Farmers Insurance Co. of Washington and its national corporation, Farmers Insurance Exchange. The Martins argue that they would have taken their business elsewhere if they had known the company would use a computer to judge how much their lives were worth.

Gilbert W. Arias / P-I

Barbara Martin and her 4-year-old daughter, Veronica, at their home in Redmond. Martin wasn’t compensated by Farmers Insurance for pain and suffering after a 1999 car accident.
The insurance company for the driver who hit Martin paid up quickly after the crash. But it took binding arbitration three months ago for Farmers to finally pay, and the family contends it wasn’t enough.

None of the insurance companies that use Colossus advertises that fact. They don’t say they adjust claims by computer, either. And many agents, either through naiveté or lying, have denied that a company uses such a process.

The Martins’ suit, filed in King County Superior Court, accuses Farmers of fraudulently using Colossus to rip off customers.

Insurance companies say the program is only used as a tool to guide adjusters’ decisions on settlements. Farmers has said that the use of computer programs help control claims costs, which then controls premium costs to benefit their own policyholders.

Colossus is reportedly being used by a dozen of the nation’s biggest auto insurance companies, and many more smaller ones, to evaluate injuries and place a value on a person’s quality of life.

But lawsuits and industry whistle-blowers have revealed that insurers have relied heavily on Colossus, using its conclusions as an excuse to offer low-ball settlements.

The Martins say they’ve suffered because Farmers refused to pay their bills — and millions of other Americans have been or could be in the same boat.

“Farmers’ actions were so outrageous in character and so extreme in degree as to go beyond all possible bounds of decency and to be regarded as atrocious, and utterly intolerable in a civilized community,” the lawsuit states.

Farmers officials this week declined to comment on the Martins’ claim, citing pending litigation. They also would not comment on their use of Colossus.

Computer Sciences Corp., the California-based company that licenses Colossus, says its program offers consistency in claims settlements and helps control costs.

But Colossus is not meant to replace the claims adjuster and is not supposed to be the ending authority in settlements, said Mike Dickerson, a CSC spokesman.

CSC has signed confidentiality agreements with insurance companies that have purchased the software and has declined to comment on how companies have modified the program to serve their own needs.

But whistle-blowers Robert Dietz and Christy Klein, former Farmers adjusters in Arlington, say the only consistency Colossus offers are settlements well below what adjusters believe is fair.

In summer 2000, after Farmers began using Colossus, Dietz and dozens of other senior adjusters were sent to California for a “tuning session” with CSC programmers. The adjusters were ordered to create a benchmark for Colossus to follow, based on hundreds of settled claims and representative settlements.

Before Dietz left, he said a company consultant told him that the averages would then be lowered 20 percent.

“So right out of the gate, I knew that Colossus values would be low,” Dietz said. “But I didn’t think much about it because I thought Colossus was going to be a guide, not the Gospel.”

Farmers has denied in previous lawsuits that they modified Colossus to generate lower settlement ranges.

However, in a presentation that Farmers’ parent company, Zurich Financial Services Group, gave to analysts and investors in 2001, the company revealed that in one year of operation, Colossus had reduced claims about 20 percent.

The Washington Insurance Commissioner’s Office says Farmers paid out $1.13 in personal injury protection claims for every dollar the company collected for personal auto insurance in 2000. That figure, called the “loss ratio,” dropped the following year to 87 cents per dollar.

“What we are saying essentially is that this is insurance fraud,” said Michael Nelson, the Seattle lawyer representing the Martins. The Martins’ arbitration in late February found that they were entitled to more than $300,000. Farmers promptly paid the rest of its policy limits — a little more than $100,000.

“It’s a principle thing now,” said Martin, 42, of the lawsuit, which seeks punitive damages. “I want people to know what they did to me.”

There have been several suits around the country accusing insurance companies of bad faith that have revealed the use of Colossus. A class-action lawsuit has recently been certified in New Mexico against Allstate over its use of the program. Both Farmers and Allstate have responded in litigation saying that the use of computer programs help control claims costs, which then controls premium costs to benefit their own policyholders.

But Dietz said insurance companies do not usually differentiate between first- and third-party claims. First-party relationships are between people and their insurer, like the Martins were with Farmers. Third-party relationships are between people and the insurance company for the people who are at fault in an injury.

The typical insurance adjustment works like this:

The adjuster receives his assignment, looks up the policy and investigates what type of coverage is available to the injured person. If it is a first-party claim, the injured person is the one paying the premium and coverage usually comes in the form of either Personal Injury Protection or Underinsured Motorist Protection.

In a third-party claim, he checks with the person insured by his company to find out what happened. If the insured person is at fault, the adjuster can begin to assess damages.

Special damages, better described as actual damages, are immediately measurable costs, such as for medical bills or loss of income. General damages are for intangible losses, called pain and suffering.

Colossus generates values for general damages, placing a monetary value on a person’s quality of life. But adjusters frustrated with the program contend it’s misused.

The quality of people’s lives hold inconsistent values that the program cannot compute by itself, the critics say. A star college baseball pitcher headed to the pros should receive a higher payment for a career-ending injury than a budding schoolteacher.

“There are issues with Colossus that are more than just being unfair to people,” said Karen Koehler, a Bellevue lawyer and expert on the insurance program. “People feel it’s creepy that a computer is telling them what their lives are worth. But Colossus is being tuned in a way that spits out low-ball offers that are even lower than the low-ball offers we usually expect.”

Within months of the tuning workshop, Dietz said adjusters at Farmers learned they no longer had the power to evaluate personal injuries themselves and offer settlements.

“We all discovered that Colossus became the authority,” he said. Adjusters had to settle claims with the much lower range set by the computer program.

A Farmers adjuster from this region, who asked not to be identified, recently confirmed that the policy is still in effect. An Allstate adjuster said his company has a similar policy.

Barbara Martin moved to Seattle 15 years ago to pursue a public relations job with Holland America, the cruise ship company. She eventually became marketing director for a subsidiary, Windstar Cruises.

“I had a really cool job,” she said. “I loved working with people; I loved going on photo shoots. I was on the fast track.”

The fast track ended April 14, 1999. That evening, Martin was eastbound on Interstate 90, approaching the Mercer Island tunnel.

The force of the blow from the Land Cruiser behind her crushed her BMW sedan. It cracked her car seat in half, rupturing three disks in her back and neck.

Trapped in the car, waiting for help, other drivers slowly passed around her. Some yelled obscenities and called her names for slowing rush-hour traffic.

That ugly scene keeps replaying in her mind, making her dread every moment behind the wheel.

“I was so afraid to drive, sometimes I had to just pull over on the side of the road and breathe.”

She stays home most of the time now.

She hasn’t enjoyed a good night’s sleep in four years. Doctors told the mother of two to abandon her hopes of having another baby.

“It bothers me to no end that there is software out there, whether it’s Colossus or something else, that says my life and my dreams are worth nothing.”

WHO USES COLOSSUS

Insurance companies that use Colossus do not advertise that fact. The Seattle Post-Intelligencer has independently confirmed, through archived investor releases, lawsuits and lawyers involved in the claims process, that these companies use the program:

· Allstate Insurance
· American Family Mutual Insurance
· California State Automobile Assn.
· CNA
· Farmers Insurance
· Grange Mutual Casualty
· The Hartford
· MetLife Home and Auto
· Travelers Property Casualty Insurance
· USAA
Read more about this issue on the P-I consumer weblog at seattlepi.com/consumer P-I reporter Candace Heckman can be reached at 206-448-8348 or consumeralert@seattlepi.com

Here are a couple tips for navigating through these questions:

1. Listen to your medical professionals and diligently seek a satisfactory diagnosis of your injuries.

You, your attorney, your partner, or the person you met in the grocery line are NOT medical professionals and they do not have the expertise to help you diagnose and treat the injuries you incurred as a result of an automobile accident. Also, your medical providers are NOT you and they do not have an equal amount of incentive as you to be properly diagnosed and treated for your injuries. Therefore, it is my opinion that when you are injured, you should ask and seek answers to all your questions regarding your injuries and treatment. You should seek these answers from medical providers. If you feel that you are receiving sub-standard care or that another diagnostic test is warranted, then seek another opinion from another qualified medical professional. I have multiple clients whose doctors initially thought that the injuries they sustained from an accident were much less severe than they actually were.

Another reason to be assertive is the availability of medical insurance. If you were injured in Oregon and you had auto insurance at the time of the accident, you were covered by Personal Injury Protection Insurance (PIP). PIP insurance covers 100% of your medical expenses (up until policy limits, which vary) and your lost wages, among other things. The catch is the coverage is generally limited to a year within the accident. Therefore, if you were recently injured in an accident and you are wondering what is wrong with you, NOW is the time to seek the answers to your questions. You pay the premium every month for your PIP coverage, do not let it go to waste.

The bottom line: do not let an auto accident become worse because of your lack of diligence in seeking medical answers.

Side Note: Even accidents that result in no symptoms are not necessarily “injury free”. For instance, there can be significant injuries to your spine that, upon injury, are initially pain free.

2. Generally do not settle with an insurance company until you believe you have a good handle on your future health.

Your personal injury claim following your accident is the ONLY time that you will be able to recover money damages for the injuries that you sustained. Upon settlement or judgment, there is generally NO other recourse for your injuries. Therefore, it is important you understand the significance of your injuries before settling with an insurance company. It is understandable that most people just want their claim resolved and want to get on with their life. However, that attitude can end up costing you and your family a significant difference in money received from an insurance company. The stress of an injury claim can be mitigated by the hiring of a qualified personal injury attorney. The bottom line: Do not settled merely out of an anxiousness to resolve the case. There is no sense in making a bad situation worse.

There are exceptions to this general rule. One being the statute of limitations. If your injuries do not resolve within the applicable statute of limitations (Generally two-years in Oregon for personal injury cases), then you are still required to bring a lawsuit, which could lead to resolution of the case before you are medically stationary. Another being that the insurance company is offering its policy limits. At that time, the right move might be to settle.

Side Note: It is important to remember that insurance adjusters are not motivated by the same issues that plague you after an accident. They are concerned with removing your file off their desk and making their supervisors happy. Keep this in mind and focus on getting healthy BEFORE settling with an insurance company. Often times, my clients will have resolved their treatment and we give it a couple months just to see if they are truly recovered from the accident. After all, you only get one chance to get what is fair.

NOTE: Non of the above is case specific nor is it intended to be legal advice. Isaac Jackson is NOT your attorney unless you have entered into a contingency fee agreement or other fee agreement. The content on this website is for general information purposes only. If you have a legal issue contact an attorney for advice. REMEMBER – most claims are subject to a statute of limitations which act as a bar to your claim if not filed within the time limits. Therefore, do not delay in seeking advice for your claim from an attorney. If you live in Oregon or your accident occurred in Oregon, please feel free to contact me directly for a no-cost consultation. Jackson Law Office is located in Eugene, Oregon. My direct phone number is (541) 556-9797.

Talk to you soon,

Isaac Jackson, esq.
Jackson Law Office, LLC.

* God and the devil were having a business discussion. The Lord said, “I’m thinking of having some repair work done on the pearly gates, and I think you should pay half.” “And just how do you figure that?” Satan asked. “Well, I do keep population pressure off your place,” God said, “and of course there’s a certain amount of wear and tear from the clawing and scratching of your people.” “That’s outrageous,” the devil objected. “I won’t pay a cent.” “Then I’ll sue you,” God threatened. “Really?” The devil smiled. “Where will you find a lawyer?” (From the book, Skid Marks)

* A physician, an engineer and a lawyer were discussing which of the three professions represented was the oldest. The physician said, “Remember, on the sixth day God took a rib from Adam and fashioned Eve, making him the first surgeon. Therefore, medicine is the oldest profession.” The engineer replied, “But, before that, God created the heavens and the earth from chaos and confusion, and thus he was the first engineer. Therefore, engineering is an older profession than medicine.” Then, the lawyer spoke up, “Yes,” he said, “but who do you think created all of the chaos and confusion?”

* A lawyer is standing at the gates of Heaven and St. Peter is listing his sins:
1. Defending a large corporation in a pollution suit when he knew the company was guilty.

2. Defending an obviously guilty murderer because the fee was high.

3. Overcharging clients.

4. Prosecuting an innocent woman because a scapegoat was needed in a controversial case.

The list goes on for quite a while. The lawyer objects and begins to argue his case. He admits all these things, but argues, “Wait, I’ve done some charity in my life also.” St. Peter looks in his book and says, “Yes, I see. Once you gave a dime to a panhandler and once you gave an extra nickel to the shoeshine boy, correct?” The lawyer gets a smug look on his face and replies, “Yes!” St. Peter turns to the angel next to him and whispers, “Give this guy 15 cents and tell him to go to Hell.”

* A prominent young lawyer was on his way to court to begin arguments on a complex lawsuit when he suddenly found himself at the gate of Heaven. St. Peter started to escort him inside. The lawyer began to protest that his untimely death had to be some sort of mistake. “I’m much to young to die!” I’m only 35!” St. Peter agreed that 35 did seem to be a bit young to be entering the pearly gates, and agreed to check on his case. When St. Peter returned, he told the lawyer, “I’m afraid that the mistake must be yours, my son. We verified your age on the basis of the number of hours you’ve billed your clients, and you’re at least 108.”

* A truck driver used to amuse himself by running over lawyers he would see walking down the side of the road. Every time he would see a lawyer walking along the road he would swerve to hit him, and there would be a loud “thump” and then he would swerve back on to the road. One day, as the truck driver was driving along he saw a priest hitch-hiking. He thought he would do a good turn and pulled the truck over. He asked the priest. “Where are you going, Father?” “I’m going to the church five miles down the road!” replied the priest. “No problem, Father! I’ll give you a lift. Climb in the truck.” The happy priest climbed into the passenger seat and the truck driver continued down the road.
Suddenly the truck driver saw a lawyer walking down the road and instinctively he swerved to hit him. But then he remembered there was a priest in the truck with him, so at the last moment he swerved back on the road, narrowly missing the lawyer. However, even though he was certain he missed the lawyer, he still heard a loud “thud.” Not understanding where the noise came from he glanced in his mirrors and when he didn’t see anything, he turned to the priest and said, “I’m sorry, Father. I almost hit that lawyer. “That’s OK,” replied the priest. “I got him with the door!”

* A lawyer was asked if he would like to become a Jehovah’s Witness. He declined, as he hadn’t seen the accident, but said he would still be interested in taking the case.

* What’s the difference between God and a lawyer? God doesn’t think he’s a lawyer.

* What’s the difference between a lawyer and a leech? A leech quits sucking your blood after you die.

* What’s the difference between a lawyer and a vulture? A vulture doesn’t get Frequent Flyer points.

* What do you call 20 lawyers skydiving? Skeet.

* Why are lawyers never attacked by sharks? Professional courtesy.

* What is a criminal lawyer? Redundant.

* Why does the bar prohibit lawyers from having sex with their clients? To prevent clients from being billed twice for the same service.

* How many lawyers jokes are there? Just two, all the rest are true.

* What do you get when you cross a bad politician with a crooked lawyer? Chelsea.

* What do a lawyer and sperm have in common? They both have a one-in-a-billion chance of being human.

* It was so cold last winter . . . . (How cold was it?) It was so cold last winter that I saw a lawyer with his hands in his own pockets.

* A man walked into a lawyer’s office and inquired about the lawyer’s rates. “Fifty dollars for three questions,” replied the lawyer. “Isn’t that kinda steep?” asked the man while doling out the money. “Yes,” answered the lawyer. “Now what’s your third question?”

* A doctor and a lawyer were attending a cocktail party when the doctor was approached by a man who asked advice on how to handle his ulcer. The doctor mumbled some medical advice, then turned to the lawyer and remarked, “I never know how to handle the situation when I’m asked for medical advice during a social function. Is it acceptable to send a bill for such advice?” The lawyer replied that it was certainly acceptable to do so. The next day, the doctor sent the ulcer-stricken man a bill. And he received a bill from the lawyer.

* How many corporate lawyers does it take to change a light bulb? Who knows? You need 250 just to lobby for the research grant.

* How many personal-injury lawyers does it take to change a light bulb? Three. One to turn the bulb, one to shake him off the ladder and the third to sue the ladder company.

* How many lawyers does it take to change a light bulb? Six. One to change the bulb and five to write the environmental impact statement.

* How many contract lawyers does it take to change a light bulb? WHEREAS, the party of the first part, also known as “Lawyer” and the party of the second part, also known as “Light Bulb,” do hereby and forthwith agree to a transaction wherein the party of the second part (Light Bulb) shall be removed from the current position as a result of failure to perform previously agreed upon duties, i.e., the lighting, elucidation, and otherwise illumination of the area ranging from the front (North) door, through the entryway, terminating at an area just inside the primary living area, demarcated by the beginning of the carpet, any spillover illumination being at the option of the party of the second part (Light Bulb) and not required by the aforementioned agreement between the parties. The aforementioned removal transaction shall include; but not limited to, the following steps:
Section 1. The party of the first part (Lawyer) shall, with or without elevation, at his option, by means of a chair, step stool, ladder or any other means of elevation, grasp the party of the second part (Light Bulb) and rotate the party of the second part (Light Bulb) in a counter clockwise direction, this point being non-negotiable.
Section 2. Upon reaching a point where the party of the second part (Light Bulb) becomes separated from the party of the third part (“Receptacle”), the party of the first part (Lawyer) shall have the option of disposing of the party of the second part (Light Bulb) in a manner consistent with all applicable federal, state and local statutes.
Section 3. Once separation and disposal have been achieved, the party of the first part (Lawyer) shall have the option of beginning installation of the party of the fourth part (“New Light Bulb”). This installation shall occur in a manner consistent with the reverse of the procedures described in Section 1 of this self-same document, being careful to note that the rotation should occur in a clock-wise direction, this point also being non-negotiable.
Note: The above described steps may be performed, at the option of the party of the first part (Lawyer), by any or all persons authorized by him, the objective being to produce the most possible revenue for the party of the fifth part, also known as the “Partnership”.

* A couple attended a funeral and after the graveside ceremony were leaving the cemetery. They came upon a tombstone which read, “Here lies Henry Doyle, a lawyer and an honest man.” The wife said to her husband: “Look dear, they’ve buried two men in the same grave!” Her husband responded: “At least they could have named the honest man.

Auto Accidents and Pain & Suffering
Provided By: CarInsurance.com
Last Updated: Tuesday, December 09, 2008
On your normal daily drive to work, the unexpected happens. Joe Q. Public runs a signal light and plows into your car. If you have read the CarInsurance.com article Auto Accidents and Lost Wages, you already know there is more than car damage reimbursement that you need to be go after. If you are injured in an auto accident, you will want to be compensated for pain and suffering as well.

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Auto Accidents: What To Do When Its Not Your Fault

This accident was not a minor collision; it hurt not only your car but you as well. You already have to settle with Joe Public’s insurance company’s adjuster for the car repairs, or possibly the car if it was totaled. You also have to discuss with them how they need to pay you for your lost wages. So do not forget to get pain and suffering compensation.

Depending on the accident that occurred, you might be more damaged than your vehicle. For your injuries, there will be medical bills and make sure the adjuster is aware of this fact. If you were pretty banged up in the collision, make sure the insurance adjuster knows this and do not let him or her forget.

To negotiate on your pain and suffering the first step is to gather together all of your medical bills. These will be your weapon against the adjuster. The best way to build up your “war chest” is to get all of your medical evidence of your injuries. Ask your doctor to keep detailed notes of your aches and pains so that they are officially documented.

If you need to visit a chiropractor for neck or back problems, make sure you get a doctor’s recommendation when you go so that there is a direct line drawn between your automobile injuries and the visits to the chiropractor or any other type of specialists. Along with this, keep a list of any medications prescribed to you by any doctor that treated you for your injuries. The medications you had to use for pain relieve or inflammation should help convince the adjuster that there is compensation due for pain and suffering.

Pain and suffering is felt and not usually seen by the naked eye. What you can do to document your medical issues is to take pictures of any of the bodily injuries that are visible. Take pictures of cuts, bruises, or marks on you. If your also have swelling of your arm, leg or elsewhere photograph that as well. Take the photos up close and from a few feet away and close up so that the area of harm can be easily seen.

Now that you have your documentation and “war chest” assembled, you can now take on Joe Q. Public’s insurance adjuster. After you have settled with the adjuster for the amount due you for car damages and the actual medical bills is when it gets hard. You now have to prove what lost wages and pain and suffering you should be due. If you do not feel comfortable doing the negotiating to get what you have coming to you it is time you should get a lawyer that is well versed in dealing with insurance adjusters.

If you decide to deal with the adjuster yourself, be ready to push for what you deserve. Talk to him or her about what injuries you had. The pain you went through, the continued pain you have and that might last for many years. The longer the length of your recovery the greater your pain and suffering settlement amount should be. You want to be compensated for future doctor visits and prescriptions. You did not cause the injuries so you do not want to be the one that has to pay for the continual medical car.

Bring out your medical records, your prescriptions, and your pictures. You want to show the adjuster you are well prepared and serious. The rule of thumb for pain and suffering is three times your medical bills. For this reason alone, all of your medical bills are invaluable. That is why you should continue to see the doctor for as long as you need after the accident. Do not stop going to the doctor if you are not back at 100%. These medical bills are calculated into what the total should be for your pain and suffering.

Pain and suffering due to accident injuries is not pleasant and you should be compensated by the at fault person’s insurance. Gather your pertinent documentation and stand up for yourself. Use your “war chest” and show the insurance adjuster what your injuries are really worth.

When you’ve been injured, you’ll usually be looking to the other person’s insurance to collect damages for your injury. If the other person doesn’t have insurance or doesn’t have enough insurance, you may be relying on your own insurance company to pay your damages. Either way, dealing with an insurance adjuster can be frustrating and downright scary. That’s why it’s a good idea to hire a lawyer to help you communicate effectively with the insurance company.

Negotiation

You can expect your lawyer to kick off the negotiation process by notifying the people responsible that you’re hurt and will be filing a claim for your damages.

Your lawyer will then thoroughly investigate the circumstances of your injury. You can help your lawyer by providing copies of the:

Police report
Traffic tickets given to the other person
Photos of the scene of the accident
Names, addresses and phone numbers of any witnesses and what they saw
Medical records and bills
Photos of your injuries
Wage stubs proving how much you made at the time of the accident and how much work time you missed due to your injury
You’ll also want to provide your lawyer with any other documentation you may have showing how your injury has negatively impacted your life.

Your lawyer will not want to begin serious negotiation with the insurance company until your injuries have stabilized enough to know what the permanent effects will be. This can sometimes take months or even years. Don’t pressure your lawyer into negotiating prematurely with the insurance company, as you are the one who will be hurt if your claim is settled before you know the full extent of your injuries.

After collecting all the information regarding your injury, your lawyer will write what’s called a “demand letter” to the insurance company. This letter will explain:

Why the other person is responsible for your injuries
The extent of your injuries and how you’re likely to be affected by them in the future
What type of medical treatment you’ve had and will need to have in the future and how much it will cost
How much income you’ve already lost and will lose in the future
Any other damages you’ve suffered as a result of the accident.
The settlement package sent to the adjuster will include all the documentation you’ve given your lawyer to support your claim.

Your lawyer will likely end the demand letter with a demand for a specific sum of money to settle your claim. You and your lawyer will already have an idea of how much you think your claim is reasonably worth, but chances are that your lawyer will ask for as much as twice that amount from the insurance company, in order to allow for some room to negotiate downward as talks with the insurance company continue.

It may take a month or two for the insurance company to respond to your lawyer’s initial demand letter. It’s important to realize that insurance companies are big bureaucracies and profit-making centers. There are many layers of management within an insurance company and the adjuster who handles your claim will have to wade through many channels to get authority to make you an offer or up an offer after an initial offer has been made. Negotiations will likely move very slowly, as your lawyer and the adjuster talk back and forth.

The adjuster will probably make an offer to settle your claim for far less than the amount you requested in your demand letter. Your lawyer will then suggest an amount lower than your original demand but higher than what the adjuster has offered. This process will continue until your lawyer and the adjuster hit on a settlement amount that everyone can live with.

Settlement

When your lawyer and the insurance adjuster have come to an agreement on how much you’ll be paid, your lawyer will write a confirming letter to the adjuster, which will include a specific date by which you expect to receive payment from the insurance company.

When you receive the settlement check, you’ll have to sign a written document that releases the insurance company from any further liability for the accident. Your lawyer will help you read through this release and answer any questions you may have about what the release covers.

Your lawyer will likely take his or her attorney’s fees out of the settlement check before you receive what’s due to you. You should expect your lawyer to give you a detailed accounting of any costs deducted from your payment, and answer any questions you may have about how he or she calculated their fee.

The big majority of insurance claims are settled at the adjuster level. If your lawyer and the insurance adjuster are unable to settle your case, however, it will be necessary to take it to trial.

By Dan Baldyga
Here comes the insurance adjuster. Is he overly friendly? If so, watch out! It’s OK to be hospitable. Be good-tempered and cordial – - but beware! Never forget he’s paid to save his company as much money as he can. That’s the name of his game.

DON’T SIGN ANYTHING: Don’t overestimate the good will of the adjuster. They’re trained to investigate accident cases in such a way, if at all possible, to make their insured look good. Many unsuspecting individuals fall prey to the adjuster who seeks to protect his company’s pocketbook at the expense of a legitimate claimant.

If a company calls you and suggests they take your statement over the telephone, tell them you would prefer to meet with an adjuster. Don’t agree to dictate a verbal statement into a tape recorder over the phone, and certainly not when you’re in the presence of an adjuster. Don’t sign a statement when you meet with him. Whatever the circumstance may be, advise whomever you’re dealing with that you’ll be more than willing to provide a signed statement, after your claim has been settled.

HOW TO PROCEED WITH THE ADJUSTER: Be pleasant, but firm. No matter how much in the wrong the person is that hit you, no matter how they acted at the scene of the accident, and no matter what they may have verbalized to or at you, don’t take it out on the adjuster. It’s not the adjuster’s fault if his insured is an idiot.

You must never underestimate the importance of the adjuster’s impressions and conclusions, all of which go into your file. What he feels and reports about you have a great influence on the final disposition of your claim. If he likes you that’s money in the bank. On the other hand, if he gets upset with you he has the ability to twist the facts to make you look bad. Once that’s been done, it will be set in cement, go into your file and, without you’re ever being aware of it, haunt you to the last dollar of your settlement.

THE ADJUSTERS CLAIM LOAD: The job performance of insurance adjusters is judged not only on how little of the company’s money they spend in settlements, but also on how quickly they settle the claims assigned to them. They’re constantly under pressure to settle your claim; to get rid of it and move on. The adjuster will never tell you, but the weight of their caseload comes down on your side of the scale. It’s an advantage people are never aware of.

THE ADJUSTERS SETTLEMENT AUTHORITY: The Adjuster’s authority to settle a claim on their own is restricted on how much experience they have. For a less experienced adjuster, perhaps $5,000 to $10,000, but for a more experienced adjuster, their settlement authority may go as high as $20,000. When bigger bucks are involved they usually have to be given permission to settle the case from their immediate supervisor.

THE BOTTOM LINE: Don’t let a sweet talking insurance adjuster manipulate you into feeling good about your relationship with him and the eventual outcome of your claim. In the vast majority of instances that’s not the way you should play the game because if provided with the opportunity, they’ll almost always take advantage of you. That’s a fact of life. Know and understand that they’re only doing their job. Their assignment is to save money for the company who signs their paychecks – - no matter what it takes.

If you have a legitimate claim stay cool and understand what you’re up against. Don’t be impossible to deal with, but remain steady. Remember that the adjuster wants to look good to his company. He doesn’t want your claim to end up in court, plus he wants to reduce his caseload. Be patient. At the end of the day, after the dust has settled, he’ll be forced to treat your loss fairly.

~~~~~

Dan Baldyga’s fourth and latest book Auto Accident Personal Injury Insurance Claim: (How To Evaluate And Settle Your Loss) can be found on the Internet at http://www.autoaccidentclaims or http://www.caraccidentclaims.com. This book reveals “How To” successfully handle your motor vehicle accident claim, so you won’t be taken advantage of. It also goes into detail regarding the revolutionary BASE (The Baldyga Auto Accident Settlement Evaluation Formula). BASE explains how to determine the value of the “Pain and Suffering” you endured – - because of your personal injury.

Copyright (c) 2003 by Daniel G. Baldyga All Rights Reserved

DISCLAIMER: The only purpose of this claim tip is to help people understand the motor vehicle accident claim process. Neither Dan Baldyga, Vince Ciulla nor About.com make any guarantee of any kind whatsoever; NOR do they purport to engage in rendering any professional or legal service; NOR to substitute for a lawyer, an insurance adjuster, or claims consultant, or the like. Where such professional help is desired it is the INDIVIDUAL’S RESPONSIBILITY to obtain said services

Below are contact links to insurance provider auto insurance claims pages. Some of these insurance providers provide online and 24 hour toll free support for reporting your auto acciddent and initiating your insurance claim.

•Allstate Insurance

•Amica Insurance

•American Family Insurance

•Farmers Insurance

•GEICO

•Hartford Insurance

•Nationwide Insurance

•Progressive Insurance

•State Farm Insurance

•USAA Insurance

•Oregon Insurance Commission Complaints Report
Consumers can review the guide or file a complaint against an agent or company on the Insurance Division’s Web site at www.cbs.state.or.us/ins or www.oregoninsurance.org.

Free printed copies of the Oregon Insurance complaint guide are also available
by calling
(503) 947-7984 or 1-888-877-4894

or by writing to:
Publications, Oregon Insurance Division
350 Winter St. NE, Room 440
Salem, OR 97301-3883.

For certain personal injury claims — such as those for severe injuries, malpractice, or toxic exposure — you’ll want to consult a lawyer.

Sometimes, the skills of an experienced personal injury lawyer — or at least the threat to an insurance company that such a lawyer may present — are worth the money you must pay that lawyer to represent you. You may need a lawyer because of complex legal rules involved in your particular claim, or because the severity of your injuries might cause your compensation to vary greatly from the norm — or simply because an insurance company refuses to settle a matter in good faith. The following types of injuries and accidents almost certainly require a lawyer’s help.

Long-Term or Permanently Disabling Injuries

Some accidents result in injuries that significantly affect your physical capabilities or appearance for a long time — over a year — or even permanently. Figuring out how much such a serious injury is worth can be a difficult business. You’ll probably require some assistance from an experienced lawyer to get the most out of your claim.

Severe Injuries

The amount of your accident compensation is mostly determined by how severe your injuries were. And the severity of your injuries is measured by the amount of your medical bills, the type of injuries you have, and the length of time it takes for you to recover. As the amount of your potential compensation increases, the range within which that compensation may fall becomes wider. In such cases, it may be worth the expense to have a lawyer handle your claim and make sure you receive compensation at the highest end of the range.

Medical Malpractice

If you have suffered an injury or illness due to careless, unprofessional, or incompetent treatment at the hands of a doctor, nurse, hospital, clinic, laboratory, or other medical provider, both the medical questions and the legal rules involved are complex. They almost certainly require that you hire a lawyer experienced in medical malpractice cases.

Toxic Exposure

In the increasingly chemical world, we sometimes become ill because of exposure to contaminants in the air, soil, or water, in products, or in food. Claims based on such exposure are difficult to prove, however, and often require complex scientific data. And because the chemical and other industries have erected a huge wall to protect themselves from legal exposure while they continue to expose us to potentially harmful chemicals, the required evidence is very hard to come by. Get expert help.

When an Insurance Company Refuses to Pay

In some instances, regardless of the nature of your injury or the amount of your medical bills and lost income, you will want to hire a lawyer because an insurance company or government agency simply refuses to make any fair settlement offer at all. In these cases, something — what the lawyer can get minus the fee charged to get it — is better than nothing.

Finding a Good Personal Injury Lawyer

One good way to find a lawyer is to ask friends, acquaintances, or other lawyers for referrals — and then interview the candidates. In addition, Nolo provides a personalized lawyer directory with information about each lawyer’s experience, education, and fees, and perhaps most importantly, the lawyer’s general philosophy of practicing law. By using Nolo’s directory you can narrow down candidates before calling them for a phone or face-to-face interview.

1. If I have been injured, who will pay for my medical treatment?

The person who caused the collision, or his or her insurance company, is legally responsible for paying for your medical treatment. In Oregon your insurance company, through your Personal Injury Protection (PIP) insurance will initially pay your medical bills, but will ultimately expect to be reimbursed by the negligent person’s insurance company.

2. What if I am unsure of the extent of my injuries?

Many injuries resulting from a traffic accident are not immediately apparent. You should seek a preliminary medical examination soon after the collision to determine the nature and extent of any possible injuries sustained. You should understand that once you settle with the responsible insurance company that you will be unable to collect more money from that insurance company (or the other driver/party) even if you suffer additional injuries.

3. Can the insurance company select the doctor I have to see?

No. The insurance company cannot tell you what doctor you have to see nor limit the medical care you receive. To recover for medical bills, you must show that the medical treatment was necessary to treat injuries associated with the traffic accident.

4. If I lost time from my job after the collision, can I be reimbursed?

Yes. Even if you used sick leave or vacation, you are entitled to be reimbursed for this time off work.

5. The careless driver who injured me had no insurance, am I out of luck?

No. You most likely have uninsured motorist coverage (UIM). Although a UIM claim is made against your own insurance company, your company will not pay for your injuries without you first showing the value of your claim. Therefore, obtaining legal counsel in a UIM claim is equally as important as any other injury claim.

6. If the insurance company pays for the repair of my automobile fairly and in full, can I expect the insurance company also to pay my personal injury claim fairly and in full?

No. The insurance company is aware that you understand the approximate amount you are entitled to receive on your property loss claim. However, the insurance company is also aware that you have minimal knowledge of the amount to which you are entitled on your personal injury claim. Injury claims typically pose a greater threat to the insurance company since they are of a higher dollar value than property claims. The insurance company’s ultimate directive to its adjusters is to limit the amount of money that they pay you on personal injury claims.

7. Is the job of the insurance adjuster to determine the amount to which I am entitled?

No. An insurance adjuster, aka “claims representative”, is paid by the insurance company to represent the insurance company’s interests and limit the amount you recover. The opposing parties insurance adjuster owes you no special duties of honesty or candor in the evaluation of your claim. Just like many attorney, many adjusters are nice people. However, their job description is directly adverse to your interests.

8. Do I need help from an attorney?

Yes.. Without the help of an attorney, you will have to face the insurance company claims adjusters alone. These adjusters know the business well, and they get paid, praised, and promoted for limiting the amount they pay you. Exception: There are some instances when you would not need an attorney. However, to know when those instances are you need to talk to an attorney. The first question that this office will answer is whether you need an attorney in your case. There are

9. Won’t hiring an attorney mean I actually receive less money than I am entitled to because I will have to pay a legal fee?

Not at this office. If I believe that you could recover more without an attorney I would tell you not to use an attorney. I only charge a percentage of the monies collected and receive nothing if we are unsuccessful. As an attorney with experience on both sides I will make sure you are compensated for all the damages you received in the collision, something you are unlikely to be able to do on your own and I will make sure that other issues surrounding your case (medical liens and insurance liens) are resolved to the best benefit to your pocket book as possible.

10. A few other questions you may have.

1. What should I do following a traffic accident?
Always call law enforcement immediately.
Obtain information on all vehicles, drivers, passengers, and witnesses.
Do not guess severity of injuries. Immediately seek medical treatment.
Photograph scene, vehicle damage, and injuries.
Do not assume insurance companies have your best interests in mind.
Notify your insurance company.
Do not provide statements to their insurance company.
Obtain your own vehicle estimates.
Pursue injury claims separately from vehicle damage claims.
Have an experienced attorney review any documents before signing away your rights.

2. If I am involved in an automobile collision, should I contact the other parties’ insurance agent?
No. The insurance agent’s job is to sell policies of insurance. The insurance companies employ special individuals whose job is to “adjust” claims, or, in the language of the insurance industry, “limit the loss.” However, you should contact your insurance agent promptly, and the other driver should contact his or her insurance carrier.

3. What can be done about the damages to my vehicle?
You are immediately entitled to enough money to pay for the repair of your vehicle so it is in the same condition it was before the accident. If the cost of repairing your vehicle is greater than its value, the negligent person’s insurance company may decide to pay you the value of the vehicle. In addition, most insurance companies will reimburse you to lease or rent another vehicle until you repair yours or have received money to replace it.

Contact Isaac Jackson for a free, confidential, no obligation, consultation regarding your injury claim. Isaac Jackson is an attorney located in Eugene, Lane County, Oregon licensed to practice law in all 36 counties in the state of Oregon in both State and Federal Court.

This page is for information purposes only and shall not be interpreted as attempt to create an attorney client relationship between you and Isaac Jackson.