Your Vancouver personal injury lawyer can help you understand what possible red flags could lead a claims adjuster to examine your case more closely.
Why a Claims Adjuster Might Question the Validity of a Case
When an insurance claims adjuster looks at a case, it must first be considered whether the policy is applicable. If it is, the extent of the coverage must be examined. Once that is completed, the adjuster will conduct an inquiry into the important facts to resolve the matter financially. In general, the adjuster will scrutinize any issue that does not seem to fit with the circumstances of the case as they are presented. Much will depend on the adjuster’s experience and judgment. Even if the adjuster has little more than a “feeling” about the claim or the claimant, it could spark a deeper look at the case. In the event that this happens, the Vancouver personal injury lawyer will have a more difficult time to resolve the case in an acceptable manner.
Red Flags in the Medical Treatment a Claimant Has Received
Your Vancouver personal injury lawyer will tell you that as the adjuster assesses the case, there must be verification and a full method of calculation of loss or damage. The following might be red flags:
- When the adjuster receives the list of medical expenses, consideration will be given to whether or not the treatment was necessary based on the medical reports.
- The doctors the claimant uses are also important. If, for example, the treatment was provided by a chiropractor when there were neurological and orthopedic issues, this will be studied. This does not mean that a chiropractor’s treatment is not legitimate, but in comparison to treatment from an orthopedist or neurologist, it can be questionable.
- The amount of treatment and how often the treatment was given can be key. If treatments are continuous and there is no discernible improvement, this could be suspicious.
- If a claimant is suffering from soft-tissue injuries and nothing else, but claims to be disabled and in pain without an objective medical diagnosis, it could be seen as a padded claim.
- If the medical bills do not match with the injury, it can lead to the adjuster wondering why. Hefty costs for physical therapy, pre-existing problems that might have been there before, and medical treatment to the same area of the body are causes for concern.
- There are certain kinds of treatment that do not equate with specific injuries. Receiving treatment for psychological trauma after a minor accident with bruises is an example. If the treatment is not applicable, it will be questioned.
- Certain attorneys and doctors frequently work together. This could crop up repeatedly. The adjuster might remember a link between them making a case they are involved in appear to be a planned attempt to file a claim and receive a settlement.
Contact an Experienced Vancouver Personal Injury Lawyer
If you have concerns about red flags, call (360) 693-2919 to speak to a Vancouver personal injury lawyer at the Etengoff Pak Law Group.