Confessions of a Highly Trained Claims Adjuster: Protecting Employers

Wooden toolbox containing a hammer, wrench, headset, magnifying glass & screwdriver.

This blog is part of a multi-part series resulting from an interview with a former insurance adjuster. While we cannot reveal that person’s identity, we can share his perspective. Information that might compromise his identity has been redacted. None of the cases discussed below were handled by our firm. We expected some of what we heard. We were surprised by the rest.

Q: What makes some insurance claims adjusters more effective (for the insurance company) than others when interacting with claimants? 

A: “Most of the time, I felt like I was at an advantage because I had more information, training, and experience than the claimant – I had all the tools I needed.

Tool #1: Active Listening Skills

Angry and frustrated man yelling on the phone and gesturing.At █████, I was trained to listen for what the claimant was – and was not – telling me. Answers that were very broad and definitive were red flags that prompted me to probe further. Part of our training included listening to recorded statements by other adjusters. My boss would also sometimes tap into my phone and listen to me on live calls, and he would instant message me with critiques or questions to ask.

Active listening became especially important when I was asking for facts about how accidents occurred.

For example, if I asked the driver who was making a claim against my client’s policy if he or she consumed any alcohol, and they responded with an immediate and definitive “I don’t drink” response, this could make me suspicious. It might prompt me to try to elicit an actual, specific response on whether they were impaired by alcohol at the time of the accident. Active listening frequently led to additional digging, and additional digging could lead to a better result for the insurance company.

Here’s another example of how my active listening skills helped me benefit the insurance company. I had a claim where our insured rear-ended a car that was occupied by a man, his girlfriend, and his girlfriend’s mother. When the claim came to me, the girlfriend’s mother’s claim was the only one that had been settled. The man was calling me to check on the status of the other claims, and since it was one of my first times talking to him, I asked some basic questions about his claimed injuries, treatment, and missed work, even though he had completed treatment.

As I’m asking these questions, I’m also reviewing things in our file, such as the police report and photos of the vehicles involved. I noticed that the caller seemed to have a significant amount of time out of work and complaints that were much more serious than his reported injury.

So, I asked him about how his injury impacted him, and he mentioned that he wasn’t able to work-out during his recovery. That prompted me to search for his social media, and sure enough, he was a bit of an “influencer” with a pretty large following and frequent social media posts. Within a few days of the accident, he had posted a video of himself doing a large number of pushups where he’s kissing his daughter on the forehead every time he goes down and he’s counting out loud to a high number…

We preserved all of this and tried to settle his claim for a small amount, which he didn’t like. Eventually, due to some of his responses not being truthful, along with a couple of other factors, he took a voluntary dismissal of his claim – getting nothing from us.

Tool #2: Relentless Negotiation Techniques

An insurance adjuster trying to negotiate.In general, most claims that adjusters pay involve negotiation – if they don’t, the claimants probably settled their claims for less than they were worth. And due to the large number of claims they handle on a day-to-day basis, claims adjusters negotiate significantly more than the average person.

When I worked at █████, we were trained, just like salespeople, to know what pain points existed, what words and phrases to avoid, and what terms and conditions are agreeable to most people. We were taught that every point of the claim could be a negotiation even though many claimants never seemed to realize it.

For example, something as simple as what size rental car you are put in may be limited based on your agreement to use a smaller or lower end car than you were really owed. We used hard-nosed negotiation strategies at every aspect of the claim where there was an anticipated payment.

Tool #3: High-Tech Investigation Skills

Two people looking through paperwork and pointing to documents.The insurance companies I worked for relied on very powerful research tools that could give them more information about claimants than the info claimants themselves had about the claim and those involved in it.

When I worked at █████, I was trained to investigate every detail and look for reasons to deny or limit the payout. In preparation for a call with a claimant, I would review as much of the following information as possible for any advantage:

  • the first notice of loss report – which included who initially reported the claim, what they told us about how the incident occurred, and who was involved
  • an ISO (Insurance Services Office) report – which detailed the claimant’s claim history including when he or she made prior claims and a rough report of what they were for
  • pictures of the vehicles involved, if anyone took them or if we had already inspected it
  • aerial/scene photos from Google to get a better idea of how the incident occurred and to know what sort of probing questions to ask
  • info on the claimant’s residence to try to get an idea of where he or she lived in relation to where the incident occurred (if directions of travel are disputed or if there was a dispute about who was in what lane, this info sometimes was helpful)
  • the claimant’s criminal history if available

While this intel could often help me devalue a claim, there were also a number of times I had information that made a claim more valuable. But sharing this info could harm my employer’s financial interests. Instead, I could often assume that I was the only one that had this info, and make a lower offer. If the claimant figured it out, I could then increase the value once he or she presented that “new” info to me.

Tool #4: Weaponized Friendliness

In general, people want to cooperate and carry on conversations with people they like, and this tendency can result in the disclosure of information. Some highly-trained adjusters may capitalize on this inclination by being extra friendly when interacting with claimants. Sometimes, it was just a matter of getting them to feel more at ease when talking. The information disclosed could usually be found in their medical records, but this could allow us to find out about it sooner, rather than later.

At █████, each conversation I had with a claimant was viewed as an opportunity to collect info that could devalue the claim or be used against the claimant during negotiations to pay out as little as possible.

The insurance companies I worked at encouraged me to hone these four skill sets. But when I came across a claimant who had consulted with an experienced car accident attorney, my skills could definitely be put to a test. Often, I would then be forced to negotiate with the lawyer instead of the claimant, and that could mean an uphill battle ahead of me.”

Learn More: Tricks and Traps of the Insurance Adjuster

The James Scott Farrin Takeaway

We encourage all car accident victims to take advantage of our free online case evaluation — before speaking with the insurance adjuster. Or call us at 1-866-900-7078 and tell us your story.  If you decide to enlist our help, there are no upfront costs, and we will not take an attorney’s fee unless we recover for you.2 We will deal directly with the insurance company, negotiate on your behalf, and help you seek fair compensation.

Claims adjusters have plenty of tools and training backing their efforts. Put our experience and resources behind yours.

About the Author

Michael Williams practices personal injury law in North Carolina for the Law Offices of James Scott Farrin. He previously worked as an attorney for an insurance company, but decided to fight on behalf of the injured, not against them. Michael is a member of the Federal District Courts of Middle and Eastern North Carolina, North Carolina Advocates for Justice, and the North Carolina Association of Black Lawyers.

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