No one likes to be lied to, especially by a professional who is responsible for determining whether your insurance claim is valid. If you have been injured in an accident and have a sizable claim, you may find the tactics used by an insurance adjuster to be accusatory, shrewd, and downright dishonest.

When you find yourself going up against an insurance company, it is in your best interest to hire a qualified insurance dispute lawyer. Wallace Law can fight for the compensation you are owed and protect you against lies an insurance adjuster might make.

If you are already dealing with a claim, we can help. Here, we will discuss more about the insurance adjustment and claims process so you have a better understanding of your rights and the tactics that adjusters sometimes employ.

What Does an Insurance Adjuster Do?

Insurance adjusters step in when a claim is made on an insurance policy. An adjuster’s job is to determine who is at fault and who is liable for damages and to act as the point of contact for settlement negotiations on behalf of the insurance company. As such, an adjuster will:

Investigate insurance claims to determine coverage.
Gather evidence through damage inspection and work with outside professionals to analyze data, reports, and costs.
Review policy details and estimate costs.
Negotiate settlements with the policyholder.
Serve as the main point of contact for claimants when communicating with the insurance carrier.

Many insurance adjusters do act ethically, but it is important to remember that their loyalty lies with the insurance company. For this reason, it can be a good idea to hire a public adjuster to get a second opinion. A public adjuster works for the claimant and can review the claim alongside the company’s adjuster.

They can be especially helpful for complex claims that involve multiple carriers, parties, and a lengthy list of damages. It is important to note that a public adjuster is different from an independent adjuster, a contractor who may be hired by an insurance company if their own adjusters are overburdened.

What Do Insurance Adjusters Look For?

No matter what type of claim you have, an insurance adjuster’s job is to meet with you and/or your legal representative to investigate it. For instance, if you submit a claim for damage sustained to your property during a storm, an adjuster will meet you at your home, view and document the damage, and ask questions about how it happened.

Specifically, an insurance adjuster will ensure that:

The damage is covered by your policy.
Any damage that you are claiming is not pre-existing.
No further damage was sustained. A good example of additional damage is the presence of mold after flooding or a medical injury that could lead to other negative health impacts.

An adjuster will look for red flags with your claim. Red flags include pre-existing injuries or damages that would not be covered under the current claim. Adjusters have a responsibility to protect the insurance company against fraudulent claims, which means they will look for anything about your claim that does not seem plausible.

Communicating with an insurance adjuster can be uncomfortable, and may make you nervous. Knowing what to expect before you meet with an adjuster takes the pressure off and will help you be prepared for their questions and any unsavory tactics.

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Tips for Dealing with Insurance Adjusters

The first time you and/or your legal representative meet with an insurance adjuster, it is best to be prepared. Knowing what to expect and having the requested information ready to provide will make the process easier.

Before your meeting:

Understand your coverage and the claims process. Knowing your policy and how it protects you is paramount to ensuring you get the compensation you deserve for your claim. Review your policy thoroughly and write down any questions you have for the adjuster before your meeting.
Document all evidence. Collecting your proof of your damages is important for your meeting with your adjuster, and for any litigation that may follow. Take pictures of your damages and save receipts, doctor’s notes, and other documents that may be relevant.

During the meeting:

Be polite and professional, but do not volunteer unnecessary information. It is not necessary to be unkind or brash with an adjuster. Many adjusters are honest and simply want to collect all the information necessary to process your claim. Answer their questions, but avoid volunteering any information that is not requested. You may wish to take notes or record your conversation, but you will need to let the adjuster know if you plan to record them.
Make sure the adjuster views everything. An adjuster may avoid looking deeper into problems or issues that extend beyond the initial damage you are claiming. For instance, if you have storm damage, the adjuster should inspect areas surrounding the damage to see if mold could be an issue.
Don’t be afraid to seek clarification. The field of insurance claims and adjustments has its terminology, and the average person may not have a working understanding of this language. If you do not understand something, ask the adjuster.

After the meeting:

Keep notes of all interactions and communications you have with the insurance adjuster.
Respond to all requests for required information in a timely fashion. However, if you feel the adjuster is requesting information that is laborious to produce, or has already been produced, it is best to seek the counsel of an insurance dispute attorney.
The adjuster may be delaying the claims process, which is an act of bad faith designed to fatigue you as the claimant and avoid a payout.

The most important fact to remember when working with an insurance adjuster is that they do not work for you, but rather for the insurance carrier from whom you are attempting to collect. This relationship can result in tactics aimed at getting you to admit fault or minimize the extent of your injuries. Many people find themselves apprehensive about talking to an insurance adjuster for fear of saying something injurious. In most cases, the less you say, the better.

What Should You Not Say to an Insurance Adjuster?

You should not have to feel uncomfortable when speaking with your insurance adjuster, but they may use certain tactics—such as leading questions and unwanted inferences—that make the interaction troublesome.

When you speak to your adjuster, answer their questions to the best of your ability, but avoid saying any of the following:

Do not say you are sorry. Even if an accident was your fault, do not apologize to the adjuster or admit fault. An adjuster may be able to use your apology against you to reduce the amount of your claim.
Do not argue. If you lose your temper or begin to argue, the adjuster may leave the site and be unable to continue with the claims process until you can meet with them civilly, which could delay your claim.
Do not provide unnecessary information. You should not provide information to your adjuster about your financial status, health, or any other claims you have ever made in the past. It is also a good idea to avoid giving the adjuster the names of any witnesses who may have seen an accident if one has occurred. Witnesses may not testify on your behalf, even if you think they might.
Do not give a recorded statement. An adjuster may ask you to make a recorded statement, which can be used against you later. You are not legally required to give one.
Do not accept the first offer. The first offer your adjuster gives you will likely be a lowball offer that is made to save the insurance company money. It is in your best interest to refuse it.

Can Insurance Adjusters Lie to You?

Yes. Insurance adjusters can lie to you to protect their employer. Adjusters are trained to look for ways to reduce your claim to the lowest payout possible. They may also use unethical tactics to try to close out an investigation and move your claim to their “completed” tasks.

Some common tactics and lies an adjuster may use include the following.

Asserting policy exclusions that do not apply.
Asserting that damages or injuries were pre-existing to the policy or incident.
Lowballing estimates for repairs or times for recovery from injuries.
Telling you that your policy prohibits legal action. These are misleading claims that should be reviewed by an attorney. They may also tell you that you do not need a lawyer for your claim to avoid having to involve their legal team.
Asking you to give a recorded statement. Your insurance adjuster may tell you that you are required to give a recorded statement, but the law does not require you to do so.
Asking for your social security number. It is never a good idea to give an adjuster your social security number. If you provide this information, they can run a background check on you and obtain medical, financial, and criminal history which is not relevant to your claim but could be used against you. In addition, you do not have to sign a HIPAA release, which can also give adjusters unlimited access to your medical records.
Telling you that they cannot offer you a higher payout. The first offer the insurance company makes will almost always be lower than the maximum amount they can give you.
Asking you to accept liability. You never need to accept liability for a claim, and you should never do so. If you do, it may affect your total compensation.

This is not an exhaustive list. If something the insurance adjuster says does not seem accurate or makes you feel uncomfortable, it is best to hire an attorney who has experience dealing with adjusters to protect your interests.

Insurance Adjuster Lied to Me: What Should I Do Next?

If you have been lied to by an insurance adjuster, you are not alone. It is not uncommon for an adjuster to use aggressive tactics to try to reduce or deny your claim. Once this happens, it is in your best interest to speak to an insurance dispute attorney to pursue fair compensation. An attorney will be able to support your claim, handle all communication with the insurance adjuster, and file a lawsuit if one is necessary.

Can You Sue an Insurance Company for Lying?

If an insurance adjuster acts unethically or lies to you, you may be able to file a lawsuit. You can seek legal action against an insurance company for:

Misrepresentation/bad faith. Bad faith cases occur when an insurance company intentionally handles your claim in a way that is unethical and injurious so as to avoid paying you the claim. This can involve delaying claims, lying, using unethical tactics during negotiations, changing policy terms without notifying you, requiring burdensome document production, and the like.
Breach of insurance contract. A breach of contract is a type of bad faith practice that demands legal action as the insurance company is directly denying a claim that is covered under your policy terms. Deceptive practices may be used to support the denial.

If you feel your insurance adjuster is not being fair and honest, it is best to contact an experienced insurance dispute attorney immediately.

Can Insurance Adjusters Lie to You: FAQs

Here are some of the questions we receive most often and their answers.

Are Insurance Adjusters Licensed?

Yes. Insurance adjusters are licensed to handle claims that arise in their respective states.

Do Insurance Adjusters Work for the Insurance Company?

Company adjusters work directly for the insurance company, while independent adjusters may be contracted by the company to perform the same role. Public adjusters do not represent any insurer and can be hired by claimants.

What Does a Public Adjuster Do?

Public adjusters may be hired by a claimant or other individual involved in a complex claim to render an opinion of the claim, damages, and payout. A public adjuster represents the individual who hires them, not the insurance company.

What Does an Insurance Appraiser Do?

An insurance appraiser determines the true and total value of a loss. Unlike an adjuster, an appraiser will not be involved in determining whether a claim is valid.

Can Insurance Adjusters Tell How Old Damage Is?

Numerous resources tell an adjuster how old the damage is. For vehicles, a comprehensive vehicle report can be obtained to determine whether the vehicle has been involved in other accidents. For homes, visual inspection and repair or inspection records can help them determine if something is pre-existing.

How Long Does an Insurance Adjuster Take?

After filing a claim, an adjuster will typically reach out to the claimant within the next few days. If you are meeting with the adjuster, such as in the event of a property insurance claim, the meeting can take anywhere from a few hours to a day depending on the extent of damage.

How Does an Insurance Adjuster Get Paid?

Many insurance adjusters, whether they are independent, public, or work directly for an insurer, are paid a salary. However, some may be paid at an hourly rate, receive a fee based on the outcome of the claim, or be compensated under another pay structure.

You Don’t Have to Fight an Insurance Company Alone – Contact Wallace Law for Help

If you are currently in a fight with an insurance company over a claim and feel you are being treated unethically, contact Wallace Law today. We understand the unethical practices insurance companies may use to deny claims, and we will use our experience to advocate for you.

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