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Why Your Own Insurance Company May Not Be Your Friend

Posted by Scott Edwards | Oct 29, 2012 | 0 Comments

The people who come into our office are often surprised that their insurer has:

1) Not helped them in processing their claim against the insurer of the person that hurt them;

2) Been very difficult in paying medical bills under the Personal Injury Protection (PIP) endorsement that they had been paying premiums on for years, and that the insurer is even insisting on them attending an examination with a doctor chosen by the insurer for an “Independent Medical Exam” (IME) for a “second opinion”;

3) Cut them off from the promised PIP benefits after the “IME” because the insurance company's doctor claims that the insured just fine, or that their on-going problems are not from the crash but are the “natural progression” of some “pre-existing” condition.

Here are answers to some of the questions that we regularly hear at the law firm of Schauermann, Thayer, Jacobs and Staples:

Why doesn't my insurer help me with my claim? Because your insurer has not contracted with you to do so. They are not in the business of helping their insureds process claims against another insurer. Even though you may have a wonderful agent, that agent is not an attorney and is not set up to assist you in your claim other than to give you VERY GENERAL information about the claims process. And the insurance adjuster will likely be looking out for the insurer's interests and not yours.

What about my PIP – why are they making it so hard? PIP is an endorsement in your policy that you paid for. It provides you with insurance to pay your medical bills with no co-pay and no limitations on the type of care that you receive (beyond that and the bills be reasonable in amount and made necessary because of the automobile collision). PIP coverage may provide you with some limited benefits for wage loss and some other benefits for assistance in your home if you are unable to do your usual activities for domestic care around the home. Some insurers are better than others in how they handle their PIP claims. Some are really bad. Your insurer may make the PIP process so hard that you won't even want to use it. Or it may cut you off by using (what the insurance adjusters call it anyway) the “Independent” Medical Exam (if they are doing this, either they don't trust your treating doctor or they just don't want to pay out any more on your PIP claim). Some insurers seem to believe that they are in the business of making sure that they pay as little as possible on claims, period. Whatever the reason, the “independent” medical examiners are usually not really independent at all. Many are doctors hired by the insurance companies on a regular basis because they give insurers the type of opinions that the insurance companies want to hear – opinions that cut off future benefits.

But I have Underinsured Motorist Protection – isn't the Insurer supposed to help me if I have this coverage too? Uninsured/Underderinsured Motorist Protection Benefits (UIM) are a very important coverage under your policy if you purchased it – it can provide you additional benefits if the person that hurt you doesn't have any insurance OR if they don't have enough insurance to fully compensate you. Insurers, though, may believe they can best boost company profits by limiting or reducing claims paid – and this not only occurs with PIP benefits (see discussion above), but also in the uninsured/underinsured motorist claim context. Contrary to what you might expect or hope for, your insurer has NOT contracted with you to help you with these claims any more than it did with your liability claim against the at-fault drive's insurance company. And yes, your own insurance carrier does have professional “adjustors” and attorneys on staff. But they are working for the insurance company, not you, and they often seem to be more mindful of the insurer's best interests, not yours (in general – there are always exceptions). We have had a number of clients describe their own insurance company's adjuster as having been really nice – until a claim of some sort was made for PIP or UIM benefits.

The key lesson here is this. Your insurer has well-trained professionals dedicated to limiting its responsibility to fully compensate you for your injuries- so you should have trained professionals who are actually on your side, helping you work through the maze of your claim. The professionals at the law firm of Schauermann, Thayer, Jacobs and Staples would welcome the opportunity to discuss your case with you if you wish. The attorneys and staff at Schauermann, Thayer, Jacobs and Staples are working diligently on these types of claims every day; the firm has done so for over 25 years.

So, while it would be nice if you could, don't count on help from your own insurance company. Instead, consult with a team of professionals.

About the Author

Scott Edwards

Scott Edwards is a partner at Schauermann Thayer Jacobs Staples & Edwards law firm. Scott is licensed in both Oregon and Washington, and has been practicing law since 2008. Though Scott started his career working for insurance companies, he now focuses his practice on personal injury, auto accident, biking accident, and insurance cases. In his free time, Scott enjoys spending time with his wife and children. He especially enjoys pedaling around the streets of Vancouver, Washington and Portland, Oregon on his bicycle.

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