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Carlsbad Personal Injury Lawyer Discusses Red Flags for Insurance Claims Adjusters

This entry was posted on Wednesday, July 29th, 2015

Posted in Uncategorized | Posted by:

Carlsbad Personal Injury Lawyer - Insurance claim formA Carlsbad personal injury lawyer will help you to understand what might raise red flags for the insurance claims adjuster.

Certain Red Flags Might Cause a Claims Adjuster to Examine the Case More Closely

Prior to calling various issues in the claim into question, the insurance claims adjuster will initially have to look at the policy and determine whether or not it is applicable to the case. If it is, the extent will then have to be examined. Next, the adjuster will begin studying important facts in the case to break it down into financial terms. There will be certain facts presented based on the situation. If some claims do not seem to be congruent with the incident, the adjuster will question them. This often hinges on the adjuster’s training, experience, and judgment. If a part of the claim has no explanation, the adjuster will deem it to be potentially suspicious. There can be little more than a funny feeling on the part of the adjuster to lead to greater case scrutiny. When this happens, the case will be harder for a Carlsbad personal injury lawyer to resolve successfully.

Red Flags That Might Arise from Medical Treatment

The adjuster might look at the following when it comes to medical treatment:

  • The adjuster will compare the medical reports with the medical costs that have accumulated and decide if they are reasonable.
  • The types of doctors that are used will be considered. For example, if much of the treatment is done by a chiropractor, this could be questioned. This is not to denigrate chiropractors, but their work is looked at in a different manner than that of an orthopedist.
  • The amount of treatment that the claimant has had along with its frequency is factored in. An example might be physiotherapy with many visits and little marked improvement.
  • Soft-tissue injuries are difficult to assess and could be questionable. If there are no medical findings of injuries worse than these, the adjuster will be suspicious.
  • Hefty charges for medical treatment that do not line up with the injuries the claimant has suffered, are all in the same area of the body, or are pre-existing issues can be looked at as potentially fraudulent.
  • The treatment being received not being appropriate for the injuries that were allegedly suffered in the accident will be questionable.
  • Doctors and attorneys who appear to be working together consistently in personal injury claims will be thought of as engaging in business dealings more than an actual attempt to receive valid compensation for clients.
  • An attorney who continually uses the same medical professionals even if those medical professionals are not appropriate for every case will be seen as a possible red flag.

Contact a Qualified Carlsbad Personal Injury Lawyer

If you have concerns about red flags that might arise during the course of a claim, call George Charles Heppner – San Diego Personal Injury Attorney at (619) 235-4300 to speak to a Carlsbad personal injury lawyer.