Over 6.8 million people visit the emergency room every year for fall-related injuries. If you are among this number, having been injured in a slip-and-fall, you understand just how serious these types of accidents can be.
After a slip-and-fall, you may be facing substantial medical debt while at the same time being unable to work while recovering from your injuries. Be assured, though, that if you were injured because of someone else’s negligence, you can try to recover damages.
Typically, the first step in recovering compensation for slip-and-fall injuries is to file a claim with the property owner’s insurance company. Once a claim has been filed, insurance adjusters begin their investigations. Unfortunately, insurance adjusters are not always fair or easy to deal with.
Why Insurance Adjusters Investigate Slip and Fall Claims
An adjuster will be assigned to investigate your slip-and-fall after you file your claim with the property’s owner’s insurance company. There are two main reasons why an insurance adjuster will investigate your claim.
Protection against fraud
Insurance adjusters investigate slip-and-fall cases to try to protect the insurance company from fraud. Statistics reveal that fraud occurs in approximately 10 percent of all property damage insurance losses.
Consider two ways fraud could occur in a slip-and-fall claim:
- Exaggerating a claim: A person may legitimately have been injured in a slip-and-fall but exaggerate the extent of his or her injuries. As an example, a person sustains a mild ankle sprain in the slip-and-fall but tries to claim permanent disability and mental anguish.
- Inventing an incident: Another type of insurance fraud occurs when a person creates an incident with the intention of pursuing compensation. For example, someone purposely spills liquid on a grocery store floor, intentionally falls, and then tries to claim extensive damages.
In an effort to prevent fraud, insurance companies may ask those filing a claim to provide evidence to support their case. Additionally, insurers will bring in adjusters and investigators to assess the claim.
The other main reason why insurance adjusters investigate premises liability claims is to minimize payout. Insurance companies are businesses and their goal is to make a profit. When an insurance company has to make a large payout, it inevitably loses money.
During an investigation, an insurance adjuster is looking for anything that could be used to deny or reduce the value of your claim.
The following are some things an adjust may find when investigating a slip-and-fall case:
- An eyewitness who can testify property owner was not negligent: For example, someone saw the supposed slip-and-fall victim intentionally spill liquid on the floor and fake a fall
- Evidence that more than one party may be liable for the accident: Suppose, for example, the property owner hired an outside company to fix a broken staircase, but the company failed to fix it correctly
- Pre-existing medical conditions that could have caused the victim’s fall: For example, if the slip-and-fall victim has a medical history of seizures or vertigo
How Insurance Adjusters Investigate Slip-and-Fall Cases
A claim begins after the insurance company of the property owner is contacted. The insurance company will then assign a representative, or adjuster, to the case.
The insurance adjuster will likely take the following steps when investigating your slip-and-fall accident.
Ask you for information
You can expect to hear from the insurance company of the property owner shortly after your claim is filed. They will want a summary of what happened and of your injuries.
When speaking to the adjuster, it is important to stick to the facts; don’t say anything that puts the blame on yourself. Be concise. Don’t agree to give a recorded statement.
Information the adjuster may request from you includes:
- The reason why you were visiting the property where you fell
- The extent of your injuries
- A copy of the accident report
- A release to look at your medical files
- Copies of your hospital bills and other medical expenses
If you choose to hire a slip and fall lawyer to represent your claim, he or she can handle all communication with the insurance company on your behalf.
Visit the location of the slip-and-fall
In some situations, an adjuster may travel to the location where the slip-and-fall incident occurred. This can help the adjuster visualize how the accident occurred and determine whether the owner of the property is at fault.
An insurance company may not send an adjuster to a property location if the claim is relatively small. However, expensive claims will more likely warrant maximum attention.
Speak to eyewitnesses
Claims adjusters will seek out witnesses to your slip and fall injury. Often, the police report includes the witness’ contact information.
The purpose of the adjuster speaking to eyewitnesses is not just to corroborate your version of events. The insurance representative may record statements that can be used against you.
Request to view your medical records
The insurance company may want a copy of your medical records to evaluate your injuries. They will use this information to determine whether your personal injury claim is legitimate.
As the slip-and-fall accident victim, it is your decision whether you want to share medical records. Refusing to share your records could prompt the adjuster to decide there is a lack of evidence and deny your claim.
A personal injury attorney can review your medical documents with you and help you decide which are worth sharing and which could harm your case.
Make a determination of fault and payout
Once the claims adjuster has gathered all necessary information regarding the slip-and-fall accident, he or she will complete a report and make a preliminary determination of fault. He or she may deny the claim, accept it, or approve it at a lower settlement amount than the accident victim requested.
If the adjuster denies your claim or gives you a low settlement offer, it is important to speak to an experienced personal injury attorney about what to do next. After reviewing your case, an attorney can advise you of your options.
Strategies Insurance Companies Use to Pay Less for Slip and Fall Cases
Insurance companies and those who represent them will employ their own strategies for handling injury claims. The following are some common tactics to reduce payouts:
- Act like a friend: Some insurance adjusters may put on a front that makes it seem that he or she is on your side and looking out for your best interests. It is important to remember the adjuster is not your friend. The job of an insurance adjuster is to financially protect the insurance company and the party who caused your injuries.
- Deny your claim outright: An adjuster may deny your insurance claim outright, with the hopes you will just pay for your losses out-of-pocket. Reasons given to deny slip-and-fall claims may include arguing the property owner did not do anything wrong, that your injuries were pre-existing, or that you did not report the fall right away.
- Make a lowball offer: The adjuster may offer you a settlement that is far less than your claim is worth. He or she may say things such as, “This is the most we can offer fall victims; it’s fair, and anything else would exceed my authority.” The purpose of this tactic is to discourage you and hope you take the offer without asking for more money.
- Delay your claim intentionally: Tactics used to delay your insurance claim may include ignoring your calls, refusing to answer your questions, or failing to respond to your counteroffers. Rather than letting the stalling cause you to lose confidence that you have a valid claim, your attorneys will be prepared to negotiate with patience and persistence.
Tips for Handling Slip and Fall Claims
It is likely that the insurance company will resist paying out the initial amount that you request for your slip-and-fall injuries. Keep the following suggestions in mind for handling negotiations with difficult insurance companies.
Keep organized and detailed records
Before you start negotiating with an insurance company, you should know the details of your case. Keep detailed notes daily from the date of the slip-and-fall. Record how much pain you feel, what the medical treatment you receive, and how your injuries affect your life.
Be sure to maintain a file where you keep important documents such as medical bills, copies of accident reports, and other evidence.
Calculate the value of your claim
It is important to understand the value of your injury claim when negotiating with an adjuster.
Damages you may be entitled to could include:
- Medical expenses
- Prescription costs
- Lost income
- Loss of future earning potential
- Loss of enjoyment of life
- Pain and suffering
Hire a personal injury lawyer to represent you
Insurance adjusters are trained negotiators. They may have access to resources and evidence that are not easy for you to obtain on your own.
Therefore, if you have been badly injured in a slip-and-fall, your best chance at obtaining compensation is to consult with an experienced personal injury lawyer.
Your slip-and-fall accident lawyer will:
- Conduct a thorough investigation of your accident
- Advise you or your legal rights
- Calculate the value of your claim
- File all necessary paperwork
- Negotiate a fair settlement, and;
- Litigate your case if necessary
Let Us Help You Recover Fair Compensation
Speaking with insurance companies can be stressful, especially if the adjusters are hostile or uncooperative. Insurers may even take statements you make out of context with the hopes of holding them against you.
Please be assured you do not have to deal with difficult insurance companies on your own. After being injured in a slip-and-fall due to someone else’s negligence, you have the right to hire a lawyer to be your legal advocate.
The personal injury attorneys at Hoffspiegel Law have years of experience dealing with insurance companies and their representatives. Let us handle the legal aspects of your case so that you can focus on your recovery.
Schedule a free case evaluation of your slip and fall case today. Call us today at (404) 760-8600, or click the Contact Us button to get started.