Legal Advice

Getting Down to the Nitty Gritty - Do Insurance Adjusters Lie

Two cartoon figures facing each other where one of their shadows displays a reference to Pinocchio's lying.

Table of Contents

I. Introduction

II. What is the Role of an Insurance Adjuster?

III. Do Insurance Adjusters Lie to Maximize their Profits?

IV. What are the Common Strategies Insurance Adjusters Use to Reduce the Value of Your Claims?

V. The Importance of Working with a Lawyer Who Can Help Pursue the Compensation You Deserve

VI. Conclusion



When it comes to your insurance, it's important to understand what's involved, and who you'll need to converse with about your policy concerns. If you're a policy holder, you'll need to cooperate with the insurance company for your legal protection. If you're involved in an accident, the insurance company will need to speak with you, the other party, the police, and any other people who can provide information.

Ultimately, the insurance adjuster's job is to settle claims. The more they settle quickly, the better they do their job. With that in mind, who is an insurance adjuster, and what should you know about the role?

Insurance adjuster discussing with victim of his accident on scene.
Image by jcomp on Freepik

What is the Role of an Insurance Adjuster?

An insurance adjuster is the insured person's point of contact and the one who examines claims on behalf of the insurance company. An adjuster's job might involve examining and evaluating the claims. In some cases, they’ll communicate with the policy holder. An adjuster might also speak to witnesses, investigators, and the other insurance company.

In some cases, the adjuster might talk to the parties involved in the accident. This is to determine liability. As much as an insurance adjuster might want to quickly settle a claim, they cannot do so until they know what happened.

An insurance adjuster's role is to investigate claims made on behalf of the insurance company, so they're committed to doing their due diligence and ensuring there are no errors or fraudulent nature made to the claims. As for the insurance adjuster's bottom line, they're essentially responsible for deciding how much the insurance company should pay.

Here's a detailed list of the types of investigations an insurance adjuster might perform and the specific tasks involved in each investigation:

  1. Claim Examination and Evaluation:The insurance adjuster thoroughly examines the claim submitted by the policyholder. They review all relevant documentation, such as incident reports, medical records, repair estimates, and photos, to understand the nature and extent of the loss or damage. The adjuster evaluates the legitimacy of the claim and determines whether it falls within the coverage of the policy.
  2. Communication with Policyholder:The adjuster communicates with the policyholder to gather additional details about the incident or loss. They may request additional documentation or information needed to assess the claim accurately. This communication ensures that the adjuster has a complete picture of the situation.
  3. Contacting Witnesses:In cases where there are witnesses to the incident, the insurance adjuster may interview them to gather their perspectives and statements. Witness testimonies can provide valuable insights into the circumstances surrounding the claim, helping the adjuster make an informed decision.
  4. Engaging Investigators:If the claim involves complex circumstances, such as suspected fraud or a large-scale incident, the insurance adjuster might hire specialized investigators. These investigators can conduct in-depth inquiries, gather evidence, and provide expert opinions on the legitimacy of the claim.
  5. Communication with Other Insurance Companies:If there are multiple parties involved in an incident, such as a car accident, the insurance adjuster may communicate with adjusters from other insurance companies to determine liability and the extent of coverage. This collaboration helps establish fault and streamline the claims process.
  6. Assessment of Liability:In situations where liability is disputed, the adjuster investigates the circumstances leading to the incident. They analyze available evidence, witness statements, and applicable laws to determine who is at fault. This investigation is crucial for determining the appropriate distribution of compensation.
  7. Fraud Detection and Prevention:Insurance adjusters are trained to identify potential fraudulent claims. They scrutinize claim details, inconsistencies, and suspicious patterns to detect instances of fraud. If fraud is suspected, the adjuster may conduct a more rigorous investigation and collaborate with investigators.
  8. Damage Estimation and Appraisal:For property damage claims, the adjuster evaluates the extent of damage and estimates repair costs. They may consult with experts or contractors to ensure accurate damage assessments. This investigation helps the insurance company determine the amount to be paid for repairs.
  9. Settlement Negotiations:Based on their investigations, the insurance adjuster proposes a settlement amount to the policyholder. They negotiate with the policyholder, ensuring that both parties reach an agreement on the claim's value. The adjuster must balance the policy's terms, coverage limits, and the policyholder's needs.
  10. Documentation and Reporting:Throughout the investigation process, the insurance adjuster maintains detailed records of their findings, communications, and decisions. These records contribute to transparency and accountability within the claims process.

In summary, an insurance adjuster is responsible for investigating claims, assessing their validity, determining liability, estimating damages, preventing fraud, and ultimately facilitating fair and accurate claims settlements. Their role involves careful analysis, effective communication, and collaboration with various stakeholders to ensure that policyholders receive the appropriate compensation while safeguarding the insurance company's interests.

Seeing as the insurance adjuster determines the estimates for the insurance company, it's only natural to ask what every insured person is concerned about: do insurance adjusters lie?

Adjuster filling a insurance claim for a car accident.
Image by on Freepik

Do Insurance Adjusters Lie to Maximize their Profits?

Some insurance companies have gained notoriety due to claims of their adjusters providing misinformation to policyholders. The perception stems from the notion that these adjusters are inclined to reduce the company's expenditures wherever possible, thus preserving their profit margins. This raises a fundamental question: Is the primary objective of an adjuster's role to enhance the insurance company's profits?

However, a different perspective on this matter emerges when one considers how insurance adjusters navigate the intricacies of insurance contracts. These contracts often contain intricate clauses and stipulations that could potentially result in reduced payouts for clients and claimants. Rather than outright lying, adjusters may exploit the nuanced wording and provisions within these contracts to minimize payouts within the boundaries of the policy's terms. In this context, the adjuster's behavior aligns with leveraging the legal parameters set forth in the policy.

Unnecessary Information and Payout Reduction

One strategy that insurance adjusters might employ is soliciting seemingly unnecessary information from claimants. This information request could encompass details such as property damage costs or medical bills. While these requests may appear extraneous, they might serve a dual purpose. Firstly, they provide the adjuster with a comprehensive understanding of the claim, which is essential for accurate assessments. Secondly, they potentially offer insights that could be used to justify a lower payout within the constraints of the policy terms.

The Complex Interplay

Determining whether insurance adjusters lie or adhere to the fine print involves navigating a complex interplay of legal and ethical considerations. Insurance companies entrust adjusters with the task of conducting thorough investigations, evaluating claims, and adhering to the legal framework outlined in insurance policies. Adjusters are expected to work within the confines of these policies, utilizing their expertise to ensure that claims are settled in line with the policy's specifications.

Balancing Act

The adjuster's role becomes a delicate balancing act between fulfilling the company's fiduciary responsibilities and maintaining ethical standards. They are tasked with interpreting policy clauses to determine the scope of coverage and applicable limits. This often leads to intricate negotiations with claimants to achieve settlements that align with both the claimant's needs and the company's financial considerations.

In conclusion, the question of whether insurance adjusters lie to maximize profits is multifaceted. While instances of misinformation are possible, it is equally plausible that adjusters adhere to the nuanced provisions outlined in insurance contracts. Their role involves interpreting and applying these legalities to balance the financial interests of the insurance company with the ethical obligation to provide fair and accurate compensation to policyholders and claimants. Understanding this intricate dynamic sheds light on the complexities of the insurance claims process.

crumbled up piece of paper with fake news written on it
Image by Freepik

What are the Common Strategies Insurance Adjusters Use to Reduce the Value of Your Claims?

To help protect your rights and get the compensation you deserve, it's worth exploring the possible strategies insurance adjusters use to settle your claims, so you can move forward with greater caution and awareness when talking to them.

1. Initial Lowball Offers

Adjusters might start with a low settlement offer, hoping that claimants will accept it out of frustration or a desire for a quick resolution. This initial offer is often lower than what the claimant is entitled to, and it's intended to save the insurance company money.

2. Questioning Causation

Adjusters may question the direct link between the incident and the claimed damages. They might argue that the damages were pre-existing or caused by factors not covered by the policy, thus reducing the scope of the claim.

3. Downplaying Injuries

In cases involving personal injury claims, adjusters might downplay the severity of injuries sustained. They may request extensive medical records or argue that the injuries are not as severe as claimed, leading to reduced compensation.

4. Comparative Negligence

Adjusters may attempt to shift partial blame onto the claimant. By asserting that the claimant's actions contributed to the incident, they can justify offering a lower settlement amount based on the concept of comparative negligence.

5. Make Delays in an Attempt to Push You to Accept a Low Settlement

Even the most patient policyholders will admit that the process of settling a claim is frustrating. As you can imagine, frustrating doesn't begin to describe the situation when the insurance company keeps making excuses for the delay.

They'll make the excuse that the adjuster is out of the office, and they'll promise to contact you later that week, or they'll promise to answer your questions within 48 hours. However, when the 48hours pass, you're left on hold and no one gets back to you.

Even when you do speak to your adjuster, they'll put you in touch with other people who will also put you on hold (or worse, tell you to call back later). Some people say this is done to push the policy holder to accept a lower payout. If the policyholder continues to make claims, the insurance company will eventually just give up.

6. They Request Your Side of the Story through Recorded Statements

Insurance adjusters may record your statement over the phone and ask you to retell your side of the story. In some cases, an adjuster may attempt to record the conversation without letting you know. If you have anything to say that could compromise your position, later on, you'll be giving up information you might not want to.

If an adjuster asks you to make a recorded statement, they're going to record it, and use it against you. You might think this is alright when you’re not aware of the situation, but if you make a statement that is later used against you, you could be in for a big surprise.

7. Asks You to Sign Medical Authorization Forms

During the insurance claims process, an adjuster will almost always require a medical authorization form (also referred to as a medical release). This is a form where you have to provide permission for your doctor to release your medical records.

This is an important form, but the problem is that it’s usually not done in a professional manner. You don’t want to sign a medical authorization form when you don’t know what it is. It’s also not worth signing a medical authorization form that gives the insurance adjuster access to your medical records.

An insurance adjuster might not even inform you when they get your records, which can leave you in a difficult position. If there is no information to report, the insurance adjuster can't use it against you.

8. Monitor Social Media Activity and Use Your Posts Out of Context

The Internet is a powerful tool, and people say some pretty weird and wonderful things online. When people express their opinions on a website, in a forum, or on social media, their views could likely be misinterpreted.

When an adjuster monitors your social media activity, the purpose is to find incriminating information about you. They want details about prior accidents and offenses. They also want information about your friends, family, and any potential witnesses. Statements made on social media can be taken out of context and used against you.

Woman looking through magnifying glass.
Image by kroshka__nastya on Freepik

The Importance of Working with a Lawyer Who Can Help Pursue the Compensation You Deserve

When navigating the complex world of insurance claims and negotiations, having legal representation can significantly protect your interests and ensure you receive a fair settlement. A skilled lawyer understands the tactics that insurance adjusters often employ to reduce claim values and can take strategic steps to counteract these strategies. Here's how a lawyer can handle various aspects of the claims process to safeguard your best interests:

  1. Comprehensive Case Evaluation:A lawyer will begin by thoroughly assessing your case, including reviewing the policy details, incident reports, medical records, and other relevant documentation. They will identify the strengths and weaknesses of your claim, ensuring that you have a clear understanding of the potential outcomes.
  2. Legal Strategy Development:Based on the case evaluation, your lawyer will devise a strategic plan tailored to your unique situation. This plan will address the adjuster's potential strategies to undervalue your claim and will focus on maximizing your entitled compensation.
  3. Skillful Negotiation:Lawyers are experienced negotiators who are well-versed in dealing with insurance adjusters. They will engage in negotiations on your behalf, countering lowball offers and presenting compelling arguments to justify a higher settlement based on the evidence and legal principles.
  4. Presenting Strong Evidence:Your lawyer will gather and present compelling evidence to support your claim. This may include medical expert opinions, witness statements, accident reconstructions, and any other relevant information that strengthens your case.
  5. Addressing Policy Interpretation:Insurance policies can be complex, and adjusters might exploit ambiguities or exclusions. A lawyer will carefully interpret the policy language to ensure that the adjuster is not misusing fine print to your disadvantage.
  6. Legal Pressure:Lawyers have the legal knowledge to assertively challenge adjusters who employ unfair strategies. They can cite relevant laws, regulations, and legal precedents to back their arguments, putting pressure on the adjuster to act in accordance with the law.
  7. Managing Communications:Your lawyer will handle communications with the insurance company and adjuster, ensuring that you don't inadvertently provide information that could weaken your claim. They will guide you on what to say and what not to say during these interactions.
  8. Thorough Documentation:Lawyers keep meticulous records of all communications, offers, and documents exchanged throughout the claims process. This documentation provides a clear record of the negotiations and can be essential if legal action becomes necessary.
  9. Navigating Legal Procedures:If negotiations stall, your lawyer can guide you through the process of filing a lawsuit if necessary. They will prepare the legal documents, gather evidence for court, and represent you during hearings or trial.
  10. Protecting Your Rights:Most importantly, a lawyer is focused solely on protecting your best interests. They are not influenced by the insurance company's profit goals and will work tirelessly to secure a fair settlement that covers your losses and damages.

In summary, a lawyer's involvement can significantly level the playing field when dealing with insurance adjusters. From strategic negotiation tactics to legal expertise, they are equipped to counteract the adjuster's strategies aimed at reducing claim values. By working with a lawyer, you can maximize your chances of receiving the compensation you deserve while navigating the complexities of the claims process with confidence.

Conclusion - Mendez & Sanchez Law: Your Trusted Partner

At Mendez & Sanchez Law, we understand the intricacies of insurance claims and the challenges that policyholders face when dealing with insurance adjusters. Our dedicated team of experienced legal professionals is committed to safeguarding your interests and ensuring that you receive the fair compensation you deserve. With our comprehensive knowledge of insurance law and negotiation expertise, we are well-equipped to counteract the strategies often employed by insurance adjusters to undervalue claims.

When you choose Mendez & Sanchez Law to represent you, you're choosing a partner who will go above and beyond to protect your rights. From conducting a thorough case analysis to crafting a strategic plan that maximizes your claim's value, we handle every aspect of the claims process with precision and dedication. Our skilled negotiators will engage with insurance adjusters on your behalf, presenting compelling evidence and legal arguments that support your entitlement to fair compensation.

We understand the fine print in insurance contracts and are well-versed in navigating policy language to ensure that your rights are upheld. Our focus is solely on your best interests, and we stand ready to take on the legal pressure, manage communications, and handle the intricacies of the claims process so that you can focus on your recovery.

Choosing Mendez & Sanchez Law means choosing advocacy, expertise, and a commitment to achieving the optimal outcome for your case. Contact us today to schedule a consultation and discover how we can be your trusted partner in navigating the often complex landscape of insurance claims, ensuring that you receive the compensation you rightfully deserve.

Mendez & Sanchez Team


Cooperating with the insurance company is crucial for your legal protection. It helps ensure that your claims are processed accurately and efficiently. Failure to cooperate could potentially lead to delays or denial of your claim.

An insurance adjuster is responsible for examining and evaluating claims on behalf of the insurance company. They gather information, communicate with involved parties, investigate incidents, and determine the validity of claims.

An insurance adjuster investigates the circumstances surrounding an accident, reviewing evidence, statements, and relevant documents. They assess who is at fault by analyzing these details and considering applicable laws.

Insurance adjusters might use strategies such as offering lowball settlements, questioning the extent of injuries or damages, and challenging the causation of losses. They might also use policy exclusions or engage in delaying tactics to reduce claim values.

A lawyer can provide a comprehensive case evaluation, develop a strategic plan, and negotiate with insurance adjusters on your behalf. They ensure strong evidence presentation, interpret policy language, manage communications, and navigate legal procedures. Ultimately, a lawyer's focus is solely on protecting your best interests and securing fair compensation for your losses and damages.

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