Manipulating claimants with a little financial squeeze

What if you were told that you had to cover an extra $600 per month in expenses, effective immediately?

Think about that for a moment. What would you have to give up? What would your family have to do without?  Would it even be possible?

This is a reality for many people who have been injured in car accidents.

Each treatment can cost in the $50 range, and many injured people require treatments three times per week.

Thank goodness for insurance.

Some of us have extended medical insurance through our work that covers most or all of that expense. But what about when you reach your annual maximum? What about the most vulnerable people and families who have no extended medical insurance?

And what about auto insurance? If you were not at fault in the crash, the law says you are entitled to complete reimbursement for any treatment expenses you reasonably have to pay as a result of your injuries.

That entitlement is against the negligent driver who caused the crash.

You make your claim for compensation through the negligent driver’s auto insurance company and instead of dealing with the negligent driver, you deal with an insurance adjuster.

On the one hand, I can assure you that the insurance adjuster knows this very obvious piece of the law. On the other hand, I will remind you of what I said in a previous column, that it is the adjuster’s duty to try to settle injury claims for as little as possible.

In the context of treatment expenses, what tactics do insurance adjusters use for settling injury claims for as little as possible?

I’ve never seen an insurance adjuster’s play book but I’ve seen how my clients have been dealt with and I have my theories.

In the early stages of a claim, it is not uncommon for the adjuster to reimburse an injured claimant 100 per cent of treatment expenses. Is that a tactic or is that just being fair and reasonable?

The fact that I have had clients immediately cut off the 100 per cent reimbursement when the adjuster found out I have was hired leads me to think it’s a tactic.

What purpose could that tactic serve?

If the injured claimant can be lulled into believing he or she will be dealt with fairly, then he or she will be more likely to trust the adjuster when he tells the claimant what the claim is worth. 

Of course, the person whose job it is to negotiate as low a settlement as possible is the last person you should trust.

By holding the purse stings, the insurance adjuster holds a lot of power.

Once a level of trust has built up, pressure can be put on the injured claimant by simply turning off the tap.

After a claimant has been relying on 100 per cent funding for treatments for a number of weeks or months, how better to “encourage” an unfair settlement than to put on a little financial squeeze.

Some injured claimants respond to the financial squeeze by stopping treatment, which is absolutely the worst thing to do.

Doctors recommend treatment for a reason. The very best outcome of any car crash injury is to recover and have as small a claim as possible. By stopping treatment, you jeopardize your recovery.

You are also hurting your case, opening yourself up to two arguments that the very insurance company putting on the squeeze can make at trial.

One argument is that you are to blame for your ongoing pain because you failed to continue with doctor recommended therapy. The other is to point to your treatment pattern and say, “Look, she must be better because she stopped her treatment.”

Get a line of credit; refinance your mortgage; borrow from family or friends.

Do whatever it takes to finance those treatments.

Allow your doctor’s advice to determine your medical treatment, not the financial squeeze of an insurer turning off the funding tap. 

It is only the most vulnerable, without access to any financing, who are actually forced into stopping treatment, unless extremely generous doctors and other medical specialists are willing to provide treatments on credit.

I received an e-mail from a retired insurance adjuster who worked in the business for more than 30 years.

“Why not go and give a seminar to the ICBC adjusters and try to explain to them that the more pressure they put on the injured people, the longer it takes for them to recover?” he asked in his e-mail.

Somehow, I don’t think I’m going to get an invitation.

This column is intended to provide general information about injury claims. It is not a substitute for retaining a lawyer to provide legal advice specifically pertaining to your case.

Paul Hergott is a lawyer practising in Westbank. If there is a particular issue you would like discussed in a future column, e-mail him directly at:

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