Outline of a lawsuit – Part 3

Once an insurance company is in possession of your medical records and other evidence, it is at that point the process of potential settlement takes place.

The records are reviewed by the individual adjuster that is assigned to your file.  Once evaluated, the adjuster will apply his or her opinion of the value of the case.  This is where subjectivity can affect the outcome of a settlement.  One adjuster may evaluate your case higher (or lower) than one of his colleagues.  Thats is why it is important for your attorney to convince the adjuster (at an early stage) that the value of the case is higher and can be substantiated by the evidence that you have submitted.

An experienced lawyer knows the importance of establishing a rapport with an adjuster.  It is important to remember that you are dealing with a human being, not a computer program or an app.  (Although some companies actually use software programs to evaluate cases, for the most part they do not reveal concise or realistic outcomes).  It is imperative that you treat your adjuster with respect and courtesy (even if you are not happy with their opinion).  You must take small steps in establishing a relationship on the telephone.  In the end, that slow, refined dialogue can mean the difference of settlement or not in your case.

In my law firm, we send all records via overnight mail.  Once they are delivered, I contact the adjuster and ask if the package was received and whether the adjuster needs anything else to evaluate the case. Additionally, each package includes authorizations to obtain medical, hospital, employment, and (if appropriate) No fault records.

It is imperative that a lawyer understand the evidence, especially the medical terms as they relate to trauma.  You need to make your case on the telephone, so connecting your argument to documentary evidence is vital to convincing the adjuster that your client deserves to be compensated. Learning the terms takes years of experience – and learning how to attack the usual defenses (“your client’s injuries are long term, degenerative changes…”) will facilitate a settlement.

After months of discussions (the wheels of settlement move very slowly in an insurance company), you will either be in a position where settlement is a viable option or not.  If you hit a brick wall in the discussions, the next option os to convince the adjuster that arbitration or mediation are positive modes of resolution.  These options are commonly called “Alternate Dispute Resolution” or “ADR.”

The advantages of ADR include economy of time and money (especially considering that most cases that go to trial require 2 to 3 years of litigation and in excess of $10,000 for expert witnesses, vis a vis, medical doctors who are paid to testify in court on your behalf). Once you have convinced an adjuster that ADR is the best option, you have just saved your client years of waiting (which amounts to stress) and thousands of dollars.

In my next blog I will discuss ADR from A to Z.


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