5 Games Insurance Adjusters Play

Insurance adjusters may use claim-handling strategies that delay payment, reduce the value assigned to damages or create disputes about liability and medical treatment. Common concerns include repeated delays, using a claimant’s statements to challenge the claim, attributing injuries to pre-existing conditions, omitting future losses and presenting an early settlement with a broad release.

Not every request, delay or disagreement is an improper tactic. An insurer has the right to investigate the accident, confirm coverage and evaluate the evidence. The concern arises when requests are repetitive or irrelevant, explanations are unclear, material information is disregarded or the claimant is pressured to settle before the losses are reasonably understood.

The five insurance adjuster tactics discussed below are:

1. Repeatedly delaying the investigation or decision
2. Using incomplete or speculative statements to dispute the claim
3. Attributing injuries to pre-existing conditions or unnecessary treatment
4. Undervaluing or omitting important categories of damage
5. Offering an early settlement tied to a broad release

A Norfolk personal injury lawyer can review the correspondence, applicable policy, supporting evidence and proposed release. Hiring a lawyer does not guarantee payment or a particular settlement.

What Does an Insurance Adjuster Do?

An insurance adjuster investigates a claim on behalf of an insurance company. Depending on the type of claim, the adjuster may:

• Confirm whether a policy provides coverage
• Interview drivers, witnesses or other involved people
• Review police and incident reports
• Inspect damaged vehicles or property
• Request medical and employment records
• Evaluate whether the insured person is legally responsible
• Estimate the value of covered losses
• Make, reject or negotiate settlement offers

The adjuster does not represent the injured claimant. The adjuster represents the insurer and evaluates the claim according to the available evidence, policy terms and applicable law.

1. Repeatedly Delaying the Claim

Some claims reasonably require additional time. Serious injuries, disputed fault, several vehicles, incomplete medical treatment and questions about coverage can make an investigation more complex.

A delay becomes concerning when the insurer:

• Repeatedly asks for information already provided
• Does not explain why additional records are necessary
• Fails to respond to communications
• Frequently transfers the claim without meaningful progress
• Provides no explanation for an extended investigation
• Waits until a deadline approaches before requesting important information
• Delays an undisputed portion of a claim to influence another disputed portion

What does Virginia require?

Under 14VAC5-400-50, an insurer generally must acknowledge notification of a claim within 15 calendar days unless payment is made within that period. The regulation also generally requires an appropriate response within 15 calendar days to pertinent claimant communications that reasonably suggest a reply is expected.

For qualifying first-party claims, 14VAC5-400-60 requires the insurer to respond after receiving a properly executed proof of loss. If additional investigation is needed, the insurer must provide the required explanation and continuing notices under the regulation.

How should you respond to a delay?

1. Keep a written claim timeline.
2. Record the date, time, name and substance of each conversation.
3. Send important communications in writing.
4. Ask which specific documents remain outstanding.
5. Ask why each requested document is relevant.
6. Request a written status update and expected next step.
7. Keep copies of everything submitted.

Do not allow continuing negotiations to distract you from the deadline for filing a lawsuit.

2. Using Your Statements to Challenge the Claim

An adjuster may compare what you say with the police report, witness accounts, medical records, photographs and later testimony. Inconsistent statements can create disputes about fault, symptoms and the accident’s effects.

Problems may arise when a claimant:

• Guesses about speed, distance or timing
• Accepts blame before understanding what happened
• Says they are “fine” before symptoms have been evaluated
• Minimises an injury out of politeness
• Exaggerates symptoms or financial losses
• Provides different accounts to different people
• Speculates about a diagnosis or future recovery

What should you say to an insurance adjuster?

Be truthful, accurate and concise. Provide facts you know without guessing.

It is reasonable to say:

• “I do not know.”
• “I do not remember that detail accurately.”
• “My medical evaluation is continuing.”
• “I cannot estimate my recovery time.”
• “Please send that request to me in writing.”

Do not adopt an adjuster’s description of the accident if you do not agree with it or do not know whether it is accurate.

Do you have to give a recorded statement?

Your own insurance policy may require reasonable cooperation, which can include providing information or a statement. A request from another person’s liability insurer presents a different issue.

Before providing a recorded statement, ask:

• Which insurance company is requesting it?
• Whom does the company insure?
• Is the statement required by your policy?
• What subjects will be covered?
• Will you receive a copy or transcript?
• Has your medical condition been adequately evaluated?

Because Virginia’s contributory-negligence rule can make statements about your own conduct especially significant, consider obtaining legal advice when liability is disputed.

3. Disputing Medical Causation or Treatment

An insurer may question whether the accident caused an injury, whether treatment was medically necessary or whether a pre-existing condition accounts for some or all of the symptoms.

Common disputes include:

• A delay between the accident and the first medical visit
• A gap in treatment
• Treatment that differs from a provider’s recommendations
• A prior injury affecting the same area of the body
• Medical bills the insurer considers excessive
• Future treatment that has not been sufficiently documented
• Symptoms that are not supported by the medical record

A pre-existing condition does not automatically defeat a claim. The legal and medical questions may include whether the accident caused a new injury or aggravated an existing condition.

How can you document the medical claim?

• Seek appropriate care based on your health needs.
• Describe symptoms accurately to healthcare professionals.
• Disclose relevant prior injuries and conditions.
• Follow reasonable treatment recommendations.
• Explain unavoidable appointment or treatment gaps.
• Keep bills, prescriptions and discharge instructions.
• Retain medical work restrictions.
• Ask treating providers about the prognosis and future care when appropriate.

Do not request unnecessary treatment merely to increase an insurance claim. Medical decisions should be based on appropriate diagnosis and care.

4. Undervaluing or Omitting Damages

An adjuster may value the claim differently from the injured person. A low valuation does not automatically establish misconduct, but the offer may be incomplete if it fails to address documented categories of loss.

Potentially overlooked losses include:

• Future medical treatment
• Lost overtime, bonuses or self-employment income
• Reduced future earning capacity
• Rehabilitation and assistive equipment
• Necessary household or personal assistance
• Permanent impairment
• Scarring or disfigurement
• Pain and disruption to daily activities
• Towing, storage and loss-of-use expenses
• Damage to personal property

Property-damage estimates

Virginia’s automobile claim standards require an insurer-prepared repair estimate to reflect an amount for which the vehicle may reasonably be expected to be satisfactorily repaired. The insurer must provide the claimant with a copy, and a total-loss valuation must be provided upon request.

When betterment or depreciation reduces a property payment, the deduction must be documented and itemised under the applicable regulation.

How should you respond to a low valuation?

1. Ask for the offer and its calculation in writing.
2. Request the policy and factual basis for any disputed item.
3. Compare the offer with medical, employment and repair documentation.
4. Identify categories of loss that were omitted.
5. Provide supporting records rather than relying on a general demand.
6. Ask whether additional coverage or another responsible party exists.

Learn more about the factors that may affect the value of a personal injury claim.

5. Offering an Early Settlement With a Broad Release

An early offer is not automatically unfair. It may provide a practical resolution when liability is clear, the injuries are minor, treatment is complete and all losses are known.

An early settlement becomes risky when:

• Your medical diagnosis is not yet clear.
• You are still receiving treatment.
• Additional surgery or rehabilitation may be required.
• You have not returned to work.
• Future earning limitations have not been evaluated.
• Medical bills or liens remain unresolved.
• Another responsible party or policy may exist.
• The release covers more claims or parties than expected.

What does signing a release mean?

A settlement release generally ends the covered claim against the identified people and companies. It may apply to known and unknown injuries arising from the accident.

Before signing, determine:

• Which people and companies are being released
• Which claims are included
• Whether future medical expenses are included
• Whether property and injury claims are both being resolved
• Whether medical liens or reimbursement obligations remain
• How much you will receive after fees, expenses and other deductions

Do not accept or reject an offer solely because it is the first offer. Compare it with the evidence and the rights being released.

Are All These Practices Illegal?

No. An insurer may investigate a claim, dispute liability, request relevant records, question causation and negotiate the amount of a settlement.

The legal concern depends on the conduct, frequency, policy, evidence and applicable Virginia rules.

Virginia Code § 38.2-510 identifies practices that may be unfair when the statutory requirements are satisfied, including:

• Misrepresenting relevant facts or policy provisions
• Failing to respond reasonably promptly
• Failing to maintain reasonable investigation standards
• Arbitrarily and unreasonably refusing to pay claims
• Failing to affirm or deny coverage within a reasonable time
• Failing to attempt a fair settlement when liability is reasonably clear
• Using repetitive proof-of-loss demands to delay a claim
• Failing to explain a denial or compromise offer reasonably

The statute generally addresses conduct occurring with enough frequency to indicate a general business practice. A violation of the section does not, by itself, automatically create a private lawsuit for the claimant.

Can You Request a Written Explanation?

Yes. Ask the insurer to explain the factual, policy and legal basis for a denial, reduction or compromise offer.

Under 14VAC5-400-70, a claim denial must be provided in writing with a reasonable explanation and a specific reference to any policy provision, condition or exclusion relied upon.

A written explanation can help identify whether the disagreement concerns:

• Coverage
• Fault
• Medical causation
• The reasonableness of treatment
• The amount of damages
• A policy limit or exclusion
• Missing documentation

What Should You Do When Communicating With an Adjuster?

1. Identify the insurer. Determine whether you are communicating with your own company or another person’s insurer.
2. Obtain the claim number. Use it in all correspondence.
3. Keep communications factual. Do not speculate about fault, diagnosis or recovery.
4. Use written communication. Confirm important telephone discussions by email or letter.
5. Keep a claim log. Record dates, names, requests, responses and offers.
6. Preserve evidence. Save photographs, video, medical records, bills and employment documents.
7. Review authorisations carefully. Determine which records the document permits the insurer to obtain.
8. Request explanations. Ask for the basis of any delay, denial or reduction.
9. Do not sign an unclear release. Understand its scope before accepting payment.
10. Track the legal deadline. Negotiations do not necessarily extend the time for filing suit.

How Long Does an Insurance Company Have to Respond in Virginia?

Virginia regulations generally require an insurer to acknowledge notification of a claim within 15 calendar days unless payment is made during that period. An appropriate reply is also generally required within 15 calendar days for other pertinent communications that reasonably call for a response.

Different rules may apply depending on whether the claim is first-party or third-party and whether the insurer has received a properly completed proof of loss.

For certain first-party claims, if an investigation remains incomplete, the insurer must provide written notices explaining why additional time is needed at the intervals required by 14VAC5-400-60.

These regulations do not create an automatic settlement deadline or require an insurer to accept a disputed claim merely because a particular period has passed.

How Do You File an Insurance Complaint in Virginia?

If you cannot resolve a claim-handling concern directly with the insurer, you may file a complaint with the Virginia State Corporation Commission’s Bureau of Insurance.

Before filing:

• Write to the insurance company.
• State the problem clearly.
• Include the claim and policy numbers.
• Identify the result you are requesting.
• Attach relevant correspondence and documents.
• Keep a copy of everything submitted.

The Bureau of Insurance may investigate complaints and request a response from the insurer. It cannot guarantee a favourable result or provide the legal representation sometimes needed to resolve a complex personal injury dispute.

How Long Do You Have to File a Virginia Personal Injury Lawsuit?

Under Virginia Code § 8.01-243, a personal injury action generally must be filed within two years after the cause of action accrues.

Other deadlines or notice requirements may apply to claims involving:

• Government defendants
• Minors or incapacitated people
• Medical malpractice
• Wrongful death
• Other special circumstances

An insurer’s delay, continuing investigation or settlement negotiation does not necessarily pause the deadline.

When Should You Contact a Personal Injury Lawyer?

Not every insurance disagreement requires legal representation. Consider speaking with an attorney when:

• You suffered a serious or permanent injury.
• The insurer disputes who caused the accident.
• You are accused of contributory negligence.
• Future medical treatment may be required.
• You cannot return to the same work.
• Several people, companies or insurance policies may be involved.
• The insurer has denied the claim.
• You received a settlement offer before completing treatment.
• You are asked to sign a broad release.
• The filing deadline may be approaching.

Read more about whether you need a personal injury lawyer.

Frequently Asked Questions

Do insurance adjusters intentionally delay every claim?

No. Some delays result from genuine coverage questions, incomplete records, disputed liability or ongoing medical treatment. Concern is more appropriate when the insurer does not explain the delay, repeatedly requests the same information or fails to respond.

Can an adjuster use my recorded statement against me?

An adjuster may compare your statement with other evidence and identify inconsistencies. Be truthful and avoid guessing. Your obligations may differ depending on whether the request comes from your own insurer or another party’s insurer.

Can an insurer blame my injuries on a pre-existing condition?

An insurer may dispute whether an accident caused or aggravated a condition. Prior medical records, post-accident examinations and treating-provider opinions may be relevant.

Is the first settlement offer always too low?

No. It should be evaluated according to the evidence, treatment status, expected future losses, insurance coverage and the scope of the proposed release.

Can I ask why my claim was denied?

Yes. Request a written explanation identifying the factual and policy basis for the denial. Virginia regulations require written claim denials with a reasonable explanation and specific reference to applicable policy provisions, conditions or exclusions.

Can the adjuster require me to use a particular repair shop?

Virginia automobile claim regulations prohibit requiring a claimant to travel unreasonably to have a vehicle inspected, estimated or repaired at a particular shop. An insurer may provide the names of conveniently located qualified repair shops.

Does filing an insurance complaint extend my lawsuit deadline?

Do not assume that it does. Administrative complaints and insurance negotiations generally should not be treated as extensions of the applicable court deadline.

Will hiring an attorney guarantee a larger settlement?

No. An attorney may investigate the claim, preserve evidence, identify coverage and present documented damages, but no lawyer can guarantee compensation or a particular outcome.

Discuss an Insurance Claim With Atkinson Law

Insurance disagreements should be evaluated using the policy, claim correspondence, accident evidence, medical records and applicable Virginia law—not simply by assuming that every adjuster request is a tactic.

Atkinson Law can review unexplained delays, disputed liability, medical-causation arguments, settlement offers and releases. Legal representation does not guarantee a particular result.

Contact Atkinson Law to request a free consultation about a Virginia personal injury or insurance claim.

This page provides general legal information and does not create an attorney-client relationship. Insurance policies, claim requirements and legal deadlines may apply differently depending on the facts.