When you present a car-accident claim, expect the insurance adjuster to do everything in their power to negotiate down your damages. For example, the adjuster may put forth these three arguments to reduce the medical portion of your damages.
You Got Too Much Medical Care
This argument is meant to reduce your medical damages by trimming away the costs of your treatment that the adjuster deems unnecessary. For example, they may argue that out of the 20 visits you made to the physiotherapist, only a half of them were necessary. The adjuster may even use comparison treatments of "similar" accident victims who "recovered" much faster than you.
The best way to rebut this claim is to have an expert witness prove why you received the treatments. After all, no accident victims are ever truly similar. Your diet, overall health, age, sex, genes, and many other factors all determine how fast you recover from an injury. An expert witness will be able to use such factors to prove the necessity of your treatment.
You Overpaid Your Medical Bills
Another argument the adjuster may make is that your treatment shouldn't have cost as much as it did. The adjuster may say this after comparing your medical bill to those of other victim-patients with similar health conditions.
Again, the best thing to do is to refute the adjuster's claim with evidence; you need to prove why those "high" bills were necessary. Here are some of the ways to combat such an argument.
- Prove that you negotiated for the best deal possible; show how you did this (there are several ways of negotiating for a fair treatment cost).
- Prove that you had to see a highly sought-after specialist (who obviously has higher charges than others) because others hadn't managed to treat your condition.
- Prove to the adjuster why the data they are using for comparison is wrong; for example, it may have come from small towns that tend to have lower rates than big cities.
Your Treatment Is Experimental
Lastly, the adjuster may also claim that the treatments you got were either unnecessary or experimental. The only way to convince your insurer of the necessity of the treatment is through your physician or an independent medical expert. Your physician or medical expert has to prove that the treatment isn't experimental or it is experimental but necessary for your condition. An experimental treatment may be necessary if:
- It is widely practiced
- It is acceptable by peer review
- There is no alternative or the alternatives have been exhausted
As you can see, you have your work cut out for you when dealing with an insurance adjuster. Remember to keep your cool and respond to the adjuster's arguments with facts supporting your position or refuting their claim and not with anger. It's also advisable to involve a personal-injury attorney, such as Greg S. Memovich, due to their experience in the negotiation process.