How to Deal With an Insurance Adjuster After an Injury

The other driver's insurance adjuster works for the insurance company and its customer, not for you. Be polite and give basic facts. You do not owe that adjuster a recorded statement, open access to your medical history or a quick signature on a release.

Who does the adjuster work for?

An adjuster for the at-fault driver's insurer represents that company and its policyholder. The Illinois Department of Insurance puts it plainly. In a third-party claim, "you do not have a direct contract with the insurance company and their primary obligation is to their own policyholder."

Your own insurer is different. Your policy is a contract, and it usually requires you to cooperate with your company's investigation. Check the "duties after an accident or loss" section of your auto policy before you refuse a request from your own adjuster.

This matters most for claims under your own coverage, such as PIP, MedPay or uninsured motorist benefits. The rest of this guide is about the other driver's insurer.

Do you have to give a recorded statement?

Not to the other driver's insurer. With no contract between you, there is no policy clause that obliges you to answer its questions on tape.

The request often comes in the first phone call, sometimes within a day or two of the crash. Anything you say can be used later to argue that you caused the crash or that you were not really hurt.

You can decline and offer a short written account instead. Stick to the date, time, location, the vehicles involved and the police report number. Leave out guesses about speed, distances and how you feel.

Why be careful with medical authorizations?

An adjuster may send a form letting the insurer collect your medical records directly. Many of these forms are far broader than the claim, covering every provider, every year and no end date.

Federal privacy rules set a minimum for these forms. Under HIPAA, at 45 C.F.R. §164.508(c), a valid authorization must describe the information "in a specific and meaningful fashion." It must also state its purpose and carry an expiration date or event.

You can revoke an authorization in writing at any time, under §164.508(b)(5). Records already released before you revoke stay with the insurer.

The safer approach is to send the records yourself. Include only the providers who treated this injury. Add prior records for the same body part only if the insurer has a fair reason to ask.

Should you accept an early settlement offer?

Usually not until your treatment is finished or your doctor says you have reached maximum medical improvement. An early offer comes with a release, and a release ends the claim for good.

The Illinois Department of Insurance warns about this. A release means "the amount offered is the only amount you will ever receive from the other driver and the insurance company." If your knee needs surgery six months later, the release still stands.

You can settle the car and the injury separately. Illinois says an insurer "may not refuse to pay your agreed-upon property damage claim because the bodily injury claim is still outstanding." Read any property damage check or form to make sure it does not release injury claims too.

Your own insurer faces a related limit in Texas. Insurance Code §541.060(a)(6) bars enforcing a full release from a policyholder after only a partial payment, unless it settles a disputed claim. See how settlements are calculated before judging any offer.

What rules do adjusters have to follow?

States regulate how insurers handle claims through unfair claims settlement practices laws. California and Texas show how specific they get.

California. Insurance Code §790.03(h) lists practices insurers may not commit knowingly or as a general business practice. They include misrepresenting facts or policy terms to claimants, and failing to act "reasonably promptly" on claim communications. Others are failing to settle in good faith once liability is "reasonably clear" and failing to explain a denial or compromise offer.

California's regulations add deadlines. Under 10 C.C.R. §2695.7, an insurer must accept or deny a claim within 40 days of receiving proof of claim. If it needs more time, it must write to you every 30 days explaining why, and a third-party denial must be in writing.

Texas. Insurance Code §541.060 also bans misrepresenting coverage and failing to settle fairly once liability is reasonably clear. Refusing to pay without a reasonable investigation is banned too. Chapter 542 sets payment deadlines, including 15 days to acknowledge a claim under §542.055.

Chapter 542 applies only to first-party claims, meaning claims on your own policy. It does not cover your claim against the other driver's insurer. If an insurer ignores these rules, complain to the California Department of Insurance at 1-800-927-4357 or the Texas Department of Insurance at 1-800-252-3439.

How should you communicate with the adjuster?

Put it in writing whenever you can. Email creates a dated record, and it gives you time to check facts before you answer.

• Open a claim file and write down the claim number, adjuster's name, direct phone and email.
• After any phone call, send a two-line email confirming what was said and agreed.
• Answer only the question asked. "I don't know" is a complete answer when you don't.
• Don't discuss fault beyond the basic facts, and don't guess at your injuries or recovery time.
• Ask the adjuster to put every offer and every denial in writing, with the reason.
• Send documents by email or certified mail and keep copies of everything.

When should you stop talking and hire a lawyer?

A lawyer is worth calling when the stakes or the pressure rise. Once you hire one, you can send all adjuster contact to the lawyer. Common signs it is time:

• You have a fracture, surgery, a head injury or treatment lasting more than a few weeks.
• The insurer disputes fault, or says you share it. Your state's negligence rule can cut or bar your recovery.
• The adjuster pushes for a recorded statement, a broad authorization or a quick release.
• The offer arrives before your treatment ends, or the claim is denied without a clear reason.
• Your filing deadline is a few months away. Talks with an adjuster usually do not pause the statute of limitations.

For a small claim with clear fault and quick recovery, you may not need a lawyer at all. If you want to compare firms, our city rankings rank injury lawyers on Google Maps position and reviews.