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Adjuster Focus on Red Flags, Medical Treatment

In order to make a decision on particular items in a claim, the adjuster must find out if they are covered by policy, and if so, for how much. After that, the adjuster will consider any factor that will lead to the most financially favorable resolution of the claim.

In fact, the adjuster is so focused on finding anything that looks suspicious or can be used to reduce the offer that he or she may even act on his or her gut feeling about the insured, claimant, or plaintiff. If this happens in your case, it will be harder for the New Jersey accident attorneys to negotiate a reasonable resolution of the case. The following are just a few of the “red flags” that adjusters are instructed to look for.

Medical treatment

Adjusters cannot rely on their subjective opinion of the situation alone. They must confirm and then calculate the amount of damage and loss, which requires questioning several aspects of the case:

  • The adjuster will consider whether the treatment found in the comprehensive list of medical expenses given to him or her is substantiated by available medical reports.

  • A red flag is raised when a certain type of doctor is primarily responsible for treating the claimant. Adjusters will be especially skeptical if only a chiropractor treats the claimant for his or her orthopedic or neurological issues. While the adjuster won’t question the medical value of a chiropractor, he tends to give more weight to a more established physician such as a neurosurgeon.

  • The amount and the frequency of treatment will be scrutinized. Adjusters will keep an eye for claimants frequently receiving long-term physiotherapy treatments that have not yielded discernible results.

  • Adjusters are typically skeptical about soft-tissue injuries, especially if the claimant alleges resulting chronic pain and disability, despite no accompanying conditions and little or no objective medical findings available to support his or her claim.

  • Adjusters will be on alert if the medical bills seem too exorbitant considering the alleged injury. Excessive charges for physical therapy, pre-existing complaints, and medical treatment on the same location of the body all raise red flags.

  • Adjusters will question any treatment atypical for the kind of injury being claimed, such as a psychiatric referral for low-impact accidents or soft-tissue injuries.

  • Adjusters will question the doctor’s records and credibility if they observe a pattern of the doctor and a law firm referring clients and patients to another.

  • If plaintiff’s New Jersey accident attorneys are exclusive with a doctor, the client being treated by this doctor will be scrutinized. The adjuster may request an independent medical examination conducted by another even if it’s not usually necessary for a given case.

If you are seeking legal counsel from seasoned New Jersey accident attorneys, please call the law offices of Gerald H. Clark today at 1-877-841-8855. The initial consultation on your personal injury case is free.

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