The insurance company and insurance adjusters
From the outset of a maritime accident, the administration of the claim and any payments of medical bills may be taken out of the hands of the company and placed in the hands of the insurance company. At the forefront of this system is the insurance company adjuster. His job is to “adjust” the claim. The insurance company, usually located in another state or abroad, must have someone employed locally who can learn about the incident and then inform them whether the claim has merit and if so, how much the insurance company should pay to resolve the claim. To do so the adjuster must secure witnesses’ statements, medical reports and medical expenses.
A second role of an adjuster may be to negotiate with the injured worker a monetary settlement. At that point the adjuster is working on behalf of the insurance company; it is his goal to secure a settlement at the lowest possible dollar figure. As such, he is not advocating on behalf of the injured worker; any representation to the contrary is untrue. If the adjuster is attempting to negotiate a settlement, his requesting a long, detailed statement is very risky business for the maritime worker.
The relationship of the maritime worker with his or her company may be of no consequence once the insurance company begins to “process the claim”. This occurs shortly after the accident. It is the insurance company which must ultimately shoulder the financial burden, and it is the insurance company which calls all of the shots.
Promises to “make good on the accident” or “to take care of our valued employee” may lack legal support unless they are preserved through a valid written contract. If a maritime worker is promised anything, that is a job, pension benefits, etc., such an agreement should be preserved in writing. As will be discussed later, settlements have great weight when in writing. Very few oral agreements have a binding effect. After a settlement, the insurance company will require you to preserve your promise not to sue in writing; why shouldn’t you be afforded the same privilege?
Adjusters are well-trained professionals who handle claims on a day-to-day basis. They are seasoned veterans who know their job very well. We have never met an adjuster who was not a “nice guy.” To reduce the value of a maritime worker’s claim they will call you, talk with you and your family members, employ private investigators, or do whatever possible to gather information which may be damaging to your claim. They may coerce you by delaying maintenance payments sorely needed by you to provide for you and your family needs. If you feel uneasy discussing your claim with an adjuster, it is probably for a good reason. In dealing with insurance companies, you are not dealing on equal ground.
The writer of this booklet has been criticized on more than one opportunity about the foregoing remarks about adjusters; most of the criticism has been levied by maritime employers or by the adjusters themselves. It must be noted that the adjusters are just doing their jobs. If, however, they are being used to negotiate a settlement, be fully aware that their job is to have the insurance company write the smallest check acceptable to you for you to settle your claim. Their job is to limit the awards or settlements of the maritime worker. They are working for the insurance company who must ultimately foot the bill. They are working for your employer and its insurance company; they certainly are not working for you!