ADJUSTER GIVES BAD “LEGAL ADVICE” TO PARENTS OF AN INJURED CHILD. MOST ADJUSTERS DO NOT HAVE LEGAL DEGREES AND ARE NOT LAWYERS. But at M&W we continue to see situations where adjusters give legal advice or draw legal conclusions about issues related to a claim.  The parents of a minor recently consulted our office about their 18 year old son’s auto-negligence claim. He was hurt in a car accident almost two years earlier and the adjuster was trying to pressure the parents into accepting a settlement offer because the statute of limitations was about to “expire” on the son’s claim. The adjuster even sent the parents a letter stating that the statute was about to expire and that they better take the settlement before it was too late.  The adjuster’s legal conclusion was wrong. Alabama law has special tolling provisions for the statute of limitations for the claims of minors. The statute of limitations was not “about to expire” as claimed by the adjuster.  Whether the adjuster’s misrepresentation was intentional or because of inadequate training, it exemplifies problems we see when adjusters try to draw legal conclusions or explain legal concepts to claimants. Keep in mind that more and more insurance companies are using “regional adjusters” to handle claims in multiple states. These adjusters are given basic summaries of the laws for the various states but the laws can vary from state to state.

            Another area of frequent inaccuracies is when adjusters try to explain and handle legal issues surrounding subrogation claims against benefits owed.  Subrogation is where one insurance company or government entity seeks reimbursement from a liability settlement for benefits paid. For example, if you are hurt in a car accident your health insurance carrier may pay for your ambulance bill and emergency room bill. The insurance company for the at-fault driver is obligated to pay you for those bills but you may have to reimburse your health insurance company since they already paid the bills. This is known as subrogation. However, as simple as the concept of subrogation may seem, it is an extremely complex area of law. Depending on what benefits are received, Federal and/or State laws may govern how much money you may have to repay. There are also extreme variations in subrogation clauses in health insurance polices and against what type of benefits a subrogation claim can be asserted.  A third party liability adjuster who tells a claimant how much of the settlement proceeds have to be repaid to a health insurance company, or government entity such as Medicare, is making a legal conclusion that he or she may not be properly trained to make.  We recently saved an elderly client over $16,000.00 in settlement proceeds that the adjuster was going to pay on a subrogation claim. In addition, we helped her secure an additional $15,000.00 over and above the offer made to her before we were hired.