The Playbook: Common Tactics Used by Insurers
Insurance companies are for-profit entities. Their financial health depends on taking in more in premiums than they pay out in claims. This fundamental business model incentivizes a range of strategies designed to minimize claim payouts. Understanding these tactics is the first step toward effectively countering them.
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Lowball Settlement Offers: This is perhaps the most common tactic. An insurer may quickly offer a settlement that seems attractive at first glance, especially to someone facing mounting medical bills and lost wages. However, this initial offer is almost always calculated to be far below the claim’s actual value. It often covers only a fraction of immediate medical costs, ignoring future care, long-term impacts, and non-economic damages like pain and suffering. The hope is that the claimant, in a vulnerable state, will accept the quick cash and sign away their right to pursue further compensation.
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Delay, Delay, Delay: The insurance industry understands that time is not on the side of an injured claimant. The longer a claim remains unresolved, the more financial pressure builds on the individual. They may be unable to work, facing collection agencies for medical bills, and desperate for funds. Insurers employ delay tactics by taking weeks to respond to correspondence, requesting unnecessary documentation repeatedly, frequently changing adjusters assigned to the file, and prolonging investigations. The goal is to force the claimant into accepting a lowball offer out of sheer financial desperation.
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Denying Claims Outright: An insurer may simply deny a claim, often citing specific policy exclusions or language they claim applies to the situation. They may argue the claimed injury isn’t covered, that the policy had lapsed due to a missed payment, or that the incident was intentional and therefore excluded. This outright denial is a powerful tactic intended to make the claimant believe they have no recourse and to abandon their claim entirely.
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Disputing Causation: In injury claims, an insurer will frequently argue that the claimant’s alleged injuries were not caused by the insured event. For example, following a car accident, they may claim that a herniated disc shown on an MRI was a “pre-existing condition” or the result of a subsequent, unrelated event. They will meticulously scour medical records for any mention of prior pain or injuries to use as leverage to reduce their liability.
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Requesting Excessive Documentation and Recorded Statements: While insurers have a right to investigate a claim, they often abuse this right. They may request years of prior medical records, employment history, and other personal documents far beyond the scope of the current claim. More critically, they will often ask for a recorded statement early in the process. These statements are not casual conversations; they are carefully crafted interrogations designed to get the claimant, who is often still in pain or on medication, to say something inconsistent or damaging that can be used later to devalue or deny the claim.
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Misinterpreting Policy Language: Insurance policies are dense, complex contracts filled with legal jargon. Adjusters may misrepresent or misinterpret specific clauses to suggest coverage does not exist or is limited. They count on the policyholder not having the legal expertise to read and understand the fine print of their own contract.
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Shifting Blame onto the Claimant: In liability cases, the insurer will actively work to assign a portion of the fault to the injured party. Most states follow comparative negligence laws, meaning if a claimant is found even partially at fault, their recovery is reduced by that percentage. An adjuster will aggressively look for any action the claimant took that could be construed as contributing to the incident to minimize the final payout.
The Counter-Playbook: How a Lawyer Fights Back
An experienced personal injury or insurance bad faith attorney does not merely react to these tactics; they anticipate and neutralize them. A lawyer transforms the dynamic from an uneven fight between an individual and a corporation into a strategic battle between equals.
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Case Valuation and Rejecting Lowball Offers: A lawyer brings expertise in accurately valuing a claim. They calculate the full extent of damages, including all current and future medical expenses, lost earning capacity, lifelong care costs, property damage, and non-economic damages like pain, suffering, and loss of enjoyment of life. They have access to medical experts, economists, and vocational rehabilitation specialists to build a data-driven, irrefutable picture of the claim’s true value. They formally reject lowball offers in writing and counter with a robust demand package supported by evidence.
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Imposing Deadlines and Fighting Delay with Litigation: Lawyers understand that delay is a weapon. They counter it by imposing strict deadlines on insurers for responses and actions. If an insurer is deliberately stalling, a lawyer will not hesitate to file a lawsuit. The moment a lawsuit is filed, the case moves into the discovery phase, a structured legal process that forces the insurance company to comply with deadlines for producing evidence, disclosing information, and providing depositions. This immediately removes the insurer’s ability to control the timeline.
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Investigating and Building an Unassailable Case: When an insurer denies a claim, a lawyer conducts their own independent and thorough investigation. This includes gathering all evidence immediately—securing police reports, identifying and interviewing witnesses, photographing the scene, and retaining accident reconstruction experts if necessary. They work with medical professionals to establish a clear, documented link between the accident and the client’s injuries, creating a “chain of causation” that is difficult to break.
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Shielding the Client and Managing Communication: A fundamental rule once you hire an attorney is that all communication from the insurance company goes directly to the lawyer’s office. The attorney becomes the sole point of contact. This protects the client from making inadvertent, damaging statements. The lawyer will handle all requests for information, ensuring only relevant and appropriate documents are provided. They will flatly refuse requests for recorded statements from their client, knowing the inherent risk.
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Interpreting Policy Language and Pursuing Bad Faith Claims: Lawyers are experts in contract law and insurance policy interpretation. They can dissect the fine print of a policy to identify coverage that an adjuster may be ignoring. Furthermore, if an insurer’s tactics cross a line from hard bargaining into unfair dealing—such as refusing to pay a claim without a reasonable investigation, failing to communicate, or misrepresenting policy terms—the lawyer can file a separate “bad faith” lawsuit. Bad faith claims can result in the insurer being forced to pay the full value of the claim plus significant additional damages and penalties, creating a major financial disincentive for unethical behavior.
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Employing Expert Witnesses: To counter an insurer’s disputes over causation or injury severity, a lawyer will engage a network of credible expert witnesses. Orthopedic surgeons, neurologists, economists, vocational experts, and life care planners can provide sworn testimony and reports that objectively validate the client’s injuries, their cause, their impact on earning capacity, and the cost of future care. This expert testimony often forms the bedrock of a strong case at trial.
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Preparing for Trial: The ultimate weapon in a lawyer’s arsenal is the credible threat of a jury trial. Insurance companies are primarily concerned with their bottom line. While they may bluff an unrepresented individual, they know that a skilled trial lawyer is prepared to take a case all the way to a verdict. Juries can award sums far larger than what an insurer is willing to offer in settlement. The vast majority of cases settle out of court because insurers seek to avoid the unpredictability and expense of a trial, but this only happens from a position of strength built by a lawyer who is fully prepared to win in front of a jury.
