Soft Tissue Injury Fraud

soft tissue injury fraud

There is a common idea among insurance adjusters that the majority of soft tissue injury claims are fraud.

Let me put my opinion out there.  As an injury adjuster for years, I saw almost every type of injury claim out there, including a lot of soft tissue injuries.  For those of you who don’t know, soft tissue injuries are injures that do not include any breakage of the skin or bones.  They are normally describes as strains or sprains.  Anyway, here is why adjusters think there is such rampant fraud. . . .

Attorneys and chiropractors solicit accident victims.  I have seen it many times and the victim is an innocent bystander to the actual fraud.  Here’s the common scenario.

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HYPE! hehehe

IT IS COMING! ! ! Watch for the WORLDWIDE RELEASE of a comprehensive new e-book that details the industry of auto claims!

If you ever wanted to know how a total loss is calculated, or what the adjuster is taught in preparation to take their license exam, or even if an adjuster has to be licensed, or how an insurance company determines what to charge you, or if that small accident is going to affect your rates and why, or how to avoid your rates from increasing, or how a salvage lot works, or who is really in charge in the claims department, or what the real adjuster’s rules are, or how insurance companies find such “shady” individuals to be adjusters, or that obscure case siting that supports your unusual accident scenario or . . . or. . . . or. . . . you get the idea, right?   This book is comprehensive from beginning to end and covers more than the average person would ever want to know about automobile claims, automobile insurance, automobile adjusting, and everything related to those subjects. . .I assure you that after you read it, you will want it by your side if you ever have to deal with an automobile claim.  From how to negotiate with the “hardnosed” adjuster, to insider tactics that claims executives would never tell you.  It’s almost like I’m that guy in the black mask revealing all the “secrets” behind the best magic tricks around.

Auto Accidents – An Insider’s Commentary is coming soon!  It will only be available for purchase directly from Petty Details, LLC.  Watch for the release before the end of 2009! !  It’s going to generate a lot of talk in adjuster’s circles, and I’ll probably never be able to get a job as an adjuster with an insurance company again!

Written by Justin Petty (the rugged, intelligent adjuster, ha!)

Yes sir, officer, well you see. . . I was testing out my new “turbo-boost”
button, you know, like Night Rider’s, me and my dad built it, but anyway. . .
here’s what happened. . . . .

Texas Small Claims Court

If I had a nickel . . . .

Okay, so you have run into a brick wall and can’t get justice served, right?  If you live in Texas, if justice means recovering money from somebody or company that owes you $10000.00 or less, then you can probably force the issue to a head by doing a little research on the Small Claims court rules.  They are located in the Texas Government Code, Chapter 28.  The rules of battle are clear and simple enough for most to understand with just a little research. 

Here are some general tips, and if you really want to get detailed, click on the title of this posting and you’ll be at my free resources page on our website:

1.  Don’t sue unless you have tried every other possibility.
2.  Do your homework.  The best way to win is to be right!
3.  Call the clerk of the court and ask general questions about procedure.  (Is the Judge informal? Does he conduct the hearing just like it says in Chapter 28 of the Government Code or does he allow the formal Rules of Civil procedure to take precedence?)
4.  Research your opponent!  Will they have an attorney?  Will they show up?  Can you get them on the telephone? Do they have any money or non-exempt property of value?
5.  Do you understand the deadlines and how to appeal if you happen to make a mistake and lose on a technicality?
6.  If you get in over your head, are you willing to just give up, or can you afford an attorney?
7.  Find all the free resources you can and ask many questions. 

Basically, if you have a valid reason to use Small Claims Court and your damages are within the limits allowed, then it can be a very useful way to get justice served.  Frankly, most people are not very informed about how the legal process works, but more people are coming forward to help out the consumer that is being “bullied” by either a landlord, or an insurance company that is fully aware of the fact that most people won’t sue because they can’t afford an attorney.  In 2007, Texas increased the limits for Small Claims Court and for Justice Courts from $5000.00 to $10000.00.  In my opinion, this change was an attempt to lessen the caseload of “minor claims” in the higher courts of record.  This is beneficial to people who know how to apply their constitutional right of access to the courts.  Normally, it costs less than $100.00 to get an official lawsuit on the books in Small Claims court, and a judgment from a Small Claims court is just as powerful as a judgment from any other court.  Depending on the circumstances, if you are forced to file a suit to recovery monetary damages, and you get to the point of having a judgment (my research and experience shows that about 80% of suits settle before a judgment is actually rendered), then the judgment can be used to garnish a bank account, seize non-exempt property, negatively affect credit ratings, and even suspend a driver license in some cases. 

If you need to use the Small Claims court, don’t be afraid to try your luck, I assure you it will be a learning experience and you will be better off in the future, win or lose.  For free information about how the Small Claims Courts in Texas work, call me or visit my website, I’m sure you can find the information you need to get your dispute resolved for a cost that is much less than what an attorney would charge.  Attorneys generally do not have the time to mess with small claims, they have big clients and bigger fish to fry that will make them much more money.  Also, be advised that I am not an attorney, and I do not give legal advice, I simply have the tools to point you to the information you need which is available for free in the public domain and on the internet.  Additionally, I provide help with finding information for free!

Good luck!

Injury Claims – How much are they worth?

In deciding to try and help auto accident victims I seem to have created some enemies, hehe.  Oh well.  I will continue to give honest and straightforward answers to the questions that accident victims have.  Recently I have had quite a few questions that relate to how to calculate how much a minor injury claim is worth.  In response to the numerous questions, I wrote an e-book which is available for purchase by clicking on the title of this posting.  I will also answer questions for free if you e-mail me or call me, but if you want it in writing to refer to when I am not personally available, you’ll have to make a very small investment.  Although I won’t give away all of my secrets here on the blog, I will offer some free tidbits and general information that will compliment the e-book. 

One of the things that I did not address in my e-book is the use of the Colossus system.  It has been said that out of the top 20 auto insurers, 12 or 13 of them have licensed Colossus.  In fact, there are a couple of articles on E-zines that list out the companies which have licensed Colossus.  For those of you that don’t have a clue what Colossus is, let me explain. . . .

Colossus is an injury claim evaluation software program.  In the most simple terms, insurance adjusters that evaluate injury claims plug in various different terms and factors from your medical reports, occupation, doctor’s office, lawyer’s office, and a lot of other “proprietary” information and then Colossus compares the information with its “database” of similar injury claims.  Once it has analyzed the information, it generates a “suggested settlement range”.  Although insurance companies won’t admit that their adjusters are required to stay within the program’s suggested range, I am here to tell you that for those companies that use it, it is “heavily relied upon”, hehe.  The insurance company will insist that the adjuster retains the ultimate authority on determining the settlement range, but they fail to tell you that when that same adjuster gets his/her “review”, then they will be evaluated on how well they settled claims within the “suggested range” from Colossus.  Additionally, although I can’t prove it, there has been testimony that some companies “filter” out the “unusual” high settlements that would make up the database of “similar” claims. 

Ultimately, my e-book explains the philosophy and the methods used to evaluate the value of an injury claim, and even Colossus has to use some of the same standards like determining the tendency of the venue and such.  I would suggest that if you have an injury claim and you are dealing with it on your own, that you do a little research to try and determine if the company you are dealing with uses Colossus or any other software to evaluate your injury claim.  If you determine that they do use a computer to “assist” with the evaluation, be frank and up front with the adjuster.  It is likely that the adjuster will help you to provide the “correct” information that they can input into the software to get your claim settled.  The software gives you back what you put in, and you just have to know what to put in, you know?

Injury claims are each different.  Getting a list of the most used and “universal” factors used in evaluating an injury claim is how you can get a rough idea of what your claim is worth.  Utilizing things like the “Stowers Doctrine” and being well advised on the methods used for evaluation will add up quickly when it comes to getting the right settlement for your injury. 

I hope you never have to file an injury claim, but if you do, I hope you find me so I can add to my list of people I have helped.  It just makes me feel good, you know?

Rental Car Companies, Tricky Tricky

I recently wrote an in-depth article about the perils of renting a rent car.  Let me recap. . .

1.  If you don’t purchase the damage waiver, beware.
2.  Make sure your insurance will really cover “contract” liability.  There are some newer policies that specifically exclude coverage for rental car damages under contract language.
3.  If you didn’t purchase the damage waiver, insist upon a written inspection report on the vehicle to be rented prior to leaving in the vehicle.
4.  Be meticulous in documenting any damages on the vehicle.  Do not forget to make note of windshield chips, minor scratches, stains, radio functions, antennae function, wheel scuffs, etc. . .
5.  No matter how insistent the rental company is that minor issues do not need to be noted, note them anyway.

The point of this advice is that it is very difficult for you to prove that you did not cause the damages if you don’t have evidence to the contrary.  It is common for a rental car company to file a claim with your insurance company for minor damages and inflate the costs related to repairing them and then negotiate for a settlement and make extra money.  They sometimes don’t even fix the vehicle and then file the same type of claim over and over again on customers insurance policies.  If this happens to you, the best advice I can give is to make sure your adjuster asks the rental company for the historical records on the rental car in question, including the prior inspection forms that were completed on the vehicle.  Many times, if the rental company can’t produce evidence that the damages weren’t there when you rented the vehicle, they will give up the fight for free money.  It is amazing how many adjusters fail to ask for this type of documentation when being presented with a damage claim from a rental company. 

Don’t be tricked by a rental company!  It could affect your insurance premiums and your credit, depending on how persistent the rental company is.  Sadly, some of the bigger names in rental companies use this tactic often.  I guess this is why they “bigger”.

Proper Use of Resources

For a small to medium sized auto insurance claims department, the best method for maximizing subrogation recovery and reducing claims severity is to hire one specialist for every 500 subrogation potential claims that are open at any one time.  Then train that specialist to promptly and effectively recover the easy money claims while sending out the “hard dollar” claims to a specialty vendor, not a subrogation mill.  By specialty vendor, someone or company that can demonstrate the ability to recover money from uninsured motorists, not a company that works for a lot of large carriers (they count on the carrier missing easy money and in my experience don’t do a good job at recovering from uninsured motorists).  The prime scenario would also include utilizing the “hard dollar” specialist to audit subrogation demands and specialty demands for proper payouts.

This scenario which is hard to find, is where my company specializes.  By utilizing a company such as ours (the only one that exists), a small to medium sized company can kill two birds with one stone and maximize uninsured motorist recovery while at the same time minimizing the amount of money they pay out on subrogation and related matters like diminished value.  By specializing in these niches, Petty Details,LLC provides the most bang for a company’s buck!

What can you do with an adjuster’s license?

If you are wondering what you might be able to do with an adjusting license, you are not alone.  Outside of being a desk adjuster for an insurance company (a pretty good option for a lot of people as one can earn upwards of $50k per year after just a short while in the industry), there are not many other great options if you have no experience.  First of all, don’t let anybody tell you that you can become a catastrophe adjuster with no experience.  Many aspiring adjusters think they can just fall into this career because it does pay pretty well, but only during catastrophe’s, and it is just not that easy.  A cat adjuster is somebody that goes out and evaluates damages to property on behalf of an insurance company.  These adjusters are also called independents.  A property and casualty license in Texas will allow you to “qualify” for this type of work, but it takes much more than just a license.  Additionally, other certifications will likely be required, such as those required to evaluate and adjust flood damages.  On top of the specialized training you will need, you will also have to invest in a great computer, great wireless technology, and great estimating software.  Even then, if you don’t have some contacts in the construction and insurance industries, you will likely fall by the wayside very quickly.  Anyway, so cat adjusting is something I would not suggest unless you are just hell bent on it.  The other options you have are limited.  I have been adjusting insurance claims of one type or another for nearly 15 years, and there are not that many opportunities to make more than $60K or $70K per year unless you are well up there in the experience range.  It is experience more than education that speaks to one’s adjusting ability and prowess.  If you are very well disciplined, then you might move up the line into litigation or some other specialty within 5 to 10 years, but you will have to work your way up the ladder.  I have seen few exceptions to this rule, and those exceptions were based on “politics”.  You know, like knowing somebody high up on the ladder.  The other option I see is self employment.  You would have to get some specialty licensing and I would still suggest having experience of at least 5 years before trying to delve into a business of auditing and specialty adjusting.  It is difficult to master all the nuances of claims adjusting without hands on experience.  If you still have questions or want more detailed information on how to become an adjuster, visit my official site and give me a call or shoot me an e-mail.  I will be more than happy to tell you what I know.

Texas Driver License Suspensions

Why can’t people just look up the law on their own?  I cannot figure out why some people can’t help themselves.  I guess that is why I exist, hehe.

Really though, if you are getting calls or letters from an insurance adjuster or subrogation specialist, you would do yourself good to follow my articles on E-zines.

Texas Driver License Suspensions – Can you be suspended due to an auto accident?

If you have a Texas Driver License and somebody has called you or sent you a letter threatening the suspension of your driver license over an auto accident, it is highly possible that it could actually happen, but it is just as probable that the person making the threat doesn’t actually understand the rules as they apply in Texas. Only the Texas Department of Public Safety can suspend your driver license (and the DPS doesn’t call people to advise of a pending suspension, they will send a written notice). What an individual, insurance, or subrogation company can do is request the suspension of your license in accordance with Chapter 601 of the Texas Transportation Code, and there are a lot of exceptions and rules that have to be followed (it is notable that if you don’t have a license, a proper request will keep you from getting one, and the suspension is supposed to affect your registration, too).

If the person calling you is an insurance company or subrogation firm, they probably know how to get you suspended, and it is not required that you be sued. You can lose your license, registration, and ability to get a license even if you have not been sued. If you have been sued over an auto accident and you lost, then 99% of the time, you will be losing your license and registration privileges until you pay. Anyway, non-suit Texas driver license suspensions are what this article is about, so here are some of the requirements your case will have to meet in order for your license to be in true jeopardy.

The Texas Safety and Financial Responsibility Act has exacting rules that relate to the ability to get an individual’s driver license suspended due to a violation of the act, here they are in layman’s terms:

  1. The accident must have happened on a public highway, road or way (like an alley) as defined by Texas rules.
  2. Somebody has to file an accident report, either a police officer or a party that was involved in the accident.
  3. There has to be a “reasonable probability” that you were at fault (like the police put on the report that you rear-ended somebody, or there are witnesses against you). This is the trickiest part, because there are so many factors that can indicate fault.
  4. There must be bodily injury (any amount) or damages to an apparent extent of $1000.00.
  5. If you are the owner of the vehicle, then you must have allowed the use of the vehicle either by saying the driver could use it, or by making it apparent by your actions that it was okay.

Keep in mind the rules I am relaying only apply to Texas and violations of the “financial responsibility law”. If all of these factors apply to you, then it is likely that your license will be suspended if the party threatening to take action follows the proper rules (in Texas) for requesting the suspension. Now, what can you do to protect yourself? Are there any loopholes? My best answer is “sort of”.

If you were unfortunate enough to be involved in an accident that is probably your fault, and if you didn’t have insurance or some other way of complying with the financial responsibility law, then you have few choices.

Here they are:

  1. Pay for the damages.
  2. Most companies will take less than what they are asking for if you can pay a lump sum, so if you have a little money, try and make a settlement for less than the alleged damage amount.
  3. Work out a payment arrangement with the insurance company, subrogation firm, or person that is threatening you (it must be a written agreement that the State will accept in order to properly protect your license).
  4. Fight about whose fault the accident was. In order to do this you must follow the rules for requesting a hearing when you get your first notice of suspension (also it is advisable to make sure the Department of Public Safety has your correct address because they will use the address on your driver license for all notices and you have a time limit to request a hearing).
  5. If you were the owner of the vehicle that was involved in the accident, and the person who wrecked your car didn’t have permission to use your vehicle, then fight about that (again, you have to use the hearing rules to fight).
  6. Always make sure you have researched all avenues of possible insurance. Sometimes you could be covered and just not be aware of it (like if you are a full time college student and your parents have insurance).

If you (as the owner) or the driver of your vehicle weren’t financially responsible at the time of an “at fault” accident, then the above things are pretty much the only things you can do to avoid Texas driver license suspensions outside of hiring an attorney. So, be careful about making the assumption that your license can’t be suspended for an auto accident (if you were uninsured). I can’t tell you how many times I tried to explain this to people and they simply didn’t believe me, so they ended up with a license suspension, and then having to call me to negotiate for their license or risk the consequences. If you get pulled over and you don’t have a valid license, you can be taken to jail. It is probably the best (and right) thing to do is to work out a payment plan to protect your driving privileges.
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Texas Diminished Value Claims

Where do some of these “diminished value experts” people get off?  I agree that insurance companies are not so inclined to pay diminished value, and people sometimes get dollar signs in their eyes when they are involved in an accident that is not their fault.  The reality is that diminished value exists, but it is definitely hard to prove. There are arguments that adjusters use all the time to try and dismiss a valid claim and save a few bucks.  The problem is that most of the “diminished value experts” out there have never actually been adjusters.  Through a little research of my own, I have found that at least four of the companies that heavily advertise diminished value services do not even have an adjuster’s license, much less actual experience adjusting.  Tactics like picking and choosing favorable points from different case laws or inappropriate “rules” are all too common.  The fact is that it takes someone who has experience adjusting claims, and has experience evaluating vehicle damages and values to properly evaluate the loss in market value of a vehicle.  Simply being an auto salesman or a damage appraiser is not enough (in my opinion).  Each only deals with one aspect of any vehicle’s value.  The salesman is out to sell a vehicle for a profit and deals in retail values and “trade in” values, and the damage appraiser is trained to identify damaged parts, and on repair methods.  Neither alone makes for a good diminished value appraiser.  Even someone who has both experiences under their belt is not the prime candidate.

I have to toot my own horn a little in this field as I have been in front of Judges and have been challenged by attorneys as to the level of my expertise in determining diminished value.  It is complicated.  First of all, the most common type that is owed by an insurance company is inherent diminished value.  One of the factors that goes into my formula for inherent diminished value is a fluctuating factor, “current market trends”.  I have recently written a report, and since it is likely going to litigation, I won’t give details, but I’ll give a similar example so you can see my point.

If one owns a vehicle that is over 8 years old, many companies will not consider diminished value on the vehicle (until their insured is involved in a lawsuit).  It is ridiculous to use this type of a “rule”.  What if I have a 1965 Ford Mustang that is damaged in a collision?  The marketability of the vehicle is a primary factor in determining how much value it could potentially lose due to sustaining collision damages and having to be repaired.  In addition to the market tendencies, the location of the damages, the components damaged, the general condition of the vehicle and a many more factors are needed in order to accurately estimate a loss in market value.

If you are an insurance company that will not appropriately evaluate diminished value, be advised that I am out here, and my reports will be admitted at trials as my methods and credentials will pass a “Daubert Challenge”.  I do not inflate any diminished value claim, and many times, I do not find any diminished value.

If you believe you have a diminished value claim, before you go off threatening suit, be sure your evidence is sound and not just some report filled with speculation by an untrained party.   

Drop us a line!