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.

A victim has been in a crash and within days, they get a call from somebody pretending to be an insurance company representative (most of the time).  This person will go into detail about the injuries the victim may have sustained and explain how serious they can be and how bad the long term effects are.  The problem is that the person has no idea whether the victim is injured, but they will tell the victim that they can come get checked out for free and just “make sure”.  I have to say that the whole pitch is normally pretty sophisticated.  It can convince a person that they need to be checked out, even if they are just sore.

injury ebookNow, once they get to the “doctor’s” office, they will be put through a series of tests that are designed to point out any pain a person may have, and then when there is “pain” then there is a reason for treatment.  The problem is the “placebo” effect.  Just think about it, if you have a “doctor” (chiropractors are not medical doctors) tell you that something is wrong with you, then all of the sudden you start to really feel that problem.  It’s like when you wrecked on your bike as a kid and weren’t really hurt very bad and didn’t even cry, but then you saw that little speck of blood on your knee and all of the sudden the pain was much worse, hehe.  It is the same thing.  The victims aren’t responsible, they really think they are hurt because of what the “doctor” or attorney is telling them.  In reality, just like with the scrape, if you just give it a couple of weeks, the soreness goes away.  I’m not saying that if you are experiencing pain that you shouldn’t get it checked out, I mean don’t be stupid, you know?  But if you are sore after an auto accident, just realize that is normal and a medical doctor that is not associated with an attorney will almost always tell you to just take it easy and maybe take some hot showers or something to ease any discomfort or pain.

The problem with thwarting the fraud by attorneys and chiropractors (not all are bad), is that it is expensive, and for a $3000 or $4000 claim, the insurance company can’t afford to prove the fraud by putting in the investigative manpower.

One Comment

  • I read your article and I see what you mean. I am fighting with allstate over a PI claim and in the begining they were nice, they found their insured at fault and offered a settlement. Now a year later I am still in chronic pain everyday.

    Allstate now wants to have a deposition and refuse to settle. I have gone toso many dang doctors, even had cortizone injection and the orthepedist told me to go home and rest. Well, that advice made my injuries worse and now I am back in p/t with results.

    If I had listened to him I would have had a frozen shoulder and need surgery. Sometimes listening to doctors is not always the right thing. He said I had bursitis, I had a sprain, ETC….

    But I actually have a inpingement of my shoulder tendon and damage to my neck. Amazing how this guy that has all these years of schooling just wanted to write me off as faking and yet my P/T saw me for 2 appt.’s and diagnosed what is wrong.

    Yet a year later I am in in agony on somedays and still taking muscle relaxers. Gee, guess I am not faking huh DOC!!!

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