Top 10 Things to Know About Your Auto Insurance Adjuster

  1. Adjusters must follow a specific procedure in order to have benefits relating to your recovery approved. The legislation demands that an adjuster make a judgment as to whether a claimed benefit or treatment is reasonable and necessary. A psychotherapist or rehabilitation counselling specialist will help you navigate this very complex system and its related procedures.
  2. There are milestones for recovery of most diagnoses and adjusters know expected recovery times for most auto related injuries. Everyone responds to treatment differently but expect a knowledgeable adjuster to question why your recovery is continuing past normal recovery timelines if your recovery is protracted.
  3. Adjusters will often be unable to tell you how to access your benefits. Due to conflict of interest concerns, the insurance companies are unable to suggest specific rehabilitation professionals. Look to experienced providers or advise from a lawyer to help you with your recovery and identifying experienced psychotherapists and rehabilitation counsellors.
  4. You can’t access some benefits without specialized reports from only certain rehabilitation professionals and adjusters cannot tell you what reports you need. Ask for a rehabilitation counsellor or case manager to help you understand what you need to help with your recovery, treatment and benefits.
  5. Adjusting is a difficult and demanding job, work with your adjuster with that in mind. Your adjuster is responsible for responding to a variety of treatment plans associated with different aspects of your care. This encompasses a multitude of services that will improve your well-being and aid in recovery. Adjusters need open communication and an understanding of what you are dealing with to help them approve suggested interventions that will aid in your recovery. Create that by asking for a psychotherapist or rehabilitation counsellor to work with your adjuster on your behalf to ensure the adjuster has the information they need.
  6. A positive working relationship with your adjuster is of utmost importance in maximizing recovery. You will not recover as well or as fast as you might otherwise if treatment keeps being interrupted. Make sure the adjuster has the medical information or reports they need to approve reasonable and necessary treatment plans.
  7. If an adjuster has a legitimate concern such as too much suggested treatment in too short a timeframe they may ask for an independent evaluation (IE). Independent evaluations are needed to assess needed treatment and are expensive to everyone. Worse, the costs of those IE reports come out of your coverage, don’t waste your medical budget on independent evaluations that are unnecessary.
  8. There are many instances where reports are misread or misunderstood. Disagreements happen but often verification of facts can solve the problem. If it seems obvious that the adjuster has made an error, often a review of the point with them first and if needed their supervisor, gets the issue resolved. Claimants should consider getting their own assessments only after exhausting problem solving efforts.
  9. Accident benefits adjusting is a an extensive field, in most cases it takes years to train adjusters to deal with all the complicated medical, legal and financial issues that relate to Ontario accident benefits. Adjusters do however receive regular in house training from some of world’s leaders in insurance law and consulting. If there is a disagreement, know that there is a great deal of expertise behind the adjuster’s position and they probably have a legitimate point, seek your own expert advice such as guidance from a rehabilitation expert and personal injury lawyer.
  10. Adjusters are employees and must follow the procedures established by that insurer or claims company. They are there to approve suggested benefits that will allow you to return as closely as possible to the state you were in before the accident happened. Insurance is not there to improve your situation but to help you recover and return to your life as quickly as possible. Work with your rehabilitation professionals to ensure that reasonable things are suggested to help you recover or compensate from things you cannot recover from.

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