How to talk to insurance adjusters after an accident

Insurance adjusters are often friendly, and many are decent people doing a job. But an adjuster works for an insurance company, and the company’s goal is to pay as little as the law and the policy allow. Knowing who you are talking to, and what you actually owe them, protects you.

Two companies, two very different relationships

After most crashes, you will deal with two insurers.

Your own insurance company has a contract with you. In New Jersey, your own policy’s personal injury protection (PIP) coverage pays your medical bills after a crash regardless of fault, up to $250,000 on a standard policy unless you chose a lower limit.¹⁰ In New York, your own no-fault coverage pays medical bills and part of lost wages regardless of fault. If the at-fault driver has little or no insurance, your own uninsured or underinsured motorist coverage may also come into play (see our page on uninsured and underinsured motorist claims).

The other driver’s insurance company has a contract with the other driver, not you. Its adjuster is evaluating how much the company may have to pay you and looking for reasons to pay less. Being polite is fine. Helping that company build its defense is not your job.

Your duty to cooperate with your own insurer

Your policy almost certainly requires you to give prompt notice of a crash and cooperate with the investigation. Skipping these steps can put your benefits at risk, so take them seriously.

In New York, the rules are written into the mandatory no-fault endorsement. You must give written notice within 30 days of the accident and submit proof of claim for medical expenses within 45 days after treatment and for lost earnings within 90 days.¹ On request, you must also submit to medical examinations by doctors the insurer selects, as often as it may reasonably require.¹ Our New York no-fault guide covers those deadlines in detail.

In New Jersey, notify your insurer promptly, complete the PIP application, and keep the claim number handy. Our New Jersey PIP guide explains what PIP covers and how disputes are handled.

Cooperation does not mean giving up your rights. You can answer questions about your own claim truthfully while declining to guess, speculate or volunteer opinions about who was at fault. If your own insurer also covers the other driver, or you are making an underinsured motorist claim against your own company, talk to a lawyer before giving any statement, because your interests and the company’s may diverge.

Examinations under oath in New York no-fault claims

An examination under oath (EUO) is a formal question-and-answer session, under oath and recorded by a court reporter, that the insurer conducts to verify a claim. New York’s no-fault endorsement requires an injured person to submit to examinations under oath as may reasonably be required by the insurer.¹

The rules also protect you. The EUO must be held at a place and time reasonably convenient to you, and you are reimbursed for lost earnings and reasonable transportation expenses. An insurer that requires an EUO to establish proof of claim must base that requirement on objective standards.²

Missing a properly scheduled EUO can lead to a denial of benefits, so never ignore an EUO letter. Bring a lawyer. What you say becomes a sworn transcript that can be used in your injury case later.

Recorded statements

A recorded statement is an informal interview, usually by phone, that the adjuster records. It sounds harmless, and adjusters often present it as routine. Here is why you should be careful.

• The questions are designed by the insurer. “Did you see the other car before impact?” sounds simple, but “no” can suggest you were not paying attention.
• Early on, you do not know the full extent of your injuries. Saying “I’m okay, just a little sore” on day two can be played back after you need surgery.
• Small mistakes about speeds, distances or times can be used later to question your credibility.

You are not required to give a recorded statement to the other driver’s insurer. You can decline politely and give your lawyer’s name. If your own policy requires a statement, it is reasonable to ask that it be scheduled when your lawyer can be present.

Medical authorizations and records

Adjusters often send a medical authorization early. These forms are frequently written broadly, allowing the company to collect every record from every provider for years before the crash. That history can be used to argue your pain comes from an old injury or an unrelated condition.

For your own insurer, some authorization may be needed so it can process benefits. Read it and ask that it be limited to accident-related treatment. For the other driver’s insurer, you do not have to sign anything. When it is time to present your injury claim, a lawyer sends the records that matter, limited to the relevant body parts and time period.

Early settlement offers and releases

A fast offer can feel like relief, especially when bills are piling up. Before you consider one, understand what comes with it.

1. A release ends the claim. To get the check, you sign a release that gives up your claim against the at-fault driver, and usually against everyone else connected to the crash. You generally cannot reopen it if your injuries turn out to be worse than you thought.
2. Early offers come before the facts are known. Some injuries need MRIs, specialist visits or months of therapy before their seriousness is clear.
3. Liens may come out of the money. Medicare, Medicaid, some health plans and workers’ compensation carriers may have to be repaid from a settlement. Our guide to settlement liens explains how.
4. There may be more coverage. The at-fault driver may have more insurance than the adjuster mentions, including umbrella coverage. In New Jersey, an insurer must disclose policy limits within 30 days of a written request from the injured person’s attorney.⁹

Property damage is a separate claim

The car claim usually moves faster than the injury claim and is handled separately, often by a different adjuster. It is generally fine to work with the insurer on repairs, a total-loss valuation and a rental. Keep those conversations focused on the vehicle.

Read every property damage release before you sign it. It should release only the property damage claim. If it says “all claims,” “bodily injury,” or “any and all damages,” do not sign it until a lawyer has looked at it.

Phrases adjusters use, and what they are for

Most adjusters are trained in how to frame a conversation. Recognizing common phrases helps you respond calmly.

• “This is just routine.” Usually said before a recorded statement or a broad authorization. Routine for the company does not mean required of you.
• “We just need your side of the story.” The company is building its file. Your side can be presented through a lawyer, with documents.
• “How are you feeling today?” A friendly question, but “fine” or “better” can end up in the claim notes as proof you were not badly hurt.
• “You don’t need a lawyer for this.” The other driver’s insurer has no reason to tell you otherwise. Most injury lawyers, including us, offer a free consultation.
• “This offer is only good until Friday.” Pressure. A fair offer on a claim does not usually vanish because you took time to get advice. Do not let a deadline set by the insurer rush you past your own legal deadlines either.
• “Your treatment seems excessive.” Often a sign the company is preparing to dispute your bills. Keep following your doctors’ advice, not the adjuster’s.
• “We’ve accepted liability.” Good news, but it does not mean the company agrees about the value of your injuries.

The rules adjusters must follow

Both states regulate how insurers handle claims.

New Jersey’s insurance law lists unfair claim settlement practices. Among them are failing to act reasonably promptly on communications about claims, refusing to pay claims without a reasonable investigation, not attempting in good faith to make prompt, fair and equitable settlements once liability has become reasonably clear, forcing people to sue by offering substantially less than they ultimately recover, and failing to promptly explain the basis for a denial or a compromise offer.³ New Jersey’s regulations also set time limits, including 90 calendar days to settle a third-party bodily injury claim absent clear justification, with written explanations of any delay.⁴

New York’s Insurance Law similarly prohibits unfair claim settlement practices when an insurer commits them without just cause and often enough to show a general business practice. The list includes knowingly misrepresenting pertinent facts or policy provisions, failing to acknowledge claim communications with reasonable promptness, not attempting in good faith to settle claims in which liability has become reasonably clear, and forcing policyholders to sue by offering substantially less than they ultimately recover.⁵

These laws are mainly enforced by the state regulators. They set the standards adjusters are expected to meet, but in most situations they do not give an injured person a separate lawsuit against the other driver’s insurer.

How to file a complaint

• New Jersey. The Department of Banking and Insurance (DOBI) accepts complaints online, by phone at 1-800-446-7467 or 609-292-7272, by mail to NJDOBI, PO Box 471, Trenton, NJ 08625-0471, and by fax. Include the company name, the policy or claim number, a short description of the problem and copies of key documents.⁷
• New York. The Department of Financial Services (DFS) takes insurance complaints through its online portal. DFS may share a copy of your complaint with the company.⁸

A regulatory complaint can get a stalled claim moving, but it does not decide what your injuries are worth or stop any deadline. Keep your claim, and any lawsuit, on track while the complaint is pending.

When to stop talking and call a lawyer

Hand the conversation to a lawyer if any of these happen.

• You were hurt badly enough to need imaging, a specialist, injections, surgery or time off work.
• The other driver’s insurer asks for a recorded statement or sends a medical authorization.
• You receive a release, a settlement check, or an offer with a deadline.
• Your New York no-fault insurer schedules an examination under oath or denies a bill.
• The insurer says you were partly at fault, or disputes that the crash caused your injuries.
• A government vehicle, bus, rideshare, delivery or commercial vehicle was involved.
• You have Medicare, Medicaid, or a workers’ compensation claim from the same crash.

Once you have a lawyer, you can tell every adjuster to deal with the lawyer instead of you. That frees you to focus on getting better. Our accident checklist covers the other steps to take in the first weeks.