20 Illusions of Auto Insurance › Episode 5
Adjusters Are Not Your Advisors
An adjuster may be courteous, organized and genuinely helpful while still
performing a different role from the injured person’s advisor. The adjuster
manages and evaluates the claim for the insurer or claims administrator.
Your job is to preserve and understand your own record before major decisions.
The Assumption
“The adjuster is helping me through the claim, so the adjuster is looking out for me.”
Claims professionals often explain procedures, request documents,
answer questions and move the file forward. That can feel advisory.
The roles are still different.
as personal advice about what is best for the injured person.
System Reality
The adjuster manages the insurer’s claim file
The adjuster’s work commonly includes investigating facts, collecting
records, evaluating coverage and damages, documenting the file,
communicating positions and attempting to resolve the claim within
the authority and procedures of the insurer or administrator.
An adjuster may be helpful without being neutral. Keep your own file,
verify important representations and make major decisions from the
complete record rather than from the tone of the conversation.
the distinction comes from role. A claims professional can act properly,
fairly and professionally while still representing the insurer’s side of
the claim process rather than serving as the claimant’s personal advisor.
Separate the Roles
Helpful communication does not make the parties’ interests identical
The adjuster’s file
Tracks coverage, liability, medical information, damages,
communications, reserves, evaluations, settlement authority and
other information used to administer the claim.
Your file
Should preserve the crash facts, injuries, treatment, bills,
wage loss, photographs, witnesses, coverage requests, insurer
communications and unresolved questions.
Your decisions
Whether to give a statement, sign an authorization, accept an offer,
execute a release or close a claim may have consequences beyond the
immediate conversation.
Claim Communications
Routine requests can still affect the record
The issue is not that each request is improper. The issue is knowing
what is being requested, why it matters and what record it will create.
Recorded statement
A preserved statement can later be compared against medical records,
testimony, timelines and other evidence.
Medical authorization
Review the scope, duration and purpose before signing a broad release
of medical information.
Employment information
Wage-loss documentation may be necessary, but the request should be
understood and tied to the claimed loss.
Photographs and documents
Preserve what is sent, when it was sent and the context in which
the material was provided.
Settlement discussion
A dollar figure may arrive before treatment, coverage, liens or
future losses are fully understood.
Release documents
The legal effect of the release depends on its language, not on a
conversational description of what it is intended to accomplish.
First-Party vs. Third-Party
Know whose policy is being adjusted
The relationship changes depending on whether you are seeking benefits
under your own policy or asserting a liability claim against someone
insured by another carrier.
First-party claim
You may be seeking benefits owed under your own policy, such as
UM/UIM, MedPay, collision or another first-party coverage.
Third-party liability claim
You may be asserting a claim against an insured person or company
under that party’s liability policy.
Different legal duties
Colorado law treats first-party benefit claims and third-party
liability claims differently in important respects. Do not assume
that every duty or remedy applies identically to both.
C.R.S. § 10-3-1115 defines a first-party claimant for purposes of
Colorado’s unreasonable-delay or denial framework and excludes a person
asserting a claim against an insured under a liability policy. Analyze
the correct relationship before relying on a first-party remedy.
Why It Matters
A friendly process can still produce an incomplete decision
Treatment may still be developing
Early symptoms, diagnosis and prognosis may not reflect the eventual
medical picture.
Coverage may still be incomplete
Additional policies, insureds, commercial coverage or first-party
benefits may not yet have been fully identified.
Liens and reimbursements may remain unresolved
The amount of a settlement is not the same thing as the claimant’s
eventual net recovery.
Wage loss may be immature
Time away from work, work restrictions and future earning effects
may still be developing.
Statements become evidence
Informal-sounding communications can become part of the permanent
claim record.
A release can create finality
Once claims or parties are released, later-discovered facts may not
restore the rights that were surrendered.
Practical Response
Keep your own claim file as carefully as the insurer keeps its file
Ask what document, statement or authorization is being requested
and what claim issue it is intended to address.
Keep emails, letters, claim notes, uploads, texts and your own
dated notes of substantive telephone calls.
Do not guess about speed, distance, diagnosis, prognosis,
future treatment or financial loss.
Coverage decisions, liability positions, requests for more
information and significant settlement positions are easier to
evaluate when documented.
Maintain a list of outstanding coverage, medical, wage, lien,
property and settlement questions.
A request for patience, documents or clarification is different
from refusing to cooperate. Make final decisions from the mature
record whenever possible.
Questions to Ask
Replace reassurance with specific information
What issue are you evaluating?
Liability, coverage, causation, treatment, damages and settlement
are different questions.
What document do you need?
Ask for the specific item and how it relates to the claim issue
being investigated.
Is this required by my policy?
In a first-party claim, cooperation duties should be evaluated from
the actual policy language and applicable law.
What remains under investigation?
A clear list of unresolved issues helps prevent assumptions about
what has and has not been decided.
Will you put that in writing?
Important representations are easier to review and preserve when
they are documented.
What rights would this release end?
Read the actual document before treating a settlement description
as the legal effect of the agreement.
Evidence & Authority
Research behind Episode 5
Colorado law regulates insurer claim practices and distinguishes
first-party claims from liability claims against another insured.
The actual policy and current primary authority control a particular claim.
C.R.S. § 10-3-1104 — Unfair Claim Settlement Practices
Colorado identifies prohibited or regulated claim practices involving
investigation, communications, settlement conduct and explanations
of claim positions.
C.R.S. §§ 10-3-1115 and 10-3-1116
These sections address unreasonable delay or denial of covered
first-party benefits and the remedies available to qualifying
first-party claimants.
Cooperation · Statements · Proof of Loss · Authorizations
In a first-party claim, the operative policy may contain duties
concerning cooperation, information, statements or proof of loss.
Read the actual language before assuming what is required.
Related VictimsGuide Research
Continue the 20 Illusions Series