Adjusters are the insurance company staff (or sometimes independent contractors) who are responsible for “adjusting” or resolving the loss claims made against insurance policies. When a personal injury loss has occurred, such as from a traffic accident that caused injury or death, the injured parties file claims against the liability insurance of the negligent party. Sometimes the injured party will file a claim under their own insurance policy, such as for medical payments coverage to help pay medical bills resulting from an auto accident or for uninsured or underinsured motorist coverage when the negligent party has no insurance or has inadequate insurance. The insurance adjuster file will be opened immediately to store information related to the claim.
During the course of an insurance claim, which in some cases may take only a few weeks to resolve, or in other cases may require years of litigation to complete, the insurance adjuster typically accumulates very important files on each claim. those files will generally include such things as copies of the injured party’s medical records and bills, official injury incident reports, private investigation reports on the incident and/or the injured party, witness statements, loss documentation wage records, the injured person’s records of previous claims and incidents, and written and electronic communications with a variety of people related to the claim.
all of the records in these sometimes extensive insurance files are pertinent to how the insurance company and adjusters will approach claim resolution and are often “traceable” during litigation activities involving following the filing of a claim. In order to uncover the contents of the insurance adjuster’s file on a claim, or at least as much of the file as a judge deems appropriate to release, the personal injury plaintiff’s attorney will often use a subpoena duces tecum to require production. of the file. The discovery process may use various formal tools for the parties to acquire and share evidence related to the lawsuit, including interrogations, document production, affidavits, and subpoenas.
A subpoena is a legal notice that requires the person who receives it to appear at a particular place and time to testify in ongoing litigation. Within the scope of the rules governing subpoenas and other forms of civil discovery, an attorney for one of the parties in a personal injury lawsuit may issue the subpoena for someone who is not a party, such as a witness to a traffic accident , a police officer investigator, or a physician for the injured plaintiff – provide testimony relevant to the case. “duces tecum” is Latin for “you shall bring with you” and a duces tecum subpoena is a legal notice that requires the witness to bring documents or items for her inspection when she testifies. Often, the recipient of a duces tecum summons is not required to testify in person, but only to provide the requested documents.
Many of the records sought when issuing a duces tecum summons to an insurance adjuster’s claim file are common to all types of claims, while others may be very specific to the particular circumstances of the incident and the personal injury claimant. the content of the file being searched for will typically include:
- the entire file related to the claims of the injured party for damages arising from the accident (traffic accident, slip and fall, dog bite, etc.) on which the claim is based;
- copies of all correspondence sent to the claimant, the claimant’s attorney, and any medical providers related to the medical bills submitted for payment, including any “explanation of benefits” or “explanation of reimbursements” documenting payment or denial payment for bills;
- copies of any medical coding lists used to identify the claimant’s injuries and/or medical procedures for which services related to the injury incident were claimed;
- copies of any and all records or lists of medical payments made or denied in connection with the claim;
- copies of any and all correspondence between the insurer and any “reviewer of e medical payments” or other person to whom the claimant’s medical bills were sent who determined that the billed services were not related to the incident nt or who determined that the billed costs were unreasonable;
- copies of the manuals, instructions, procedures, company policies, and other insurer documents that govern the methods, processes, and considerations by which the insurer’s adjusters must review and allow or deny payment of any medical bills submitted as part of the claim;
- copies of any and all recorded statements of the plaintiff;
- copies of any and all recorded statements of witnesses;
- a copy of the entire insurance policy that covers the claim object of the claim;
- copies of each and every one of the photographs of the vehicles involved in the traffic accident (or other incident of injury that is the basis of claim o);
- copies of correspondence with any physician who determined that any portion of the claimant’s medical care and associated medical bills were unrelated to the incident of injury or unreasonable.
The above list is not exhaustive and these specific items relate primarily to discovering the contents of an injured claimant’s insurance file related to medical care and medical billing, its causal relationship to the injury incident, and its reasonableness. Depending on the type of injury and litigation, many other categories of documents can also be searched.
Watch this video describing what our law firm is all about:
hi, my name is ed smith and i am a sacramento personal injury attorney. When someone has suffered a serious injury as a result of a traffic collision or other type of personal injury incident, the insurance companies involved in your claim will begin to collect a large amount of information related to the incident, the claimant, and the claimant’s claim. claimant. injuries and monetary losses. Although the insurance company adjuster may have an ethical obligation to settle the claim fairly, the process often leans toward denial or reduction of the claimant’s recovery; the adjuster’s file will document these efforts. If you or a family member has been injured as a result of another party’s negligence and find yourself dealing with these injury claims adjusters, call us at (916) 921-6400 or (800) 404-5400 toll-free. , friendly advice. You can also contact us using our online contact form.
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