Insurance Company Tactics: How Adjusters Try to Minimize Your Claim

The Truth About Insurance Adjusters

Let's be clear: insurance adjusters are not your friends. They may sound sympathetic on the phone, but they work for the insurance company—not you. Their performance is measured by how much money they save their employer.

Every dollar they deny you is a dollar their company keeps. Adjusters receive training in claim denial techniques, settlement negotiation psychology, and legal loopholes. They know injured workers are vulnerable, in pain, and financially desperate. And they use that against you.

This article exposes the most common tactics so you can protect yourself.

Tactic 1: The Friendly Adjuster Act

How It Works

Your adjuster calls within days of your injury. They're warm, concerned, and helpful. They say things like "we're here to help you" and "we want to get this resolved quickly so you can move on."

This friendliness serves a purpose: to get you to let your guard down and make damaging statements.

What They're Really Doing

• Recording calls: Everything you say may be recorded and used against you
• Extracting admissions: "How are you feeling?" sounds innocent, but if you say "pretty good," they'll claim you're not actually injured
• Building rapport: Making you trust them so you don't hire an attorney
• Creating urgency: Pressuring you to settle before you understand your injury's severity

How to Protect Yourself

Be polite but guarded. Stick to basic facts about your injury. Never speculate about your condition or recovery timeline. Don't discuss your medical history. And absolutely hire an attorney before agreeing to anything.

Tactic 2: Delay, Delay, Delay

How It Works

Your claim sits in limbo. Weeks turn into months with no progress. The adjuster "needs more information," is "waiting on medical records," or "has to get approval from a supervisor."

Why They Do It

Delay is a weapon. The longer you wait, the more desperate you become. Bills pile up. You can't work. Your family suffers. Eventually, you'll accept a lowball settlement just to survive.

Insurance companies know this. They literally budget for "claims aging" strategies—the longer a claim takes, the less they ultimately pay.

How to Fight Back

• Document every delay in writing
• Send follow-up emails after every phone call summarizing what was discussed
• File complaints with the Division of Workers' Compensation for unreasonable delays
• Have your attorney file for expedited hearings if delays are harming you
• Demand payment of penalties under Labor Code §5814 for late temporary disability checks

Tactic 3: The Lowball First Offer

How It Works

You receive a settlement offer that seems substantial—$25,000, maybe $50,000. The adjuster frames it as generous: "This is more than most people get for this type of injury."

The Reality

First offers are almost always 30-50% below fair value. The adjuster knows you don't have a lawyer, haven't researched typical settlements, and are financially stressed. They're counting on your ignorance.

What to Do

Never accept the first offer. Consult an attorney before responding. We can tell you within minutes whether an offer is fair or insulting. Often, simply having legal representation doubles or triples the settlement.

Tactic 4: Disputing Causation

How It Works

The adjuster claims your injury didn't happen at work, or that it's not work-related. Common arguments:

• "You have degenerative disc disease—this is age-related, not from your job"
• "Carpal tunnel is a normal condition, not a work injury"
• "Your shoulder pain started before you reported it"
• "There's no documented accident in your employer's records"

The Truth

California law doesn't require a dramatic accident. Cumulative trauma—injuries developing over time—is fully compensable. Pre-existing conditions that worsen due to work are covered under the "aggravation rule."

How to Prove Causation

• Get your doctor to write a detailed report linking your injury to work activities
• Provide job descriptions showing repetitive motions or physical demands
• Obtain witness statements from coworkers who saw the accident or observed your pain
• Document your work history (how long you've done the job, what tasks you perform)
• Hire a medical expert who will testify that your injury is work-related

Tactic 5: The "Independent" Medical Exam (IME)

How It Works

The insurance company sends you to "their" doctor for an "independent" evaluation. The adjuster assures you it's just a formality.

What's Really Happening

These doctors are not independent. They're hired guns who perform hundreds of exams for insurance companies annually. Their income depends on minimizing injuries and providing reports that justify claim denials.

Studies show insurance medical examiners find "no injury" or "pre-existing condition" in 80%+ of cases—regardless of actual medical evidence.

Your Rights During an IME

• You can bring a witness (friend, family member, attorney representative)
• You can record the exam (California is a two-party consent state, so inform the doctor)
• Answer questions honestly but don't volunteer extra information
• Don't downplay your pain—describe your worst days, not your best
• If the doctor asks you to perform movements that cause pain, say so clearly
• Request a copy of the report to review for inaccuracies

How to Fight a Bad IME Report

Your attorney can:

• Obtain the doctor's examination history showing bias toward insurance companies
• Hire your own medical expert to rebut their findings
• Cross-examine the IME doctor at deposition or trial
• File complaints with the medical board if the exam was improper

Tactic 6: Surveillance and Social Media Monitoring

How It Works

The insurance company hires private investigators to follow you, film you, and scour your social media profiles looking for "proof" you're not really injured.

What They're Looking For

• Photos of you doing physical activities (gardening, playing with kids, exercising)
• Check-ins at gyms, sporting events, or vacation destinations
• Videos showing you moving without apparent pain
• Posts contradicting your injury claims ("feeling great today!")

The Problem with Surveillance

Investigators film you on your best days and ignore your worst. They capture 30 seconds of you lifting a bag of groceries, but not the three days you spent in bed afterward. They take statements out of context and present misleading "evidence."

Protecting Yourself

• Assume you're being watched: Especially if your claim is high-value
• Lock down social media: Set all profiles to private immediately
• Don't post about your case: Ever. Period.
• Be careful with photos: Even innocent activities can be twisted
• Tell friends and family: Ask them not to tag you or post about you
• If confronted by investigators: Don't speak to them. Note their appearance and inform your attorney

Tactic 7: Utilization Review Denials

How It Works

Your doctor recommends surgery, physical therapy, or medication. The insurance company sends the request to "utilization review" (UR), which denies it as "not medically necessary."

Why They Do It

UR doctors (who never examine you) second-guess your treating physician's recommendations. They cite obscure medical guidelines and claim your treatment exceeds "evidence-based protocols." In reality, they're denying care to save money.

Your Options

• Request Independent Medical Review (IMR): A state process where impartial doctors review UR denials
• File for expedited hearings: If delayed treatment is causing harm
• Document deterioration: Show how the denial is worsening your condition
• Get a second opinion: Additional medical support strengthens your case
• Consider private treatment: Pay out-of-pocket and seek reimbursement later (risky but sometimes necessary)

Tactic 8: The "Pre-Existing Condition" Defense

How It Works

The adjuster discovers you had back pain five years ago (or saw a chiropractor, or mentioned joint stiffness to a doctor). Suddenly, your entire claim is attributed to "pre-existing degeneration."

California Law on Pre-Existing Conditions

You're still covered. If work aggravated, accelerated, or worsened a pre-existing condition, it's compensable. The insurance company must prove what percentage is pre-existing versus work-related.

In practice, this means apportionment—you get a percentage of the full settlement based on how much work contributed. But you don't get zero just because you had prior issues.

Fighting Back

• Obtain all old medical records yourself to see what they actually say
• Get your doctor to explain how work worsened your condition
• Show you were functional before this job, even with prior issues
• Use medical experts who specialize in apportionment analysis
• Demonstrate your work duties directly caused the worsening

Tactic 9: Pushing for Compromise & Release (C&R)

How It Works

The adjuster offers a lump sum payment to close your case permanently. You sign a Compromise & Release agreement waiving all future medical treatment and disability claims.

When C&Rs Make Sense

Sometimes C&Rs are appropriate:

• You've reached maximum medical improvement with no ongoing treatment needs
• You want to sever ties with workers' comp and move on
• The lump sum is substantial enough to cover future needs independently

The Danger

Adjusters push C&Rs early, before you know the full extent of your injuries. Once you sign:

• You can't reopen the claim if your condition worsens
• You're responsible for all future medical costs
• You lose the right to additional disability benefits
• The settlement is usually less than you'd get through a stipulated award

Alternative: Stipulations with Findings & Awards

"Stips" allow you to settle disability while keeping medical treatment open. This is often better for injured workers with ongoing medical needs.

Tactic 10: Misrepresenting California Law

Common Lies Adjusters Tell

Tactic 11: Forcing You Back to Work Too Soon

How It Works

The adjuster pressures you to return to "light duty" or "modified work" before you're medically cleared. They may threaten to cut off temporary disability benefits if you refuse.

Your Rights

Your Primary Treating Physician (PTP) controls your work status, not the insurance company. If your doctor says you're off work, you're off work. Period.

You can refuse modified duty if:

• The duties exceed your medical restrictions
• The job offer is not genuine (sham positions to cut benefits)
• Your doctor hasn't released you for any work
• The employer can't accommodate your restrictions

When You Must Accept Modified Duty

If your doctor approves light duty work within your restrictions, and your employer offers suitable work, you generally must accept. Refusing can result in benefits being suspended.

Tactic 12: Settlement Mills and Quick Closures

How It Works

Some "attorneys" run settlement mills—high-volume practices that churn through cases with minimal work. They pressure you to settle quickly for whatever the insurance company offers.

Red Flags

• Attorney you never meet (only paralegals handle your case)
• Pressure to settle within weeks of hiring them
• No investigation, no medical expert, no negotiation
• Generic advice that doesn't address your specific situation
• High-volume advertising ("we've helped thousands!")

What Real Representation Looks Like

A good workers' comp attorney will:

• Meet with you personally to discuss your case
• Review all medical records thoroughly
• Coordinate with your doctors to strengthen medical evidence
• Hire experts when needed (medical, vocational, engineering)
• Negotiate aggressively, not just accept first offers
• Prepare for hearings if settlement negotiations fail
• Keep you informed throughout the process

How Insurance Companies Train Adjusters

Here's what most injured workers don't know: insurance companies literally train adjusters in claim-minimization techniques. Internal training materials teach:

• Anchoring: Making low initial offers to set expectations
• Good cop/bad cop: Alternating between friendly and aggressive tactics
• Manufactured urgency: Creating artificial deadlines to pressure settlements
• Information asymmetry: Knowing more about claim values than injured workers
• Psychological profiling: Identifying desperate or unsophisticated claimants to exploit

This isn't conspiracy theory—it's documented practice. Insurance is a business, and minimizing payouts maximizes profits.

When to Lawyer Up

Hire an attorney immediately if:

• Your claim is denied (full or partial denial)
• The insurance company delays paying temporary disability
• Treatment is denied through utilization review
• You're offered a settlement (before accepting anything)
• The adjuster disputes your injury is work-related
• You have a catastrophic injury (paralysis, amputation, TBI, etc.)
• Your employer retaliates against you for filing a claim
• You feel confused or overwhelmed by the process

Don't wait. Early legal representation prevents mistakes that can cost you tens of thousands of dollars.

The Power of Legal Representation

Here's what changes when you hire an attorney:

Adjusters Stop Playing Games

Once you have counsel, adjusters know they can't manipulate you. Recorded statements stop. Pressure tactics end. They negotiate with your attorney, who knows the law and won't fall for their tricks.

Medical Evidence Improves

We work with your doctors to obtain detailed reports linking your injury to work. We hire medical experts who provide opinions that insurance doctors can't easily dismiss.

Settlement Values Increase

As mentioned earlier, represented workers receive significantly more than unrepresented workers. Insurance companies know attorneys will take cases to trial if necessary—that threat alone increases settlement offers.

You Focus on Healing

Instead of fighting the insurance company while injured and stressed, you hand that burden to someone who does this professionally. You can focus on medical treatment and recovery.

Real-World Examples

Frequently Asked Questions

Your Best Defense: Knowledge and Representation

Insurance companies count on injured workers being vulnerable, uninformed, and desperate. They use sophisticated tactics developed over decades to minimize payouts. But you're not powerless.

By understanding their playbook, you can protect yourself from the most egregious tactics. But the single best defense is hiring an experienced workers' compensation attorney who knows these games and fights back effectively.

Don't let an insurance adjuster's "friendliness" fool you. Their job is to save their company money, not to help you. Your job is to protect your rights—and that starts with getting proper legal representation.