Dealing With Insurance Adjusters: Common Tactics and How to Protect Your Claim

Within a day or two of almost any accident, a phone call arrives. The caller is friendly, sympathetic, and wants to know how you’re feeling. They may say they just want to “get your side of the story,” “take a quick statement,” or “get you taken care of.” This is an insurance adjuster, and understanding what that person’s job actually is may be the single most useful thing you can know in the days after a crash.

An adjuster is not your enemy, and many are professional and courteous. But an adjuster is an employee of a company with a financial interest in paying as little as the law and the facts will allow. That is not cynicism; it’s the structure of the business. This post explains who the different adjusters are, the tactics that most commonly hurt injury claims, the rules California imposes on how insurers must behave, and practical steps to protect yourself.

Whose Adjuster Is Calling?

The first thing to figure out is which insurance company the adjuster works for, because the rules are different depending on the relationship.

• Your own insurer’s adjuster. Your policy is a contract, and it typically requires you to cooperate with your insurer’s investigation. Your insurer also owes you a duty of good faith and fair dealing. If you make a claim under your own policy, such as collision coverage, medical payments coverage, or uninsured and underinsured motorist coverage, the adjuster is handling a first-party claim.
• The other driver’s insurer’s adjuster. This is a third-party claim: you are making a claim against someone else’s policy. That insurer’s duties run to its own policyholder, the driver who caused the crash, not to you. It has no obligation to look out for your interests, and it is trying to resolve the claim against its insured for as little as possible.

That distinction matters more than most people realize. In a first-party claim, an insurer that unreasonably delays or denies a valid claim can face a bad faith lawsuit. In a third-party claim, California’s Supreme Court held in Moradi-Shalal v. Fireman’s Fund Insurance Cos. (1988) that an injured person generally cannot sue the other side’s insurer directly for unfair claims practices, though the insurer’s regulatory obligations still apply and its conduct can matter to its own insured’s exposure.

The Most Common Tactics

None of the following is universal, and many adjusters simply do their jobs professionally. But these patterns come up often enough to recognize.

• The quick call and the recorded statement. The adjuster reaches out fast, often before you’ve finished medical treatment or even fully understood your injuries, and asks for a recorded statement. Early statements are easy to make imprecisely: “I’m fine” said on day one, before whiplash symptoms set in, can be quoted for months. Under California’s privacy law, recording a phone call generally requires the consent of everyone on the line, and adjusters will usually tell you they are recording. You are not required to give a recorded statement to the other driver’s insurer. Your own insurer may ask for cooperation under the policy, and even there it’s reasonable to understand what’s being asked first.
• The fast, modest offer. Some insurers make a settlement offer very early, sometimes within days, at a number that looks like a lot of money when you’re facing bills and missed work. Once accepted, the release usually ends the claim permanently, including for injuries that later turn out to be worse than expected. We discuss this at length in our post on first settlement offers.
• The broad medical authorization. An adjuster may ask you to sign a blanket authorization for all of your medical records, sometimes going back years. Insurers are entitled to information relevant to your claim, but a broad authorization can be used to search for unrelated history to argue that your problems were pre-existing. It’s reasonable to limit any authorization to relevant providers and time periods.
• Minimizing the injury. Common arguments include that the impact was low-speed and the vehicle damage minor, so you couldn’t have been badly hurt; that your symptoms are “just soft tissue”; or that treatment is excessive. We cover soft-tissue injuries in our post on whiplash.
• The gap in treatment. If you stop treating for a period, the insurer may argue that you must have recovered, or that your later complaints are unrelated. Life gets in the way of medical appointments, but gaps are often used against claimants.
• The pre-existing condition argument. Almost everyone has some prior aches, degeneration, or prior injuries, especially with age. Insurers frequently argue that current problems come from earlier conditions rather than the crash. California law recognizes that a defendant takes the plaintiff as they find them, and that aggravation of a pre-existing condition is compensable, but the argument is a common way to reduce claims.
• Shifting the blame. As we explain in our post on comparative negligence, an insurer may assign you a percentage of fault to reduce what it pays. Such assignments are often aggressive and not final, and our e-bike post describes a case in which an insurer’s initial ninety percent fault assignment fell apart under scrutiny.
• Social media and surveillance. Adjusters and investigators review public social media accounts, and in larger claims may hire surveillance. A photo of you at a family barbecue or on a hike may be presented as inconsistent with your complaints, regardless of the context or how you felt afterward.
• Delay. Slow responses, repeated requests for the same documents, and long periods of silence can wear claimants down, particularly those facing mounting bills. Delay works in the insurer’s favor because pressure to settle increases as financial strain builds.
• The check with strings attached. A check sent with language like “payment in full and final settlement” may, if cashed, be treated as accepting a settlement. Property damage payments and injury settlements should be kept separate, and any check should be reviewed before it’s deposited.

The Rules Insurers Must Follow

California regulates how insurers handle claims, and knowing the basic rules helps you tell ordinary process from misconduct. Insurance Code Section 790.03(h) defines unfair claims settlement practices, and the Fair Claims Settlement Practices Regulations (Title 10 of the California Code of Regulations, beginning at Section 2695.1) set specific standards. Among the key requirements:

1. Acknowledgment. An insurer generally must acknowledge notice of a claim within 15 calendar days.
2. Decision timing. After receiving proof of claim, the insurer must accept or deny the claim, in whole or in part, within 40 calendar days, unless it gives written notice explaining why it needs more time and continues to update the claimant in writing every 30 days.
3. Written denials. As we explain in our post on e-bike insurance, a denial of a first-party claim must be in writing and must state the factual and legal bases for the denial (Section 2695.7(b)(1)). An insurer that denies a third-party claim or disputes liability or damages must also do so in writing.
4. Reasonable investigation. Insurers must conduct a thorough, fair, and objective investigation and may not persist in seeking information that isn’t reasonably required.

These rules are enforced primarily by the California Department of Insurance, and a complaint to the Department is an available step when an insurer appears to be violating them. In first-party claims, violations can also support a bad faith claim.

What You Can Do to Protect Yourself

1. Know what you owe and to whom. With your own insurer, be honest and cooperative but read your policy’s requirements. With the other driver’s insurer, you may politely decline to give a recorded statement and provide only basic information.
2. Keep communication in writing when possible. Emails and letters create a record and prevent misunderstandings about what was said. If you speak by phone, keep notes with the date, time, name, and content of the call.
3. Don’t guess. If asked about your injuries, speed, distances, or how the accident happened, say “I don’t know” or “I’m still being evaluated” rather than estimating. Estimates become statements.
4. Don’t minimize. Saying “I’m fine” or “I’m okay” out of politeness can hurt you later. Simply say you’re still assessing your injuries and receiving treatment.
5. Limit medical authorizations. Share records relevant to the injuries claimed, not a blanket release of your entire medical history.
6. Don’t sign anything you haven’t read, especially releases. A general release can waive claims you don’t yet know you have.
7. Be careful with social media. Assume that anything you post can be seen and used. Many claimants find it easiest to stop posting about their activities during a claim.
8. Follow your treatment plan. Consistent care both promotes recovery and prevents the “gap in treatment” argument.
9. Keep good records. Save bills, receipts, pay stubs, photographs, and a simple daily log of symptoms and limitations.
10. Consider talking with an attorney before giving any statement. A consultation costs nothing at our firm, and it can clarify what to say, and what not to say, before a statement is made.

Adjusters and Visitors, Rental Cars, and Out-of-State Policies

South Orange County sees a steady stream of visitors, and accidents involving out-of-state drivers add wrinkles: policies issued in other states, rental car coverage, and insurers with no local presence. The same principles apply, but the practical difficulty of pursuing a claim from a distance can make claimants more vulnerable to quick offers. We discuss this in our post for out-of-town accident victims.

Working With Your Own Insurer

Your own insurer is a different relationship from the other side’s insurer, and it deserves a different approach. You’re required to cooperate, which generally means promptly reporting the accident, providing information and documents the policy requires, and responding to reasonable requests such as a medical examination in certain claims. Cooperation doesn’t mean surrendering your judgment. If you’re asked for a recorded statement, it’s reasonable to ask what the statement is for and to keep the questions to the accident itself. If you believe your own insurer is denying or delaying a valid claim, California’s regulations give you rights and remedies, including a complaint to the Department of Insurance and, in some cases, a claim for bad faith.

Remember also that when you make a claim under your uninsured or underinsured motorist coverage, your insurer effectively steps into the other driver’s shoes, so the dynamics of a third-party claim can apply even though the company is your own. We explain that in our post on UM/UIM coverage.

What a Fair Claims Process Looks Like

It helps to know what good looks like. In a fair process, the adjuster acknowledges your claim promptly, explains what documents are needed and why, tells you in writing what is happening and when a decision is expected, evaluates the claim on the evidence rather than on assumptions about people who make claims, and explains any denial or reduction in writing with reasons. Requests for records are tied to the injuries claimed. Offers are explained: the adjuster can tell you what expenses and damages the offer covers and how it was reached.

If the process doesn’t look like that, such as when you’re getting silence, shifting requests, or offers no one can explain, that is a signal to slow down, put things in writing, and get advice before doing anything you can’t undo.

The Bottom Line

Adjusters do a real job and many do it fairly, but the structure of the relationship is what it is: the insurer’s interests and your interests are not the same. You don’t have to be adversarial, but you do need to be careful, and the early days of a claim, when injuries are still unfolding and offers are coming in, are when careful matters most.

If you’ve been in an accident anywhere in San Clemente, Dana Point, or South Orange County and an insurance company is asking for a statement or making an offer, Rosen Law Offices can help you understand your options before you respond. Call us at (949) 335-0020 for a free consultation.

This article is intended for general informational purposes and does not constitute legal advice. Every accident involves unique facts, and the outcome of any claim depends on the specific circumstances involved. If you’ve been injured, consult with a licensed attorney, like those at Rosen Law Offices, about your particular situation.