Q: Why would a claims adjuster deny a claim and then turn around and want to offer payment for pain caused by the incident?
I am the third party in a product liability insurance claim. The claim was denied earlier this month and just yesterday, the adjuster called me wanting to "resolve" the claim by offering payment for "pain" from the injury.
Before the insured sent the complaint over to her insurance company and before any investigation the Insured stated in her first reply to me that she was getting with her supplier to see if they can fix the problem. For about a month now I have been asking the claims adjuster to reach out to the insured to find out if this has happened and have never gotten an answer from the Insured or the Claims Adjuster. On the 28th I get an email from the claims adjuster letting me know she reached out to the insured regarding the status of the product and within exactly 30mins the adjuster called stating she had spoken with the insured and "they" would like to "resolve" the claim.
Could the original email from the insured be causing problems?
A:
It's difficult to say what the cause for the change in position on the part of the insurance carrier was without seeing the file and all communications. But what you describe is not uncommon. A claim could initially be denied because the examiner has not been presented with sufficient evidence to make a determination of liability and damages. It's possible that following your requests for the insured to reach out to their carrier, they did, and this could have provided the information necessary for the examiner to make a decision to offer you settlement terms. But that is a general speculation - again, it would be helpful to see the file to make a more meaningful assessment. Good luck
Tim Akpinar
Jonathan R. Ratchik agrees with this answer
A: When you state you're the "third party" I'm assuming you mean you're the claimant and not a third-party defendant. Regardless, as my colleague correctly advised, the claims adjuster's change in position can be due to many reasons. More likely than not, the adjuster has since spoke with his insured and recognized that the insured is liable for whatever harm the product caused. Not uncommon for an adjuster to change his position after completing his own internal investigation. On the other hand, the adjuster might just be making a business decision and deciding it's more economical to pay out on the claim than hire counsel and defend it for years.
Tim Akpinar agrees with this answer
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