Filing the Claim: What to Say, and What Not To

Once the scene is documented and the medical care is underway, the whole thing moves to the insurance companies. Both of them. The at fault driver's, and in most cases your own.

This is the stage where people hurt themselves without meaning to. Not by lying, and not by being careless. By being helpful. Somebody friendly calls and asks how the accident happened and how they're doing, and they answer the way they would answer anybody, with more information than the question needed.

The whole chapter comes down to one idea. The less talking, the better.

If you're going to file a claim against any insurance company, I highly recommend talking to an attorney first.

If you can hire one and let them do all the talking and open the claim for you, that's always best. Because even when what you're saying does not sound like anything bad, the other side and the insurance company will always figure out a way to twist your words.

Once we're retained, we send out what we call letters of representation to every insurer involved, theirs and ours. It lets them know we represent the client, and that any future conversations and communications need to go through us. That letter is the thing that actually stops an adjuster from calling with a claim-relevant question. It is not a formality, and it's the practical reason hiring somebody before the first phone call closes off almost everything in this chapter.

I have trouble imagining the situation where an attorney shouldn't do this first. But let's say it falls to you. Then here's how.

Call the other side's insurance company and say you were involved in an accident and you need to file a claim. A lot of these carriers actually have a way to file claims online, and if you can limit it to that, do. Use as few words as possible and go through the process that way. No live agent means nobody can trick you on the spot.

Sometimes what I'll do with a client in that spot is have them send me screenshots as they go through the prompts on their phone, so I can see what they're entering before they submit it. That way nothing gets typed into a form that hurts the case later.

A lot of clients don't want to open a claim with their own insurance company. They're worried their premiums are going to go up, and they think, why do I have to open a claim with my insurance company when I'm not at fault.

Both halves of that have answers.

Start with why it's necessary. For anyone claiming injuries, there's a law in California called Proposition 213. It does not require anybody to go out and buy coverage. What it does is close off part of the recovery for a driver who was uninsured at the time of the crash. Any kind of pain and suffering, any general damages, which usually make up a huge portion of the claim, are excluded from being compensated. What decides that is whether you were carrying insurance on the day of the accident, not whether you picked up the phone afterward.

Which is where your own carrier comes in. The other side does not take the driver's word for coverage, and the cleanest way for yours to be confirmed is through your own insurance company. Opening the claim is how that confirmation gets made, which is why I want it done rather than skipped.

Now the premium worry, which has a better answer than most people expect. By California law, insurance companies are not allowed to increase your premiums just because you file a claim. You would have to be at fault for the ding. I call it a ding. It's like the blemish, the mark left on your profile, and then your premiums get raised.

The way I explain it is this. There's a car accident and there are two cars. One of them gets the mark. One of them is the one at fault, and whoever that person is, they get their premiums raised. It is not everybody.

So opening a claim is not the same event as being found at fault. A driver who wasn't at fault has no reason to expect a rate change from making that call.

Clients are often unsure whether the call they're on is a recorded statement, and the confusion is fair. A lot of times a company will say this call is being recorded or monitored for training purposes, and people assume that's the same thing.

That is not it.

After that they start going into the question and answer.

If you're hearing that, you can hang up. There's no obligation. You don't have to be nice about it and you don't have to comply. And if you don't realize you were being recorded until later, you can just hang up then. That's fine too.

I want to be blunt about why this one matters more than it sounds. These conversations are engineered and designed to trap people. The adjuster's tone is friendly and polite so the whole thing feels casual, and the questions are structured to produce damaging admissions. Something as simple as "how are you doing today" gets a reflexive "oh, I'm fine, thank you," and that's an admission of not being hurt and not being in pain. Normal conversations don't work that way, but nothing about a recorded statement is a normal conversation.

The guessing is the other trap. They ask how fast you were going, how fast the other driver was going, what damage you saw on the other car, things of that nature. And they keep asking until they get something, so people guess. Those guesses get run through their own systems and used to dismantle the version of events you gave them.

You have the absolute legal right to say no. You have the legal right to hang up. You have the legal right not to pick up the phone. The California Department of Insurance does not require you to give one. Route them to your attorney instead.

One more thing while we're here. Don't sign anything they send, especially a medical authorization. They'll say it just helps them collect the records faster. Once it's signed, do you think they're only pulling the records related to the car accident? No. These forms usually carry no time limit, so they get the entire medical history. A shoulder you hurt in high school, a back strain from a job you left, things that have nothing to do with any injury being claimed, going back potentially to birth. And then everything you're feeling now gets called preexisting.

If a claim has to be opened by phone, be factual and be concise.

If a question can be answered with a yes or a no, just say yes or no. Don't add anything else. If they want more information, they'll ask for it. Answer in one sentence.

And if you are not sure, say so.

The reasoning here is procedural rather than dramatic. Adjusters are trained to go through a list. Most of that list tolerates "I'm not sure" perfectly well, because a caller can always ring back and let them know later. A few things, like the date of the accident and the time of the accident, can't just be skipped, and those should be given accurately.

Everything else, when there's real doubt, is safer as "I'm not sure" than guessed at out loud.

After the claim opens, an adjuster gets assigned. Usually that takes a couple of days.

During that first call, they may ask if you're hurt. Sometimes they'll phrase it as "how are you feeling," which makes it sound like it has nothing to do with the claim and like they're just concerned. If you are not symptomatic at the time, don't say no and don't say you're okay. Say you are not sure. If you're symptomatic, tell them what your symptoms are.

The adjuster who gets assigned is either a property damage adjuster or what's called a bodily injury adjuster, and depending on the claim there may be one or both. The property damage adjuster handles the repairs on the vehicle, or, if the car is totaled, the compensation paid out on it. The bodily injury adjuster is assigned when injury is claimed, and handles that portion.

Knowing which one is on the line matters more than it sounds, because the two are handling different halves of the claim and the questions they ask you are aimed at different things.