How Does an Insurance Company Handle a Slip and Fall Claim?

Learn the strategies insurers use when handling slip and fall accident claims. Gain the knowledge you need to boost your injury compensation.

Slip and fall accidents account for over 1 million emergency room visits every year, racking up several billions of dollars in medical costs. ¹

When someone else’s negligence caused your slip and fall injuries, you have a right to expect the at-fault party to pay for your damages. Most of the time, you’ll end up dealing with the property owner’s insurance company.

Slip and fall accidents are common, and cost a lot of money. Insurance companies handle these injury claims every day and do their best to reduce the victim’s settlement or avoid paying a slip and fall claim at all.

If you’ve suffered a slip and fall accident, do yourself a favor. Think like an adjuster and look at a slip and fall injury claim from their perspective. What you learn about insurance companies can mean more compensation for you or a family member.

The Insurance Company’s Bottom Line

Insurance companies have three important goals when handling slip and fall injury claims.

In order of importance, their goals are:

  1. Save Money – Adjusters won’t pay you any more money than they have to. Lower payouts mean greater profits for the insurance company and bigger bonuses for the adjuster.
  2. Save Reputation – Insurance companies are obligated to protect their insured. If you fell at a restaurant or retail store, they have to protect the business’s reputation.
  3. Save Time – Time is money, and adjusters can have hundreds of claim files to handle. They don’t want time-consuming claims that take away from their other responsibilities.

While the adjuster wants to accomplish all three goals, they’re usually willing to risk wasting time to protect money and reputation. When push comes to shove,  the adjuster will also risk a moderate loss of the insured’s reputation to protect the insurance company’s financial bottom line.

It’s important to know the insurance company’s priorities, so you can understand where the adjuster is coming from.

With this knowledge, you have a starting point in your discussions with the insurance company.

If you take the time to organize your evidence and brush up on basic settlement negotiation skills, you may be able to convince the adjuster that offering a fair settlement will:

  • Minimize bad press for the at-fault insured
  • Save the adjuster’s time and energy

The adjuster will soon realize that you have a strong case and are a credible injury victim. The adjuster will offer a fair settlement, rather than risk you winning a larger award in court.

Insurance Adjuster Tactics for Paying Less

When you put the insurance company on notice of your intent to file an injury claim, your claim is assigned to an individual adjuster. The adjuster’s job is to quickly resolve your claim for as little money as possible.

Claims adjusters get rewards for their performance just like any other type of worker. The adjuster’s next promotion and year-end bonus can depend on settling every claim for less, including yours.

Insurance company adjusters have their own style and use a variety of strategies for handling slip and fall claims.

Strategy One: Act Like a Friend

The adjuster is not your friend. Insurance adjusters work for the insurance company and are obliged to protect the party who caused your injuries.

Beware of the sympathetic and friendly claims adjuster, who tells you not to worry because they’ll “take care of everything.”  They’ll look you right in the eye and say you don’t need a lawyer.

If you’ve done your homework, you can probably settle a minor injury claim on your own. Severe or complicated injury claims should be handled by a personal injury attorney for the best outcome. 

Adjusters often try to “buddy-up” to you to ask for a recorded statement.  If you agree and aren’t prepared, they’ll trick you into saying things that can be used against you.

Attorneys don’t recommend giving a recorded statement on your own, because it’s common to be manipulated by the adjuster.

Strategy Two: Deny Your Claim

Denying a claim, regardless of its merit, is a powerful strategy to deter a claimant. The adjuster is banking that you’ll let your claim go.

The adjuster might deny your slip and fall claim by arguing that:

  • You’re at fault for your injuries
  • There’s no evidence of injuries
  • Your injuries were pre-existing
  • You didn’t report the fall right away
  • The property owner didn’t do anything wrong

Don’t be discouraged. Insurers can use any excuse to attempt to deny your claim, but that doesn’t mean you can’t continue to seek compensation.

Strategy Three: Lowball Offers

If your claim isn’t outright denied, you can expect to get a lowball settlement offer for far less than what your claim is worth.

The adjuster might say:

  • It’s the most they can offer for your claim type
  • It’s a fair deal
  • The offer is in everyone’s best interests
  • Anything more would exceed their authority

Like flat denials, the insurance company has a reason to make a low offer. They’re hoping you’ll become discouraged or take the low offer and go away without asking for more.

If you get angry, distressed, or sound desperate for more money, the adjuster will have the advantage.

Don’t take the low offer personally. Stay calm, reject the lowball offer, and get on with your negotiations.

Strategy Four: Delay

Most insurance companies want claims resolved as soon as possible – unless it improves their bottom line to drag it out.

Stalling tactics include:

  • Ignoring your phone calls
  • Not responding to your counter-offers
  • Failing to answer your questions

Stalling may cause you to lose confidence in your claim. It may also prompt you to accept a lowball offer, especially if the adjuster knows you need the money to pay bills or have an expensive upcoming event.

It’s also possible that you just ended up with a lazy or overworked adjuster who only jumps when an attorney is on the phone.

Be prepared to negotiate with patience and persistence. Know that a slip and fall injury claim can take time, even if the insurer is not intentionally stalling.

Strategy Five: Threatening

Some adjusters are pushy and belligerent, even if they start out acting like your “buddy.” Aggressive adjusters might use scare tactics to threaten you into taking their “final offer.”

Pushing a Fast Settlement: Pushy adjusters will act like they’re doing you a favor by giving you any money at all. They might say you have to act fast, or they’ll close down your claim.

What they won’t tell you is that each state has a statute of limitations, meaning you have a certain amount of time (usually two years) to resolve your injury claim or file a lawsuit. If you don’t file a lawsuit before the statutory deadline, you lose the right to compensation.

Forcing an IME: Sometimes the adjuster will play hard-ball and threaten to schedule an independent medical exam, called an IME for short. If you are handling your own claim, this is a good time to talk to an attorney.

IME doctors work for the insurance company. They are supposed to be unbiased, but IME doctors get paid to look for reasons to question the scope of your injuries or the medical necessity of your treatments.

See You in Court: The adjuster might suggest that they have no choice but to go to court if you don’t take their offer. Insurers know that injured parties rarely want to face the costs, delays, and uncertainties of a court case.

However, adjusters often change their tune when they realize you are ready to file a lawsuit against their insured. It’s amazing how fast they raise their settlement offer when you get your own attorney involved.

Handling Your Slip and Fall Negotiations

If you’ve fully recovered from minor injuries after a slip and fall, you might decide to negotiate your own claim directly with the insurance adjuster.

After you file your claim, the insurance company will either deny your claim or make a settlement offer.

You’ll rarely want to accept the first offer because it’s usually an unacceptably low amount. Rather, you should prepare a strategy to negotiate with the adjuster and reach a settlement that is acceptable to you and the insurance company.

Here’s how to build an effective negotiation strategy:

Be Thorough: Know your case before you start to negotiate. Review and organize all the relevant evidence, including your detailed notes about what happened.

Everything you have helps, including:

Estimate Your Claim Value: Try to calculate the value of your slip and fall claim before speaking with an adjuster. Your demand for compensation can include:

  • Medical bills
  • Out-of-pocket medical expenses, like medications
  • Lost Wages
  • Travel costs to medical appointments
  • Pain and suffering

It’s easier to justify your hard costs, like medical bills and lost wages, because you’ll have receipts and wage statements to back them up.

There are no objective measurements for general damages like emotional distress. The adjuster will resist, but there are ways to negotiate your pain and suffering after a slip and fall.

Don’t make the mistake of overestimating a pain and suffering claim. Extremely high claims are rejected outright, weakening your negotiating position.

Be Patient: Be patient and let your case unfold. For example, don’t begin negotiations until you know all the costs associated with your claim – including your medical bills. It’s better to wait until you’ve recovered before discussing settlement.

Patience during preparations can give you time to build your case, learn as much as you can about negotiations for slip and fall claims, and to consider consulting an attorney.

Negotiations take time. Don’t rush to accept the adjuster’s first offer. Be prepared to hold out for what you deserve.

Be Persistent: Know the strongest parts of your claim and vigorously support them. Don’t feel your points aren’t valid just because an adjuster brushes them off.

There will be times during your negotiations when you feel like telling the adjuster to “pound sand.” Resist the temptation.

It pays to stay calm and stress the strong points in your evidence. Adjusters are more willing to “deal” with people who are polite and professional.

Be Realistic: Every case has its strengths and weaknesses. While you need to stand firm on your case’s strong points, you must be willing to retreat on weaker ones.

Take some time to pinpoint weaker areas of your claim. If you can’t answer questions about those areas, be realistic about their compensation value. Good negotiations require some give and take on both sides.

Know Your Options: It’s good to know your options if negotiations fail. You can pursue some options without filing a lawsuit.

Mediation and arbitration are types of Alternate Dispute Resolution(ADR) that might be a good fit for you if you can get the insurance company to participate.

  • Mediation is like negotiations, but a “neutral” third party, called a mediator, facilitates your discussions with the insurance company.
  • Arbitration also involves a third party. It’s similar to mediation but gives the third party, called an arbitrator, the authority to decide the outcome.

ADR may be more attractive to you and the insurance adjuster than the uncertainty, expense, and time investment of a court case.

Attorneys Can Boost Slip and Fall Payouts

Insurance companies have many advantages over injury victims in slip and fall claims. They have insurance adjusters who are trained negotiators. They have a lot of resources, including access to evidence you can’t easily get on your own. They also have legal experts who keep them up to date on state injury laws.

If you’ve been badly injured in a slip and fall, the best way to protect your rights and maximize your compensation is to consult an experienced personal injury attorney.

Even minor injury claims are best handled by an attorney when:

  • The adjuster is blaming you for your injuries
  • You feel the insurance company is discriminating against you
  • Evidence is destroyed by the adjuster or at-fault party
  • The adjuster won’t respond to calls or emails
  • You believe the adjuster is using unfair or deceptive tactics in handling your claim

Your attorney will negotiate with the insurance adjuster on your behalf, and your injury claim will likely settle before it ever gets to court.

Most adjusters will offer more to settle once an attorney gets involved. The last thing the insurance company wants is for their insured to be named in a lawsuit.

Most injury attorneys don’t charge slip and fall victims for their first consultation. There’s no cost and no obligation to find out what a skilled attorney can do for you.

Dustin Reichard, Esq. is an experienced attorney with 20 years of work in the legal field. He’s admitted to the Illinois State Bar and the Washington State Bar. Dustin has worked in the areas of medical malpractice, wrongful death, product liability, slip and falls, and general liability. Dustin began his legal career as a JAG... Read More >>