Adjusters are the insurance company staff (or sometimes independent contractors) who are responsible for “adjusting” or resolving the loss claims made against insurance policies. When a personal injury loss has occurred, such as from a traffic accident that caused injury or death, the injured parties file claims against the liability insurance of the negligent party. Sometimes the injured party will file a claim under their own insurance policy, such as for medical payments coverage to help pay medical bills resulting from an auto accident or for uninsured or underinsured motorist coverage when the negligent party has no insurance or has inadequate insurance.  The insurance adjuster file will be opened immediately to store information related to the claim.

During the course of an insurance claim — which in some cases may just take a few weeks to resolve, or in other cases may require years of litigation to complete — the insurance adjuster will typically accumulate very substantial files on each claim. Those files will usually include such things as copies of the injured party’s medical records and bills, official reports on the injury incident, private investigative reports on the incident and/or on the injured party, witness statements, wage loss documentation, records for the injured person from prior claims and incidents, and written and electronic communications with a variety of people connected with the claim.

The records in these sometimes-extensive insurance files are all pertinent to how the insurance company and adjusters will approach resolving the claim, and they are often “discoverable” during the litigation activities that follow the filing of a lawsuit. In order to discover the contents of the insurance adjuster’s file on a claim — or at least as much of the file as a judge may deem to be appropriate to turn over — the attorney for the personal injury plaintiff will often use a subpoena duces tecum to require production of the file.  The discovery process may use several formal tools for the parties to acquire and share evidence related to the lawsuit, including interrogoraties, document production, depositions, and subpoenas.

A subpoena is a legal notice that requires the person who receives it to show up at a particular place and time to provide testimony in ongoing litigation. Within the scope of rules governing subpoenas and other forms of civil discovery, an attorney for one of the parties in a personal injury lawsuit may issue the subpoena to have someone who is not a party — such as a witness to a traffic accident, an investigating police officer, or a doctor for the injured plaintiff — provide testimony relevant to the case. “Duces tecum” is Latin for “you shall bring with you” and a subpoena duces tecum is a legal notice that requires the witness to bring documents or items with them for inspection when they testify. Often, the recipient of a subpoena duces tecum isn’t required to personally testify, but only to provide the requested documents.

Many of the records sought when issuing a subpoena duces tecum for an insurance adjuster’s claim file are common to every type of claim, while others may be very specific to the particular incident circumstances and personal injury claimant. The file contents that are sought will usually include:

• The entirety of the file related to the injured party’s claims for damages resulting from the incident (traffic accident, slip-and-fall, dog bite, etc.) that is the basis for the claim;
• Copies of all correspondence sent to the claimant, the claimant’s attorney, and any medical providers related to any medical bills presented for payment, including any “explanation of benefits” or “explanation of reimbursements” documenting the payment or denial of payment for the bills;
• Copies of any medical coding lists used to identify the claimant’s injuries and/or medical procedures for which services were claimed related to the injury incident;
• Copies of any and all logs or lists of medical payments made or denied related to the claim;
• Copies of any and all correspondence between the insurer and any “medical payment reviewer” or other person to whom claimant’s medical bills were submitted who determined that the billed services were not related to the incident or who determined that the billed costs were unreasonable;
• Copies of the insurer’s manuals, directions, procedures, company policies, and other documents directing the methods, processes, and considerations by which the insurer’s adjusters are to review and allow or disallow payment of any medical bills presented as part of the claim;
• Copies of any and all recorded statements from the plaintiff;
• Copies of any and all recorded statements from independent witnesses;
• A copy of the entire insurance policy that may cover the loss that is the subject of the claim;
• Copies of any and all photographs of vehicles involved in the traffic accident (or other injury incident that is the basis of the claim);
• Copies of correspondence with any medical practitioners who determined that any portions of plaintiff’s medical care and associated medical billings were unrelated to the injury incident or were unreasonable.

The list above is hardly exhaustive, and these specific items are primarily related to the discovery of insurance file contents dealing with an injured claimant’s medical care and medical billings, their causal relationship to the injury incident, and their reasonableness. Depending upon the type of injury and litigation, many other categories of documents may also be sought.

View this video describing what our law firm is all about:

Hello, my name is Ed Smith, and I am a Sacramento Personal Injury Lawyer. When someone has sustained a serious injury as a result of a traffic collision or other type of personal injury incident, the insurance companies involved with their claim will begin to collect a very great deal of information related to the incident, the claimant, and the claimant’s injuries and monetary losses. Although the insurance company adjuster may have an ethical obligation to fairly resolve the claim, the process is often skewed toward denying or reducing the claimant’s recovery — the adjuster’s file will document these efforts. If you or a member of your family has been injured as a result of another party’s negligence and find yourself dealing with these injury claim adjusters, please give us a call at (916) 921-6400 or (800) 404-5400 for free, friendly advice.  You can also reach us by using our online contact form.

I am proud to belong to the Million Dollar Advocates Forum and the National Association of Distinguished Counsel.

See some of our injury lawyer case results on our past verdicts and settlements page, and read our client reviews at Yelp, Google, and Avvo.

Photo by mohamed Hassan from Pixabay.

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