Adjuster Liability Assertions and NCS Zap Language
1. Adjuster Assertion: The claimant was partially responsible for the accident.
Zap Response: The police report’s causation narrative, based on objective accident reconstruction, attributes primary fault to the opposing party. As an unbiased and independently prepared document, the report is more credible than baseless comparative negligence claims without supporting evidence.
2. Adjuster Assertion: The incident did not directly cause the claimant's injuries.
Zap Response: Causation is clearly documented in the police report, corroborated by witness statements, and supported by medical records. These provide a consistent narrative linking the injuries to the incident.
3. Adjuster Assertion: The injury is due to pre-existing conditions, not the accident.
Zap Response: The Eggshell Doctrine establishes that the claimant must be taken as they are, pre-existing conditions included. Medical records confirm that the accident exacerbated the condition, making the defendant fully liable for resulting damages.
4. Adjuster Assertion: The claimant delayed seeking treatment, which suggests their injuries were not severe.
Zap Response: Medical literature and provider statements confirm that certain injuries, such as soft tissue or neurological conditions, often have delayed onset of symptoms. Additionally, logistical or financial barriers may have contributed to treatment delays, which does not diminish the validity of the injuries.
5. Adjuster Assertion: Gaps in treatment indicate that injuries were resolved or not severe.
Zap Response: Treatment gaps are often due to logistical reasons, financial constraints, or provider availability. Medical notes and continued care plans from treating physicians confirm the claimant’s ongoing injury and recovery process.
6. Adjuster Assertion: Liability cannot be established without a police report.
Zap Response: Liability is established through multiple forms of evidence, including witness statements, photographs, and other corroborating documents. While a police report is valuable, it is not the sole determinant of liability in a claim.
7. Adjuster Assertion: The claimant was partially or fully responsible for the incident.
Zap Response: The police report clearly attributes causation to the opposing party. Any baseless allegations of partial fault violate the Unfair Claims Practices Act (UFCPA) for third-party claims and could be construed as bad faith in first-party claims.
8. Adjuster Assertion: The claimant did not take reasonable steps to mitigate damages (e.g., refusing treatment or returning to work too soon).
Zap Response: The claimant’s actions were consistent with medical recommendations and their personal financial circumstances. Any perceived failure to mitigate damages is unsupported and lacks evidence contradicting the treating physician's guidance.
9. Adjuster Assertion: The IME doctor found no evidence supporting the treating physician's assessment.
Zap Response: Treating physicians, with long-term insight into the claimant’s condition, provide a more thorough and accurate assessment than a single IME. The greater weight of evidence standard applies in such disputes, favoring treating providers.
10. Adjuster Assertion: Future treatment costs are speculative and unsupported.
Zap Response: Detailed projections from treating physicians establish future medical expenses with reasonable certainty. Without an IME, the adjuster has no authority to dispute these medical assessments.
11. Adjuster Assertion: The claimant was non-compliant with prescribed treatment, impacting their recovery.
Zap Response: The claimant adhered to treatment plans where reasonably possible. Any interruptions were due to valid reasons such as financial hardship, logistical barriers, or physician availability.
12. Adjuster Assertion: The pain and suffering multiplier or valuation is excessive.
Zap Response: The claimant’s daily limitations and quality-of-life impacts are well-documented and consistent with similar case precedents. If the attorney has applied a historical pain and suffering multiplier, this serves as a reasonable benchmark should the matter proceed to trial. For GEICO claims, reference implied reliance on ClaimIQ's valuation range.
13. Adjuster Assertion: Insurance or other sources covered some or all of the claimant’s losses.
Zap Response: Collateral source payments are inadmissible in determining damages in most jurisdictions. The claimant is entitled to recover damages in full without consideration of external payments.
14. Adjuster Assertion: The claimant's lost wages are exaggerated or unsupported.
Zap Response: Employer verification, pay stubs, and tax records substantiate lost wage claims. If necessary, economic expert reports can further support these losses.
15. Adjuster Assertion: Soft tissue injuries from minor impacts are not credible or significant.
Zap Response: Medical imaging and peer-reviewed studies confirm that soft tissue injuries can result from low-impact collisions. For instance, this study supports the credibility of such injuries.
16. Adjuster Assertion: Surveillance shows the claimant moving freely and without signs of injury.
Zap Response: Surveillance evidence must be assessed in context. Short clips do not reflect ongoing limitations or pain levels, which are comprehensively documented by treating physicians. Surveillance must comply with legal, ethical, and proportionality standards.