Behind the Curtain: An “Interview” with a Senior Insurance Adjuster About “Delay, Deny, Defend” and Other Insurance Industry Tactics 

This is a fictional account of an interview with a senior insurance adjuster for a national insurance company. The information shared in this fictional interview is based on actual events and real insurance industry tactics, including delay, deny, defend, and devalue. The facts presented are grounded in my 30 years of experience as a personal injury litigator in Illinois. This story represents an amalgamation of true statements, rationalizations, and confessions made to me by insurance executives, defense experts, senior adjusters, insurance defense attorneys, and even judges. The insights gathered come from courtroom interactions, discussions in judges’ chambers, local bar events, and one-on-one negotiations during hard-fought battles for my clients’ rights to compensation and justice. While there is no single person interviewed in the piece, the information shared in this fictional interview is based on real conversations and events.

This blog is part of the “Delay, Deny, Defend” series, in which we discuss the tactics used by insurance companies to defeat personal injury claims.

Interviewer: Thanks for sitting down with me today. To start, can you describe your role as a senior adjuster at a national insurance company? What does your job typically entail?

Senior Adjuster: Sure. As a senior claims adjuster, my job is to evaluate and settle claims made by people who’ve been injured, whether it’s from a car accident, a slip and fall, or something else covered under their policy or someone else’s. On the surface, my role might seem straightforward—assess the claim, determine liability, and pay out a fair settlement if warranted. But in practice? It’s a lot more nuanced than that.

Interviewer: How so?

Senior Adjuster: Well, our primary goal isn’t to pay out what’s “fair” to the claimant. Our goal is to protect the company’s bottom line. From day one, years ago, my training revolved around the principle of minimizing payouts—a practice that remains in place today. Every dollar we don’t pay out is a dollar saved for the company, and frankly, it’s what my performance is measured against.

Interviewer: Interesting. Could you elaborate on that training? How were you taught to minimize payouts?

Senior Adjuster: Absolutely. When I joined the company, I went through an intensive six-month training program. It’s not just about learning the technicalities of insurance policies or how to evaluate medical records. A big part of the training focuses on strategies to delay, deny, defend, and devalue claims—practices that are still taught and used today.

We’re taught to delay payments by requesting additional documentation or dragging out negotiations. The hope is that claimants will either give up or accept a lower offer out of frustration. Denial comes into play when there’s any ambiguity about liability—if there’s even a sliver of doubt, we’re encouraged to deny the claim outright. Defending the claim means fighting it hard if it goes to court, using expert witnesses or other tactics to challenge the victim’s case.

Then there’s devaluing the claim, which is probably the most insidious part. That’s where we nitpick medical records, argue about pre-existing conditions, or claim the treatment was excessive or unnecessary. Sometimes we even hire private investigators to track claimants and look for ways to discredit their injuries.

Interviewer: That sounds… calculated. What’s the incentive for you personally to handle claims this way?

Senior Adjuster: My performance—and my paycheck—is tied directly to how much I save the company. We have metrics for the “average payout per claim” and “claims closed under reserve,” meaning we settle for less than the amount we initially set aside for the claim. If I consistently close claims under reserve or get claimants to settle for pennies on the dollar, it reflects well on me. That translates into bigger bonuses, faster promotions, and, frankly, job security.

Interviewer: So your career advancement depends on minimizing payouts?

Senior Adjuster: Exactly. And it’s not just me. The whole system is built to incentivize adjusters to squeeze claimants. Supervisors and managers get their bonuses based on the performance of their teams. If my numbers are good, my boss looks good, and so on up the chain. It’s a self-reinforcing cycle.

Interviewer: Can you give me an example of a claim you handled that sticks out in your memory?

Senior Adjuster: Sure. There’s one case I’ll never forget. It involved a woman who I will refer to as “Lisa”—a single mother who was rear-ended by one of our insured drivers. She had a herniated disc and needed surgery. Her medical bills were substantial, and she was out of work for months. On paper, her claim was solid. Liability was clear, and the damages were well-documented.

But when I reviewed the case, I saw an opportunity. Her medical records showed that she’d seen a chiropractor years ago for back pain. I argued that her injuries were pre-existing and not entirely caused by the accident. We hired an independent medical examiner—and I use the term “independent” loosely—who downplayed the severity of her injuries and suggested that her surgery might not have been necessary.

We also delayed the case as much as possible. I’d request additional documentation, then claim we never received it. I’d ask for clarifications on her medical bills, knowing it would take weeks for her providers to respond. By the time we were ready to negotiate, she was months behind on her rent and desperate for money. We ended up settling her claim for $25,000, even though I knew it was worth at least four or five times that amount.

Interviewer: That’s a significant difference. How did you feel about handling the claim that way?

Senior Adjuster: Honestly? At the time, I felt pretty good about it. It’s the nature of the job. You’re trained to think of claimants as adversaries, not people. The more you save the company, the more you’re rewarded. It wasn’t until later in my career that I started to reflect on the human cost of what we do.

Interviewer: Did you ever face any pushback from claimants or their attorneys?

Senior Adjuster: Of course. Attorneys are a lot harder to deal with than unrepresented claimants. They know the game, and they’re not as easy to intimidate or wear down. But even with attorneys, we have tactics. We’ll lowball their clients, hoping they’ll recommend accepting the offer to avoid the time and expense of litigation. We’ll demand excessive documentation to bury them in paperwork. And if a case does go to trial, we’ll use every resource at our disposal to undermine their case.

Interviewer: What about unrepresented claimants? How do you approach those cases?

Senior Adjuster: Unrepresented claimants are the easiest to deal with. Most people don’t understand the value of their claim, and they’re intimidated by the process. I’ll act like I’m on their side, tell them the company wants to “do right by them,” and then offer them a lowball settlement. If they push back, I’ll remind them that litigation is time-consuming and expensive, and they might end up with less if they go that route. Nine times out of ten, they take the offer.

Interviewer: Do you ever feel guilty about the way claims are handled?

Senior Adjuster: It’s complicated. On one hand, I’m just doing my job. The company’s goal is to maximize profits, and minimizing payouts is part of that. On the other hand, I know that what we do can have devastating consequences for people. Lisa, for example, probably struggled to pay her bills and get back on her feet after we settled her claim. But if I hadn’t handled her case the way I did, someone else would have. That’s the culture of the industry.

Interviewer: If you could change one thing about the industry, what would it be?

Senior Adjuster: I think there needs to be more accountability. Right now, the deck is stacked against claimants, especially those who don’t have legal representation. Insurance companies have deep pockets and endless resources, while most people are just trying to get by. I’m not saying we should pay out every claim without question, but there should be a fairer balance between protecting the company’s interests and doing right by the people we’re supposed to help.

Interviewer: Do you see any hope for change?

Senior Adjuster:  I doubt that. There’s been more scrutiny of the industry in recent years, and some states are implementing stricter regulations. But as long as insurance companies prioritize profits over people, I think it’ll be an uphill battle. Change would require a fundamental shift in how the industry operates, and I’m not sure that’s something most companies are willing to embrace.

Interviewer: Thank you for your candor. Any final thoughts?

Senior Adjuster: Just this: If you’re ever injured and dealing with an insurance company, don’t go it alone. Get an attorney who knows how to navigate the system. Because the system isn’t designed to help you—it’s designed to protect the company. And the sooner you understand that, the better your chances of getting a fair outcome.

Years ago, during a pre-trial settlement conference, a seasoned judge, clearly frustrated, tried to explain the defense’s initial lowball offer to my client with these striking words: “Insurance companies rule the world.” Turning to my client, he added, “This is why having the right personal injury attorney matters. You need someone who knows how to push back against their tactics.” That day, we rejected the inadequate settlement offer and, through persistence and skilled negotiation, ultimately secured a significantly higher settlement from the insurance company. – Illinois personal injury attorney John J. Malm.

Contact the Award-Winning Illinois Accident Attorneys at John J. Malm & Associates

If you or a loved one has been injured through someone else’s negligence, contact our office for a free consultation. At John J. Malm & Associates, our dedicated Illinois personal injury lawyers have over 90 years of combined experience successfully advocating for injured clients. Our injury attorneys have successfully recovered higher settlements from insurance companies that have tried to delay, deny, defend, and devalue claims. Let us fight for the justice you deserve.