How to Deal With an Insurance Adjuster in Massachusetts

After a Massachusetts car accident you are dealing with two insurance companies at once, and the law treats them completely differently. Your own insurer is on the other side of a contract you bought, and that contract requires prompt notice and cooperation with the investigation of your own claim, an obligation reinforced for PIP benefits by M.G.L. c. 90, sec. 34M. The other driver’s insurer is a stranger to you. There is no contract, no duty to cooperate, and the adjuster assigned to that file is a claims professional whose employer pays what the file supports and no more. What that adjuster may and may not do is measured against the unfair claim settlement practices listed in M.G.L. c. 176D, sec. 3(9), which an injured claimant can reach through M.G.L. c. 93A. Most of the self-inflicted damage in these claims comes from treating the two relationships as if they were one. To talk through a specific claim, call Jim Glaser Law at (617) JIM-WINS; the first telephone consultation is free.

Two Relationships, Running at the Same Time

Within a day or two of a Massachusetts collision the phone starts ringing. One call comes from your own insurance company. Another comes from a company you have never done business with, calling about a driver you had never met until the moment of impact. Both callers are professional, both use the same vocabulary, and both want to talk about the same crash. The legal relationships behind them are nothing alike.

With your own insurer you have a contract. You bought a policy, you pay premiums, and the company agreed to provide specific benefits. Contracts bind both directions, and yours obligates you to report the accident promptly and to cooperate with the company’s investigation of your claim. That obligation is enforceable, and disregarding it can cost you benefits you already paid for.

With the other driver’s insurer you have nothing. No contract, no premium, no promise in either direction. That company’s obligations run to its own policyholder, the driver who hit you. In insurance language you are a third-party claimant, a formal way of saying you stand outside a contract between two other parties.

Almost every avoidable mistake in a Massachusetts injury claim traces back to that distinction being invisible to the person making it. The duty to cooperate that genuinely governs one phone call gets carried over to the other, and a claimant who was only trying to be a responsible adult hands free discovery to the party whose financial interest is opposed to their own, weeks before anyone knows how serious the injuries are.

Who the Adjuster Is, and What the Job Is Measured On

An insurance adjuster is a claims professional employed by an insurance company or working for it under contract. The job is to investigate what happened, determine what the policy covers, place a value on the claim, and close it. Your accident, which reorganized your month, is one open file among many.

None of that is sinister, and treating an adjuster as a personal enemy usually makes a claim worse. The useful framing is narrower. An adjuster on the other side is paid by a company whose money is exactly what the claim consumes, and is not evaluating whether you were hurt. That adjuster is evaluating what the file proves, and only the second thing gets paid. A significant injury documented thinly reads on paper as a minor claim; a moderate injury with a complete record of prompt treatment, consistent complaints, missed work, and out-of-pocket cost reads as a real one. Every conversation, every form, and every gap in treatment goes into that record.

Not every adjuster on a file plays the same role, either. A first-party adjuster handles the claim you make against your own policy, including personal injury protection benefits. A liability adjuster works for the other driver’s insurer and evaluates that driver’s exposure to you. Some are company staff, some work for independent adjusting firms, and some sit in a special investigations unit. The first practical step is knowing which one you are talking to.

Your Own Insurer: A Contract, and a Real Duty to Cooperate

Massachusetts auto policies are unusually uniform. The Massachusetts Automobile Insurance Policy is a standardized form whose opening agreement states the bargain plainly: the company agrees to provide the insurance protection you purchased, and you agree to pay premiums when due and to cooperate with the company in case of accidents or claims.

The policy then sets out what to do when there is an accident or loss. You help anyone injured, make the police and Registry of Motor Vehicles reports Massachusetts law requires, which the article on reporting a car accident in Massachusetts covers, then file the claim with your own company promptly and with as many details as possible. The policy warns that if you or anyone seeking payment fails to notify the company promptly of an accident or claim under the personal injury protection, uninsured motorist, medical payments, or underinsured motorist parts, the company may not be required to pay under them.

Then comes cooperation, and it is broader than most people expect. Under the standard policy, after an accident or loss you or anyone else covered must cooperate with the company in the investigation, settlement and defense of any claim or lawsuit, and copies of all legal documents connected to the accident must be sent to it. The company may require you, and any person seeking payment under any part of the policy, to submit to an examination under oath at a place it designates, within a reasonable time after it is notified of the claim. Anyone claiming personal injury protection, uninsured motorist, medical payments, or underinsured motorist benefits can be required to be examined by doctors the company selects and pays for. The section closes with a sentence worth reading twice: failure to cooperate may result in denial of the claim.

Statute reinforces the duty for no-fault benefits. M.G.L. c. 90, sec. 34M provides that the injured person shall submit to physical examinations by physicians selected by the insurer as often as may be reasonably required, and shall do all things necessary to enable the insurer to obtain medical reports and other needed information to assist in determining the amounts due. The same section makes noncooperation of an injured party a defense to the insurer in any suit for those benefits, and sets the outer boundary on the claim: it must be presented as soon as practicable after the accident, and in every case within at least two years from the date of accident.

Two things follow. Stonewalling your own insurer is not a strategy; it is a way to lose benefits you already paid for. But the duty has an edge. Cooperation means cooperating with the investigation of the claim, not answering every question instantly and unprepared in whatever format suits the company. An examination under oath is a sworn proceeding rather than a casual phone call, and the recorded statement article covers how the two differ.

One wrinkle is worth flagging. Your own insurer is on your side when it pays personal injury protection benefits and squarely across the table when it defends an uninsured or underinsured motorist claim, because there the money at issue is its own. The cooperation clause still applies; the relationship underneath it has changed. The mechanics are in the article on uninsured and underinsured motorist coverage.

The Other Driver’s Insurer: No Contract, No Duty

None of the obligations above attach to the liability adjuster working for the driver who hit you. There is no cooperation clause, because there is no policy between the two of you. Massachusetts has no statute requiring an injured person to sit for an interview with an adverse insurer as the price of making a claim.

That does not mean the claim proves itself. If you want that company to pay, you will have to establish liability and damages, which means producing medical records, bills, and wage documentation. The difference is in the how. A documented claim submitted in an organized package at a time you choose, after treatment has run its course, is a different artifact from answers given on day three while you are still on pain medication and have not seen the police report.

Answer Capsule

After a Massachusetts car accident you have two separate insurance relationships. With your own insurer you have a contract: the standard Massachusetts auto policy requires prompt notice and cooperation in the investigation, settlement and defense of any claim, and M.G.L. c. 90, sec. 34M makes noncooperation a defense to a suit for PIP benefits. With the other driver’s insurer you have no contract and no duty to cooperate, and no Massachusetts statute requires you to submit to its investigation. That adjuster’s conduct is measured against the unfair claim settlement practices in M.G.L. c. 176D, sec. 3(9), including the duty to effectuate prompt, fair and equitable settlements of claims in which liability has become reasonably clear. Those standards reach an injured claimant through M.G.L. c. 93A, sec. 9(1), and Clegg v. Butler, 424 Mass. 413 (1997) confirms a third-party claimant’s standing. Chapter 93A also requires a written demand for relief at least thirty days before suit, with a thirty-day window for the insurer to respond. Call Jim Glaser Law at (617) JIM-WINS; the first telephone consultation is free.

Whether to give a recorded statement is answered in full in a separate article in this library. The point here is wider: the absence of a duty to cooperate covers the entire relationship. There is no obligation to speculate about your speed, no obligation to adopt the adjuster’s summary of what a police report says, no obligation to characterize your own injuries before a doctor has, and no obligation to sign a broad medical authorization. That last one deserves attention: a form drafted to reach your complete medical history opens records that have nothing to do with the crash and everything to do with an argument that your pain started somewhere else.

Being unhelpful is not the goal. Confirming your name, the claim number, and that you are represented or intend to be costs nothing. The line falls at substance: injuries, fault, medical history, prior claims, and anything that sounds like an estimate.

What Massachusetts Law Requires of an Adjuster

The other side’s freedom is not unlimited. M.G.L. c. 176D, sec. 3 defines unfair or deceptive acts and practices in the business of insurance, and clause (9) lists unfair claim settlement practices. Several describe, almost line for line, the behavior injured people complain about most:

• Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue
• Failing to acknowledge and act reasonably promptly upon communications with respect to claims
• Failing to adopt and implement reasonable standards for the prompt investigation of claims
• Refusing to pay claims without conducting a reasonable investigation based upon all available information
• Failing to affirm or deny coverage of claims within a reasonable time after proof of loss statements have been completed
• Failing to effectuate prompt, fair and equitable settlements of claims in which liability has become reasonably clear
• Failing to provide promptly a reasonable explanation of the basis in the insurance policy in relation to the facts or applicable law for denial of a claim or for the offer of a compromise settlement

Other clauses address compelling insureds to institute litigation by offering substantially less than the amounts ultimately recovered, delaying investigation or payment by requiring an insured or claimant to submit a preliminary claim report and then a formal proof of loss containing substantially the same information, and failing to settle promptly under one coverage in order to influence settlement under another.

Two features of the statute matter practically. The first is that clause (9) sets no numerical deadlines anywhere. It uses reasonableness: reasonably promptly, reasonable standards, a reasonable time, a reasonable investigation, a reasonable explanation. No rule says an adjuster must call back within five days. Whether a delay was unreasonable is a comparison between what this company did and what a reasonable company would have done, and it is made with dates.

The second is the phrase that does the most work in car accident claims: prompt, fair and equitable settlements of claims in which liability has become reasonably clear. Everything turns on those last three words. Where fault is genuinely disputed, an insurer is entitled to dispute it. Once liability is reasonably clear, the calculus changes, and continued delay starts to have a statutory name.

How Chapter 176D Becomes Something a Claimant Can Enforce

Chapter 176D is a regulatory statute, and on its own it does not hand an injured person a lawsuit. The bridge is the Massachusetts consumer protection act. M.G.L. c. 93A, sec. 9(1) permits an action by any person, other than a person entitled to bring an action under section 11 of that chapter, who has been injured by another person’s use or employment of any method, act or practice declared unlawful by section 2, or any person whose rights are affected by another person violating the provisions of clause (9) of section 3 of chapter 176D. That last clause is the hook, broad enough to reach someone who never bought the policy.

It was not always so. In Van Dyke v. St. Paul Fire and Marine Insurance Company, 388 Mass. 671 (1983), the Supreme Judicial Court recounted that under the earlier version of the statute, considered in Dodd v. Commercial Union Insurance Company, 373 Mass. 72 (1977), only an insurance company’s policyholder could assert a chapter 93A violation against it for improper claim settlement practices. The Legislature amended section 9(1) in 1979, and the Court described that amendment as having substantially broadened the class of persons who could maintain actions under chapter 93A, section 9.

The Court has since applied the principle squarely in the third-party context. In Clegg v. Butler, 424 Mass. 413 (1997), it held that a third-party claimant to an insurance policy has standing to seek recovery under chapter 93A against the insurer for failing to effectuate a prompt, fair, and equitable settlement, pursuant to chapter 176D, section 3(9)(f), of claims in which liability has become reasonably clear.

A chapter 93A claim carries its own procedure, and one piece of it is worth knowing even if litigation never happens. Section 9(3) requires a written demand for relief, identifying the claimant and reasonably describing the unfair or deceptive act and the injury, mailed or delivered to the prospective respondent at least thirty days before suit is filed. The respondent then has thirty days to make a written tender of settlement, and if the claimant rejects it, the respondent can limit recovery to that tender where the court finds it was reasonable in relation to the injury actually suffered. A willful or knowing violation, or a bad-faith refusal to grant relief on demand, exposes the respondent to up to three but not less than two times the actual damages, plus reasonable attorney’s fees and costs under section 9(4).

Whether any of that fits a particular claim is a question for a lawyer looking at real facts, and this article is not a guide to litigating one. The reason to know the mechanism exists is simpler: it explains why the record you keep during the ordinary, unremarkable months of a claim has a second life later.

The Paper Trail Is the Claim

Everything above converges on one instruction. Reasonableness is proven with dates, and nobody reconstructs dates from memory two years later.

Keep a contact log. Every time an adjuster reaches you, write down the date, the time, the adjuster’s name, the company, the claim number, what was asked, what you said, and anything promised. Six weeks of unreturned calls and six weeks of diligent handling look identical in hindsight unless someone wrote it down while it was happening.

Follow important calls with a short written message. A few sentences, no argument: as we discussed this morning, you indicated the company is waiting on the police report and expects to finish its liability review by the end of the month; please let me know if I have that wrong. That converts an oral statement into a record, politely. You are not building a case against the adjuster; you are removing the chance of an honest disagreement about what was said.

Keep the rest of the file with the same discipline. Every letter and explanation of benefits. Photographs of the vehicles, the scene, and any visible injury, taken early. Medical records and bills as they accumulate, plus a note of any treatment you were referred for but could not get. Wage documentation showing what you missed and what it cost. Receipts for prescriptions, equipment, mileage, and household help. A short journal of what you cannot do now that you could do before, written as it happens rather than reconstructed at the end.

Gaps do damage. A month with no treatment reads to an adjuster as a month with no symptoms, and the argument that follows is that whatever came later belongs to something other than the crash. If you stop treating, the reason should exist somewhere in writing.

Where the Two Tracks Meet

The two relationships are separate, but they run on the same clock. Personal injury protection is the first money to move, and it comes from your own insurer regardless of who caused the crash. M.G.L. c. 90, sec. 34A requires coverage of at least $8,000 per person per accident, and the standard policy pays medical expenses, up to 75 percent of lost wages, and replacement services within that limit. The PIP article covers coordination with health insurance and why the deductible you elected matters.

The claim against the other driver is a different track with its own gate. Under M.G.L. c. 231, sec. 6D, a plaintiff in a motor vehicle tort action may recover damages for pain and suffering only if reasonable and necessary medical expenses exceed $2,000, unless the injury causes death, consists in whole or in part of loss of a body member or permanent and serious disfigurement, results in the categories of loss of sight or hearing described in the workers compensation statute, or consists of a fracture. The serious injury threshold article covers how that gate is applied.

Fault sits underneath the liability adjuster’s entire evaluation. M.G.L. c. 231, sec. 85 provides that a plaintiff’s contributory negligence does not bar recovery so long as it was not greater than the total negligence attributable to the parties against whom recovery is sought, and that damages are diminished in proportion to the plaintiff’s share. Every percentage point an adjuster can attribute to you reduces the payout proportionally, and past the halfway mark it eliminates the claim. That is a direct financial incentive to build a story about your speed, your attention, or your reaction time, and it is why offhand remarks are expensive. The comparative negligence article sets out the mechanics.

Claims also move slowly for legitimate reasons, most of them medical, and the settlement timeline article explains what a normal pace looks like. Slow is not the same as indefinite. Most Massachusetts injury claims run against a three year statute of limitations, described in the statute of limitations article, and a claim that drifts while everyone waits for one more record can reach that deadline without anyone having decided to let it.

Handling the Calls Without Damaging the Claim

Sort the calls before answering questions. Ask which company the caller represents and whose policy the claim is under, then write it down. Everything else depends on that answer.

Give your own insurer prompt notice. Report the accident even if you are not yet sure whether you are hurt. Late notice can relieve the company of its obligation to pay under the personal injury protection, uninsured motorist, medical payments, and underinsured motorist parts.

Cooperate with your own insurer, with preparation. The duty is real. It is not a duty to answer hard questions unprepared, or to face an examination under oath alone.

Keep substance out of conversations with the other insurer. Name, claim number, and a referral to counsel are enough. Injuries, medical history, and fault are not topics for an unrepresented person on a recorded line.

Read before signing. A broadly drafted medical authorization reaches records unrelated to the crash, and a release ends the claim permanently, including the parts of the injury that have not fully declared themselves.

Do not guess. Saying that you do not know, or that you will get back to the adjuster with the exact answer, is a complete response. Estimates given from memory become fixed facts in a file.

If you were hurt in a Massachusetts crash and the calls have already started, a first conversation with a lawyer costs nothing. Jim Glaser Law can be reached at (617) JIM-WINS, a line answered 24 hours a day, and the first telephone consultation carries no charge. How the firm handles car accident claims is described on the practice page, and the first 24 hours after a car accident guide covers the immediate steps.

Frequently Asked Questions

Q: Do I have to talk to the other driver’s insurance adjuster in Massachusetts?

A: No. You have no contract with the other driver’s insurer and no statutory duty to cooperate with its investigation, because that company’s obligations run to its own policyholder, the driver who hit you. You can confirm your name and the claim number and then decline to discuss injuries, medical history, or how the crash happened. Declining does not forfeit your claim. The insurer still has to investigate and, under M.G.L. c. 176D, sec. 3(9)(f), to effectuate a prompt, fair and equitable settlement once liability has become reasonably clear.

Q: What is the difference between my duty to my own insurer and my duty to the other driver’s insurer?

A: The difference is a contract. The Massachusetts automobile policy states that you agree to pay premiums when due and to cooperate with your insurer in case of accidents or claims, and it requires you to notify the company promptly and to cooperate in the investigation, settlement and defense of any claim or lawsuit. For personal injury protection benefits, M.G.L. c. 90, sec. 34M adds that noncooperation of an injured party is a defense to the insurer in a suit for those benefits. None of that applies to the other driver’s insurer, because you never contracted with it and no Massachusetts statute obliges you to submit to its investigation.

Q: What does a car insurance adjuster actually do?

A: An adjuster investigates the accident, determines what the policy covers, places a value on the claim, and tries to resolve it. The adjuster is not deciding whether you were hurt; the adjuster is deciding what the claim file proves, and only the second quantity gets paid. A serious injury documented thinly reads on paper as a small claim, and a moderate injury documented completely reads as a real one. Understanding that the file is the product is more useful than treating the adjuster as a personal adversary.

Q: How long does an insurance adjuster have to respond to my claim in Massachusetts?

A: M.G.L. c. 176D, sec. 3(9) sets no numerical deadlines. It sets standards of reasonableness. The listed unfair claim settlement practices include failing to acknowledge and act reasonably promptly upon communications with respect to claims, failing to adopt and implement reasonable standards for the prompt investigation of claims, and failing to affirm or deny coverage within a reasonable time after proof of loss statements have been completed. Because the measure is reasonableness rather than a fixed number of days, the dates in your own contact log are what make a delay visible later.

Q: What is M.G.L. c. 176D and does it let me sue the insurance company?

A: M.G.L. c. 176D, sec. 3(9) is the Massachusetts list of unfair claim settlement practices, covering misrepresenting policy provisions, refusing to pay claims without conducting a reasonable investigation based upon all available information, and failing to effectuate prompt, fair and equitable settlements of claims in which liability has become reasonably clear, among others. Chapter 176D is a regulatory statute and does not by itself create a private lawsuit. The path runs through M.G.L. c. 93A, sec. 9(1), which allows an action by any person whose rights are affected by a violation of clause (9) of section 3 of chapter 176D.

Q: Can an injured person sue the other driver’s insurance company directly in Massachusetts?

A: For unfair claim settlement practices, yes, in appropriate circumstances. In Clegg v. Butler, 424 Mass. 413 (1997), the Supreme Judicial Court held that a third-party claimant has standing to seek recovery under M.G.L. c. 93A against an insurer for failing to effectuate a prompt, fair, and equitable settlement under M.G.L. c. 176D, sec. 3(9)(f) of claims in which liability has become reasonably clear. That standing exists because the Legislature amended c. 93A, sec. 9 in 1979, an amendment the Court described in Van Dyke v. St. Paul Fire and Marine Insurance Company, 388 Mass. 671 (1983) as substantially broadening the class of persons who could maintain such actions. It is separate from the underlying injury claim against the driver.

Q: What is a 93A demand letter and what happens in the thirty days after it?

A: M.G.L. c. 93A, sec. 9(3) requires that a written demand for relief be mailed or delivered to the prospective respondent at least thirty days before filing suit, and the recipient then has thirty days from that mailing or delivery to make a written tender of settlement. If the claimant rejects a tender, the respondent may limit recovery to the relief tendered where the court finds it was reasonable in relation to the injury actually suffered. If the court finds a willful or knowing violation, or a bad-faith refusal to grant relief on demand, recovery can be up to three but not less than two times the actual damages, and sec. 9(4) provides for reasonable attorney’s fees and costs.

Q: Is Jimmy Knows AI giving me legal advice?

A: No. This article provides general Massachusetts legal information, not legal advice for your specific situation. For advice about your particular claim, call Jim Glaser Law at (617) JIM-WINS.