| If you or your small business has been harmed by a | | | | insurance company will reply to you with a letter |
| large insurance company or other big organization, | | | | citing one or more of the improper clauses or |
| there's a good chance strong legal advocacy can help | | | | paragraphs as the basis or reason for denying your |
| you to make it right. | | | | claim. |
| If the problem is a refusal to pay an insurance claim, | | | | Delay |
| the starting point is to recognize the reality is that | | | | As indicated earlier, what is seen most often from |
| insurance companies make money when they don't | | | | insurance companies is delaying tactics. The purpose |
| pay claims. | | | | of this is to frustrate you into giving up, dropping the |
| In fact, since the mid-1990s, based on a concerted | | | | claim or accepting less in compensation than you |
| strategy developed by the McKinsey consulting firm, | | | | should accept just to get it over with. In other |
| the insurance industry has developed and | | | | words, they intend to "wear you out." |
| implemented an aggressive "three Ds" approach to | | | | This is accomplished in several ways. They usually |
| avoid paying claims - deny... delay... and defend. | | | | start out with a pleasant manner, although some |
| First, they almost automatically deny the claim. | | | | choose actual rudeness. It starts with the first call. |
| Second, they do anything possible to delay | | | | Whether the tone is pleasant or bothered, you have |
| negotiations. Then third, they vigorously defend | | | | to look past their words and see what happens. |
| against any legal action. | | | | You can expect to see some or all of the more |
| The Insurance Industry's Background | | | | obvious ways of frustrating you.o Putting you on |
| Legal practice experience and information obtained | | | | hold for a long time - they will deliberately do this in |
| from insurance agents and adjusters make it clear | | | | hopes you will hang up.o Your calls to them will only |
| that there's at least some truth in the books and | | | | get voice mails, and no immediate return call.o |
| movies that claim there is a "Chapter X" in the | | | | Transferring your file to different adjusters.o Giving |
| insurance claims manual that teaches adjusters how | | | | you incorrect claim number information. Later, when |
| to deny claims. | | | | the number you are using does not connect with |
| Although these books and movies are fictional and | | | | your case, they can imply you wrote down the |
| produced for entertainment purposes, and many legal | | | | wrong claim number. |
| practitioners have never heard of or experienced a | | | | This will be followed by the less obvious tactics, the |
| written "Chapter X" for claims denials, it is apparent | | | | ones that make it seem they are trying to get your |
| that insurance companies have "unwritten" guidelines | | | | situation handled but, guess what, not really.o Mail |
| for adjusters to follow. | | | | Dodgeball - You may asked to mail a document of |
| This is not a conspiracy theory. Rather, it is a | | | | some sort, usually a bill, to substantiate part of the |
| reasonable explanation of how an insurance agent | | | | claim. After you mail it and have not heard anything |
| makes money, and how an adjuster earns his raises, | | | | back, when you call they say they have not received |
| promotions, and pats on the back for saving the | | | | it (they really did). You resend the document. Then |
| company money. In other words, these individual | | | | they ask for another document. Replay previous.o |
| agents and adjusters are simply trying to look out | | | | Never-ending Document Requests - Then, days or |
| for themselves. | | | | weeks later, they ask for another document. After |
| Everyone does that to a certain extent. The problem | | | | you make sure they've received it, they say "thank |
| with agents and adjusters doing it is they are | | | | you for sending that, now we need..." a form filled |
| cheating and breaking the laws that regulate claims | | | | out, a report taken, a statement, to talk with a |
| handling procedures. | | | | witness, or doctor, or appraiser. More time goes by. |
| Tactics | | | | Next they ask for a copy of your tax return. (This is |
| Here is a short list of the tactics most often | | | | illegal 95% of the time). While all of this is going on |
| employed by insurance agents and adjusters to bend | | | | you are, 1) inconvenienced, 2) dealing with your job, |
| things in their direction in an insurance claim.o Forgery | | | | 3) dealing with your family life, and 4) dealing with |
| - Your signature or initials are actually forged on | | | | the loss which is the reason you are making the claim |
| papers you would have signed in the application | | | | in the first place.o Unnecessary Time and Expenses - |
| process. In Texas, when a person purchases auto | | | | You are spending time on the phone and doing the |
| insurance, the law requires that the insurance | | | | things the insurance adjuster has requested, spending |
| company furnish the person with uninsured | | | | money on postage, sometimes including certified mail, |
| underinsured motorist (UM) benefits. This coverage | | | | and spending time and effort obtaining records and |
| provides benefits for situations where the insured | | | | copies. Needless to say, you are getting sick and |
| person (you) have an accident where the other | | | | tired of this process. Worse, you know you are being |
| driver is uninsured or the other driver does not have | | | | screwed around with, but you do not want to take |
| enough insurance to cover the damages. The | | | | the time or spend the money to talk with an |
| insurance company is also required by law to provide | | | | attorney about this for fear of driving up the total |
| Personal Injury Protection (PIP) benefits, which is | | | | costs involved. So, you give up. When you give up, |
| coverage for medical bills and lost wages. A person | | | | the insurance company has won. |
| who purchases auto insurance in Texas automatically | | | | The Basic Principle |
| has these two coverages unless the person | | | | You will be well-served to remember this basic |
| purchasing the insurance rejects them in writing. | | | | principle: The business of insurance is a bet. Insurance |
| What typically happens is the agent has the person | | | | is nothing more than a large company with a larger |
| sign the application for insurance but forgets to have | | | | balance sheet playing the odds against you...on your |
| the person sign the "rejection of UM and PIP" | | | | health, risk of an accident, storm damage, theft, |
| coverage. Later, when that person is involved in an | | | | death or other potentially catastrophic loss. Insurance |
| accident and makes a claim for these benefits, the | | | | companies educate themselves in extreme detail on |
| agent discovers there is a signature on the application | | | | the odds of actually having to pay on a claim. From |
| but the "rejection" was not signed. So, the agent | | | | this data, they can calculate how much they can |
| forges the signature or cuts and pastes with a copier | | | | charge you based on the eventually that some claims |
| to transpose the application signatures onto the | | | | will be made, and still make a profit. |
| rejection forms.o 515 Exclusion - Another example in | | | | When they pay a claim, they have lost their bet. |
| the auto insurance area occurs when a husband and | | | | They do not like losing their bet. It all boils down to |
| wife buy insurance. The husband might have a | | | | money. They don't want to lose their bet on |
| previous DWI conviction or too many tickets so that, | | | | insurance! |
| if he is on the policy with his wife, the rates go too | | | | There are laws regulating how insurance companies |
| high for them to be able to afford the coverage. So, | | | | handle claims. The Humphreys Law Firm is familiar |
| they purchase the insurance under the wife's name | | | | with these laws and handle these types of situations |
| only and sign what is called a "515 exclusion," which | | | | against insurance companies on a daily basis. It costs |
| provides that if anything happens while the husband | | | | nothing to talk to with them and in most cases |
| is driving the car, there is no insurance coverage. | | | | payment of fees waits until the case is resolved and |
| Some agents will have the "515 exclusion" signed, but | | | | the insurance company is required to pay legal fees |
| avoid putting a name on the form indicating who is | | | | or reimburse you for anything paid up front. |
| excluded. Later, if a claim is made, if the driver is | | | | How to Beat The Insurance Company Strategy |
| someone other than the named insured, (in this | | | | There are ways to beat the 3-Ds strategy and all of |
| example, the wife) the agent will complete the 515 | | | | its tactics and permutations. When your claim is |
| form with that person's name, saving the company | | | | denied or if you're being stonewalled... here are 5 |
| from having to pay any money on the claim.o | | | | things to do immediately: |
| Fill-in-the-Blank - An agent helping you prepare an | | | | 1. Document everything. Write down the details of |
| application for auto, homeowners, life, health, or | | | | conversations, keep letters from the company, |
| commercial insurance will ask a lot of questions, write | | | | copies of forms you've filled out. All with the dates |
| your answers on the application form, and then put | | | | and the names of people you spoke with. |
| the form in front of you for signature. What is not | | | | 2. Recall the details. Think back to the start of the |
| obvious is that the agent knows how each of the | | | | claim - an accident, property damage, death, |
| questions needs to be answered for you to be | | | | injury...whatever the cause of your loss. Write down |
| qualified for coverage. If you answered the agent's | | | | all the information about it that you can remember. |
| question in a way that would have resulted in | | | | 3. Get all the official records...your policy, reports, |
| coverage being rejected, the agent likely ignored | | | | statements, forms, explanations of benefits. Make |
| what you said and answered in a way that results in | | | | copies if necessary. |
| coverage being extended. The agent is motivated to | | | | 4. Continue doing what's needed to repair the |
| complete the sale and earn the commission. The | | | | damage. If you're supposed to be getting medical |
| agent also knows that the statistical odds are heavily | | | | treatment or repairs on a car or property, continue |
| against a claim being made. However, if you do later | | | | doing so. |
| file a claim, the agent and the insurance company | | | | 5. Contact an insurance attorney. Actually, this should |
| have created for themselves the option to accuse | | | | be the first step you take, and he'll tell you to do the |
| you of fraud and lying on the application you signed, | | | | other four. Listen to what he says and follow his |
| and using this as grounds for denying your claim.o | | | | instructions. |
| Improper Denial - Many policies include paragraphs and | | | | Regardless how large or strong your opponent is, |
| clauses that are not legal or legally enforceable. But | | | | you can win with this proof...and with an experienced |
| the general public, including you, typically is not aware | | | | insurance lawyer who is willing to fight it out. |
| of this subterfuge. So if you make a claim, the | | | | |