Unfair Claims Practices - Has Your Insurance Company Or Adjuster Handled Your Claim Unlawfully?

Unfair Claims Practices

Insurance companies refused to settle thousands of claims after Hurricanes Katrina and Rita and showed America just what Unfair Claims Practices can look like. But Unfair Claims Practices happen in more than just hurricanes losses. Insurance companies deny and delay claims on a very regular basis.

What do you do when your insurance company drags its feet and will not settle your claim? How do you tell what actions are just simply annoyingly poor customer service, and what actions violate the law?

How do you know if your insurance company is treating you fairly and lawfully after you have filed an insurance claim?

Every state has Unfair Claims Practices regulations to protect policyholders and claimants from being abused by insurance companies in the claims process.

A state regulator's primary task is protecting the interests of insurance consumers. Check with your state's Department of Insurance to find out the regulations in your state.

Let me give you some examples of Unfair Claims Practices:

* Attempting to settle a claim based on an application which the company changed without the insured's knowledge or permission. The simplest example of this is when an insurance company changes the date of the application. But it could be any information on the application that might be altered.

* Failing to act promptly after receiving information concerning an insurance claim. Many states require response within 15 days. When there's a storm like Katrina, you might have to wait weeks to meet your adjuster. But that might be an Unfair Claims Practice.

* Delaying a claim investigation by requiring unnecessary reports or documents which contain substantially the same information. Recently I witnessed a major well-known insurance company send a claim to their Special Investigations Unit (SUI), and then take recorded statements from the insureds...and then ask the insureds to submit to an Examination Under Oath. In my opinion, that was Unfair Claims Practice perpetrated by that insurance company.

* When applicable, failing to pay a claim quickly, fairly and equitably. Unethical insurance companies could just stonewall you by telling you it is still investigating your claim.

* Failing to promptly settle claims where liability is reasonably clear under one portion of the policy to influence settlements under any portion of the insurance policy coverage. For example, your auto insurer can't refuse to pay your bills under the medical coverage in your policy so you'll settle your uninsured motorist claim.

* Failing to promptly and clearly explain the policy or the law for either denying a claim or offering a compromise settlement. If you get a denial letter for your claim, the letter should quote the policy language directly that applies. No quote, could be Unfair Claim Practice.

* Attempting to persuade insureds not to invoke and use the arbitration process. Also, an insurance company is prevented from appealing almost all of the arbitration awards in favor of policyholders as a way to force a settlement of claims.

* Misrepresenting significant facts or insurance policy provisions. Insurance companies sometimes deny claims on their misinterpretation of the policy. Then, it's up to you to change their minds.

* Refusing to tell an insured what is happening with a loss within a reasonable time after receiving a completed proof of loss statement. Many policies require the insurance company to accept or deny the proof of loss within 30 days after receiving it. It's in your policy...read it.

* Denying claims without a reasonable loss investigation. The problem comes with the definition of "reasonable." Still, insurers sometimes try to settle a claim using a "lowball settlement offer" without much investigation, just to see if they can make the claim go away.

* Offering very low settlements to encourage insureds to sue. That would cause the length of time for a claim settlement to stretch out, possibly for years. The only ones who benefit from that delay are the insurance company...and the attorneys

* Settling claims for less than the amounts a reasonable person would expect. Insurance companies regularly make "lowball offers" for settlements to their own policyholders as well as third-party claimants. The insurers will pay the LEAST amount of money in a settlement that the policyholders or claimants will accept...always. That's one way to maximize profits.

If you think that your insurance company examiner or adjuster is has committed an Unfair Claims Practices action, talk to that person's supervisor. If the situation doesn't improve or get entirely resolved, file a complaint with your state's insurance department.

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Who's Who - Company Insurance Brokerage & Independent Insurance Brokerage Listings

Agents can choose to place business with either a company insurance brokerage office or an independent insurance brokerage firm. Here are insurance brokerage listings for many of the various tiles used within the business. Find out the difference among insurance brokerage titles, and how to distinguish who's who.

Health and life agents can earn over 90 insurance designations. Fortunately, the numbers of titles for firms obtaining brokerage business are fewer.A listing is provided of many different title names used, and any actual differences that separate one's firm title from another. The potential producers that might write insurance cases for you should also know these differences.

Before this, it is critical because of some many misconceptions to define the terms broker and brokerage as they refer to life and health insurance. You would be surprised at how few of the general public understands what your firm title or function means. Likewise, hundreds of thousands of agents do not understand these terms. The mix up occurs primary with stock brokers and stock brokerage firms. That is what the majority of the public thinks of when hearing these terms.

Insurance brokerage firms of all different titles, obtain a written annuity, life, or health insurance case from a broker. All their producers should be called brokers and their cases called brokerage business. When an agent writes a case outside their primary career company, they are called a broker and their business is brokerage. There are many agents that are "agent brokers". They have a primary insurance company as an agent and submit business to a brokerage firm as a broker. There are also independent life and health insurance agents that should rightfully be called independent brokers, with the before mentioned group better referred to as semi-independent agents.

Writing brokerage business is a true form of independence of the agent's part. Rarely will this occur to any extent until the agent has surpassed a full three years of insurance dependence on career orientated companies. The three main reasons an agent writes insurance brokerage are independence, client needs, and higher commissions.

COMPANY INSURANCE BROKERAGE

What truly baffles insurance agents is the fact that some of the insurance companies training new insurance career agents often operate and highly promote through large advertisements their brokerage operations. They preach to the agents that they should only do business with the career company you are licensed with. Moreover, agents are firmly reminded they have all the products they need, and the company is supporting them 100%. Meanwhile the company insurance brokerage operation is trying to pilfer away as much business as possible from the career agents of fellow insurance companies. Less confusing of course, are the expanding number of insurance companies that only accept brokerage business and have no agency force of their own.

Starting with one insurance company brokerage operations, you have many different variations and titles among the people that distribute the products. A main difference would be those that are directly employed by the insurance company as a salaried or salaried plus bonus individual. Others have an independent contractor style contract, with fringe benefits like health insurance missing. They are paid through a combination of commissions and overrides along with possible production bonuses.

Director of marketing, national director of recruiting, director of product development and sales, Northwest marketing director, divisional director of disability sales, are just a taste of titles usually reserved for higher up home office employees. Many of these have never sold or brokered an insurance policy! Among them are fortune telling number crunchers with little reality of what it takes to be a successful brokerage manager. In turn, rarely do they do the actual recruiting of agents. The sad part is that they frequently set the company recruiting, marketing, and budgeting policies that others must follow.

The common one company insurance brokerage devoted titles include General Agent, Brokerage General Agent, Regional General Agent, State Manager, Managing General Agent, District Manager, Director of Brokerage, Wholesaler, and Regional Manager. If an insurance company is brokering three main products, they for example, may be LTC Brokerage Manager, Annuity Brokerage Manager, and Advanced Life Brokerage Manager. The inter combinations of titles are virtually countless. A high percentage of these one insurance company brokerage operations maintain the name of the company in their firm name.

Here is one conflict of interest. As some insurance companies want to sell as many insurance brokerage cases, as possible they often contract with independent marketing organizations and national brokerage firms. There is frequently true competition among them, going after agents and brokers to acquire insurance brokerage. It should be mentioned what the danger factor is. When you rely on just one insurance company what happens when your prime product is suddenly dropped, your territory is cut, your position is eliminated, or when another insurer buys out the company?

INDEPENDENT INSURANCE BROKERAGE LISTINGS

Non-existent just 25 years ago, independent insurance brokerage firms have erupted on the market scene. Here are some reasons why. First brokers like to find a company that can give them the best product for their client, or the highest commission when they make a sale. With some independent insurance marketing firms representing over 50 companies, they can sometimes do both. Some national firms are so powerful that they can dictate that an insurance policy develop a product only they can distribute. Insurance companies know that they can keep adding new policy features or constantly introduce a rehashed, but now called new policy. Insurance marketers love promoting a familiar product that has new features, a new name, or new commission structure. As insurance marketers like to make money, unfairly some of those where the highest override exists, are the products most heavily promoted . A 35% override sure beats 20% on a similar product in the mind of numerous marketers.

Titles that independent insurance brokerage marketers have on their contract include product distributor, national wholesaler, and exclusive product marketer, along with all independent contractor titles mentioned under one-company marketers. They often distinguish themselves by keeping their personal name out of the firm's official name. Others insert the word independent or national to separate them. Usually they promote a variety of company insignia trademarks or names in their advertising materials.

It is essential to describe briefly independent insurance marketing organizations. Over 250 independent insurance brokerage firms are associated with to at least one of the top 20 independent insurance marketing organizations. While 250 out of 15,000 to 20,000 separate brokerage titled operations does not seem significant, it really is. The smaller firms combine contracting and some advertising to form the larger independent insurance brokerage marketing organization. The organization thereby is able to obtain a higher compensation level contract with more insurance brokerage companies. Although sometimes members only operate in one state, others cross-territories, even on a national basis. The longevity of profitability for these firms is amazing, especially when compared with brokerage firms overall. The dues and advertising cost sharing is well offset by the extra training tips, bonding, shared marketing tricks, and higher overrides they could receive on their own.

Who's Who in major league, big-time insurance brokerage is constantly changing. Some are 3-generation family owned firms, and others mightily spring up and disappear just about as quickly. One of the key factors never mentioned above is of great magnitude. That factor is service. What can you do to make sure your broker stays your broker? Regardless of what title you or your firm has, all is irrelevant if the broker writes one case and moves on elsewhere.

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What Should You Look For in an Auto Insurance Company?

What is a car insurance? What will an auto insurance cover?

Auto insurance companies cover you and your passengers in the event of an accident. But it is up to you to decide the level of cover you will get.

Will the damages to your property be covered by the company? Will all the passengers be covered or only your family? What if your daughter was driving your car?

What questions should you ask your auto insurance company when it comes to auto insurance? This article help you choose between the various insurance policies.

Types of auto insurance

Liability insurance, or third party insurance.

This is general the lowest form of insurance offered by an auto insurance company. This is the basic insurance, if you are involved in an accident, and it is proven to be your fault, the auto insurance company will pay damages to the other party.

The cover offered by the auto insurance company is usually set beforehand. These are the maximum amount the auto insurance company will pay in case of accident

For example the agent will agree on a $10000 coverage per person, (bodily injury) and/or $40000 coverage in bodily injury and/or $10000 in property damage per accident

You need to confirm with your auto insurance company what they will cover and what are the limits.

You might be offered a very low premium by some auto insurance company only to realize that your cover is minimal and unrealistic.

Collision and comprehensive coverage, comprehensive insurance and full comprehensive insurance

An auto insurance company will also offer you a comprehensive insurance, as the name indicates, you will be comprehensively covered.

In simple terms it means that if you are responsible for a collision the insurance company will pay for the repair of the vehicle.

But it is not so simple, an auto insurance company will almost always have the final say on what amount will be paid out, so if it is cheaper to give you market value for the car, then they will.

You might think that your car is worth $1000.00 but the real market value might be $500.00. This is not an uncommon scenario. So if the repair of your car are more than $500.00 then the auto insurance company will simply pay the book value of the car.

You must make sure that the insurance company is not in control of the market value of the car, normally organisations like the AA will give an impartial market value.

As with the third party insurance, the auto insurance company will almost certainly limit the amount that will be paid out, but in general terms, a comprehensive insurance will have higher limits.

Recreation Vehicle

A recreation vehicle needs its own insurance, a Recreation vehicle insurance is not the same as auto insurance.

You should not assume that because your car is comprehensively insured, so is your recreation vehicle.

Other Types of auto insurance

Medical (MedPay), Persona Injury protection (PIP) and no fault cover

This insurance will cover you and your passengers medical expenses in the event of a collision.

The no fault cover means that the auto insurance company will pay regardless of who is at fault. This give you the piece of mind that, at the very least, your family and friends are covered.

PIP is often a minimum requirement in some countries or states, ask your auto insurance company what the requirements are.

Uninsured/Underinsured motorists' coverage

This cover, (also sometimes a minimum requirement in some states), will cover you if the person at fault is not insured or is underinsured.

You must ask your auto insurance company what you will be charged in case of such a situation. Normally the auto insurance company should not charge you some extra premiums.

Rental reimbursement, towing and labour

Those 'extras' often given with a comprehensive insurance is often use by auto insurance companies as specials.

So in case your car is damaged the auto insurance company will pay for rental costs, (sometimes only for a few days).

The auto insurance company might also offer to pay for the towing of your vehicle, (not always included).

As always you should ask your auto insurance company what is included in the cover.

The legal requirements.

Most states, and most countries will require a certain level of cover, from full comprehensive car insurance to third party auto insurance.

In most cases it is up to you, the driver, to ensure that your auto insurance company offers you the minimum required. In most cases the insurance company, (the auto insurance company), is under no obligation to instruct you of the requirements.

But of course, a good auto insurance company will, (should?), try its outmost to advise you on the best deal for you.

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What Do to When Your Insurance Company Denies Your Claim

A determination by your insurance company that you are not covered is not the final word, but only the beginning of a process for you to obtain the insurance coverage which you purchased. Upon further investigation, facts may come to light which may cause the insurance company to re-evaluate its position and provide coverage.

Also, if suit is necessary, the courts may find that you are covered by your insurance policy when your insurer says you are not covered.

The realities of insurance

Whether you are a business that purchased a commercial general liability insurance policy or an individual who purchases a homeowner's policy or a life insurance policy, "peace of mind" was probably a big selling point made by the selling insurance agent. In return for payment of money to the insurance company today, the insurance provider promises that it will be there for you in the future should you suffer a loss.

Unfortunately, many find that after having consistently paid their premiums, an insurance provider denies their claim when they call upon their insurance company for the coverage promised in the insurance policy. In many cases, the one who determines and advises you that your insurance policy does not provide coverage is not an attorney, but a claims adjuster without knowledge of Louisiana insurance law.

Should your insurance company deny you coverage, you should seek the advice of an attorney familiar with the interpretation of insurance policy language.

When doing so, you are obtaining the opinion of a person trained in insurance law and not employed by the insurance company. If your attorney's opinion is that you are entitled to coverage, the denial of your claim is the beginning of your claim's process, not the end.

Why insurers and the insured always seem to be at odds

As an insurance company is a business, and a goal of a business is to make a profit, it is understandable that an insurance company has a bias towards denying insurance coverage. However, this bias may not be the only reason for an insurance company denying coverage to its insured.

At the time that you prepare and submit your claim to your insurance company, you may not know all of the facts and the insurance adjuster may not know all of the facts particular to your situation. In this situation, an attorney can review the insurance provisions, discover the relevant facts that trigger coverage and transmit these facts to the insurance adjuster for a re-determination of coverage.

When problems with claims persist

If the adjuster continues to deny coverage in the face of the newly presented facts, your attorney will be able to further pursue and protect your interests by filing suit against the insurance company. In this suit, your attorney will ask the court to declare that you have coverage under your policy.

In some situations it is not the lack of knowledge of certain facts which cause the insurance adjuster to deny coverage, but the policy language as the policy language relevant to your claim may have acquired a legal meaning which is not apparent to the layman or the insurance adjuster upon reading of the policy. Again, your attorney will be able to explain to the insurance adjuster the legal meaning and ramifications of the policy language and how that meaning entitles you to coverage.

Should the adjuster continue to deny coverage in the face of such law, your attorney will be able to further pursue your interest by filing suit against the insurance company asking the court to determine that you are covered by your policy.

The above situations may be best explained by real life examples:

Family #1 - Accidental Death Claim

In a claim for accidental life insurance policy proceeds, an insurance company denied the claims of a parent for the death of their child, when that child died after losing control of a car he was driving. Scientific examination of blood samples showed trace amounts of a prescriptive medicine, a medicine which was not prescribed to the child.

The insurance company denied the claim upon the basis that the child was under the influence of a controlled substance, and coverage for such was excluded by the policy. The parents hired an attorney who reviewed the policy, reviewed the chemical analysis and obtained information from a forensic pathologist about the chemical analysis. The attorney's efforts proved that the amount of the controlled substance that appeared in the chemical analysis was the minimum amount which could be registered by the test, and that a test reading of this amount could mean that there was none of the controlled substance in the child's bloodstream.

End result -

Upon being presented with this information, the insurance company reversed its position, provided coverage, and paid the full amount of the accidental life insurance proceeds to the parents. This is an example where facts relevant to coverage where not apparent to the policy holder and the adjuster. An experienced attorney was required to discover the relevant facts and present them to the insurance company.

Family #2 - Life Insurance Disputes

In another situation, an insured was delivered an insurance policy while in the hospital. The insured was diagnosed with a terminal illness during this hospital stay and died soon after. The insurance company denied coverage claiming that the insured knew of the presence of this disease prior to delivery of the life insurance policy. The insured's surviving spouse obtained the services of an attorney and suit was filed.

End result-

This attorney conducted a thorough and exhaustive research of the deceased's medical records. This attorney discovered that the only evidence of the deceased having knowledge of a terminal illness occurred within one day after the life insurance policy was delivered. The attorney presented this information to the insurance company and the insurance company settled the law suit by paying benefits to the surviving spouse.

Business Scenario - Lawsuit protection

In another situation, a commercial business was sued for libel and slander. That commercial business had purchased a comprehensive general liability policy which provided coverage for attorney's fees and court costs in defending this claim. The insurer refused to provide coverage.

The business hired an attorney to defend the business in the libel and slander suit. That same attorney then sued the insurance company for reimbursement of the insured's attorney's fees and court costs incurred in defense of the libel and slander suit.

End result-

The result of this suit was that the court found that the insurance policy sold to the business provided coverage for a cost of defense and that the insurance company owed reimbursement to the business for the attorney's fees and costs it incurred in defending the suit. Interestingly, the insurance company owed this "cost of defense" whether the business won or lost the libel and slander suit filed against it.

There are many more examples in the law books where an insurance company denied insurance coverage to its insured, only to later be found by the courts to have provided coverage to its insured. Each case is different, and each case must be carefully examined.

Just because your insurance company tells you that you are not covered does not mean that is the final verdict. When this occurs, you should seek the services of an experienced insurance attorney who is well versed in insurance law to examine your policy and the facts of your particular case as you may end up having coverage when all is said and done. The New Orleans law firm of Greenberg and LaPeyronnie can help in such cases.