Timeliness of insurance claim investigation and payment is often critical to the well-being of a policyholder. One of the fundamental “rules of the road” of good faith claim handling requires the insurance company to timely investigate, evaluate and pay claims if owed. Likewise, a company’s unreasonable, unfair failure or refusal to do so is bad
Bad Faith Basics
An Adjuster’s Evaluation of a Claim Cannot be Good Faith if it Cannot be Explained
How can an insurance company’s evaluation of its policyholder’s personal injury claim be considered fair, reasonable and in good faith if the insurance company cannot explain how it arrived at the dollar value it assigned to the claim? I don’t believe it can.
This issue often arises in uninsured motorist (“UM”) breach of contract/bad faith…
Insurance Companies Must Investigate Coverage Before Denying It
Insurance adjusters often don’t know how to properly interpret the language of the very insurance policies their companies sell their policyholders. My experience tells me adjusters often read the insurance policy looking for any arguable as (even outlandish) way to deny coverage. They take language out of context, misapply language to the facts of the…
Policyholders Should Not Blindly Accept Coverage Denials
When an insurance company receives a claim from its policyholder, the first thing the adjuster does is “check coverage.” This means they verify the policy is in force by making sure the premiums have been paid and the policy period is in effect. Then, the adjuster looks at the facts of the claim the policyholder…
Claim Handlers’ “Say No First, Ask Questions Later” Attitudes Can be Costly
There are many people working as claims professionals in the insurance business who strive to do the right thing by the company’s policyholders. When I run into one of them, it is like a breath of fresh air. These folks seem to genuinely care about policyholders and work hard to try to find ways to…
Does Using Biased Experts Violate the Duty of Good Faith?
Insurance companies often hire an “expert” as part of their investigation of a policyholder’s claim. The expert can be a doctor, an engineer, an accident reconstructionist, an accountant, etc. , depending on the type of claim and the issue being investigated. Insurance companies and their lawyers love nothing better than to claim that because they…
How Do Insurance Companies Track “Quality” Claim Handling?
“Quality Assurance” or “QA” is a familiar concept in lots of industries (like manufacturing for example), and the insurance industry has widely implemented QA operations in their business as well. Insurance companies say they want their adjusters to handle policyholders’ claims in a “quality” fashion. To be sure adjusters are doing so, insurance companies use…
Profit-Making Culture in Insurance Claim Departments
As discussed in previous posts, an insurance company violates the duty of good faith and fair dealing when it attempts to alter the terms of its policy bargain with the policyholder by attempting to use its claim department as a profit center.
How does an insurance company get its claim personnel to buy in to
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An Insurance Claim Department is Not a Profit Center
As discussed in my last post, insurance companies (not policyholders) gamble when an insurance policy is issued. The insurance company takes on the risk of paying claims under the policy in exchange for the policyholder’s premium. The policyholder does the opposite of gambling. She does away with (or at least protects against) the risk of…
Insurance Companies (Not Policyholders) Gamble When a Policy is Issued
As discussed in earlier posts, insurance is not a gamble taken by a policyholder. Instead, the policyholder buys insurance to protect himself from the risk of a loss, whether it be a medical bill, damage to the policyholder’s property, an untimely death or a liability claim made against the policyholder by a third party. The…