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
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
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
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
“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
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
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
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
Most of us define insurance by what it does for us under the policies we have purchased. If asked “what is insurance?,” most people would say “it pays for damage to my car” or “it pays my medical bills if I get sick” or something to that effect. These are good working definitions, but a
As a policyholder who has experienced a loss, you might think it goes without saying that an insurance company must tell you all the coverages in place under your policy that might apply to your claim. While insurance companies often do so, it is certainly not unheard of for an applicable coverage to be “overlooked.”