Exercise Caution When Dealing with Insurers

Exercise caution when dealing with insurers

When dealing with property-related insurance claims, people should maintain a certain healthy suspicion of what insurance adjusters and claims representatives say when denying a claim, portion of a claim, or providing valuations for a loss.

Whether they admit it or not, insurance company employees are always trying to pay the least possible amount on any claim.  This makes sense to the extent that insurers have “trimmed the fat” out of each claim, thereby paying for only the real loss and not any fluff.   This theoretically benefits us all as we presume it enables insurers to keep insurance premiums low.  However, this practice raises questions when claimants are improperly denied legitimate reimbursement for losses and, there is little, if any, evidence that insurers actually pass on the savings to us as policyholders.

Some of the things you may be told by a claims representative or adjuster may be blatant misstatements of the law in your state, but may be said with such authority as to sound legitimate.  Never hesitate to demand the source of the authority the insurer is relying on for the statement.  Ask to see the statute, regulation, case or specific policy provision the insurance representative is basing the denial on.  Many times, they won’t be able to show you any authority to substantiate the denial.

Likewise, just because something may be or seem to be included in a policy doesn’t always mean you don’t have the right to recover for a loss.  Insurance representatives frequently try to apply limiting policy provisions to which the insured agreed against innocent persons harmed by the insured’s actions.  A perfect example is when the at-fault automobile driver’s insurer tries to force the person collided with to accept inferior parts in the repair of her vehicle. The person who hit her may have agreed to accept cheaper, inferior parts for the use in his vehicle repair under the policy terms, but that does not mean those terms can be imposed on someone else who didn’t agree to them.

Don’t hesitate to challenge the insurance representative, whether you are claiming under your own policy or someone else’s.  Remember that saving the insurance company money is something many insurers reward their employees for, and those employees are not always scrupulous about how they reduce claims payouts.

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