Insurance Claim

Many types of insurance policies cover wide varieties of situations and conduct, and yet most have several things in common. First, to recover, most liability policies require that you are not the at-fault party, to recover under the policy. The “why” seems self-explanatory, as otherwise, insurance companies feel there would be rampant fraud and collusion. Secondarily, almost all policies have a reporting requirement. There is a “duty” to report known or suspected claims to the insurance company as early on as is practical so that they may investigate matters and preserve evidence.

There are further duties incumbent upon both parties, most notably the insured, (beyond just the reporting requirement). Duties can include the obligation to cooperate with investigations, the responsibility to give statements [written and recorded] as well as statements under oath if required and to even assist with litigation if that is necessary. Failure to do any of these things may nullify coverage or the policy.

There are companies out there which don’t always have your best interest in mind when it comes to selling your structured settlement payments. There are some who will even go as far as creating fake reviews, testimonials, and credentials. This is fraud. Most feel that fraud is only at the end of the person filing the claim. There is fraud with the companies themselves too. You need to be aware of this and report them.

Insurance companies are worried about, and always on the look out for, fraud or suspected fraud. They feel that many claims are overblown or outright untruthful. In fact, many companies have 1-800 fraud reporting lines and also work cooperatively together, operating and funding things like the National Insurance Crime Bureau, where they monitor and share information with each other to try to keep fraudulent claims in check. In fact, insurance companies are probably the biggest compilers of information, data, and statistics of any entity outside the government. They are big believers in compiling, comparing and contrasting data with other insurance entities and databases to help root out many claims, fraud or what they deem “professional plaintiffs.”

This is perhaps a good thing, and a logical thing, considering that they are primarily in the business of handing out checks. However, sometimes they can be overzealous and become too aggressive in thinking or acting like all claims are fraudulent. This is particularly the case when they act this way towards their insureds; who have often never even made a claim before (and may have been insured with them for years). Many times the first claim is so contrary, that the insureds end up dropping the insurance company. More often, the insurance company loses an insured after their first claim – since they now have become a “liability.” (i.e. They are no longer just sending them money, but they now want money in return) It is for just such situations, and other insurance abuses that many states have enacted laws to protect consumers and insurers.

Many states have passed Unfair Claims Practices Acts or other similar types of legislation to protect consumers, and it is also why each state has an Insurance Commissioner. They oversee what is going on and monitor and investigate these types of abuses, so they do not occur, or if they do see that they are investigated and rectified. Sometimes the abuses of insurance companies are subtle. Many times things are not overt, but they nevertheless still occur. For instance, many times insurance companies will request the same data over and over and state they did not receive it. They may also claim was “never filed;” or they request Independent Medical Exams (in reality, Insurance Defense Doctors) to examine insureds to state there is nothing wrong with them – and that is their finding in about 98%+ of the cases – so that benefits or treatment can be discontinued. Further, insurance companies needlessly delay every aspect of a claim for manufactured reasons.

After awhile, injured parties simply get worn down and want the claim to be concluded. That works in the insurance companies’ favor. Delay of the process allows the insurance companies to continue holding on to their money (earning interest on it all the while) that much longer. They are effectively keeping YOUR money at that point. Also, as cases drag on, plaintiffs who are injured and unable to work grow desperate to bring some money in, to make their house payments and to buy food; and subsequently often take any offer. Insurance companies not only know this, but it is one of their main strategies. They essentially starve plaintiffs out and bleed them dry, until they wear them down into submission.

This may seem unsavory, but it is the way the industry is, and has been, working for many years. This is not so much a commentary on the right or wrong of insurance company conduct, but more a recitation of reality – of what IS currently GOING ON in the industry. You cannot effectively combat insurance companies and deal with them if you do not understand what you are up against. However, you can fight back. You can avail yourself of your State Insurance Commissioner, or other applicable entities, as well as news outlets, internet blogs, etc. if certain conduct is engaged in. There are ways to combat insurance companies other than in court. One man effectively picketed in front of his insurance company and had the news network there filming his “spectacle,” as he began explaining their abuses. That matter was rectified and resolved rather quickly. Insurance companies do NOT like negative press; it is not good for business or sales.…

Evaluation of Personal Injury Cases

Personal Injury Evaluation

Like many things in life, evaluating a personal injury case is not as simple as it might seem at first. Perhaps you are feeling overwhelmed at this point. If counsel represents you, you can discuss some of these techniques with your lawyer, but you need not undertake them yourself. But you may have chosen to represent yourself, particularly before litigation.

Information-gathering is the first step. Before you attempt any evaluation, make sure you have a copy of every bill, every expense which had to be paid because of this case. Talk to care providers and perhaps your health insurer about what expenses will be necessary for the future. Be prepared to document what you earned before and after the occurrence which is the basis of your claim.

Consider whether your case is well-suited to the application of a simple evaluation formula. Check the internet for jury verdicts or settlement reports of cases with injuries like yours.

Will treatment of your injuries require long-term treatment with accompanying medical expense? Has this injury affected your earning ability? If so, total the long-term cost and then discount it for present value. This works best for ongoing treatment. The expense of one-time events like a major surgery might be best evaluated at today’s cost, especially if you don’t know when that event will happen.

Chart all the possible outcomes. Are some issues definite winners, but others not so much? What is the dollar range? If the parties have already made offers and demands, you already know the upper and lower limits. The answer will be in between. Sometimes parties “split the baby” (remember the King Solomon Bible story?) and equally divide the difference, sometimes not. In general, you are at the disadvantage because the insurer can delay resolution until an acceptable settlement is reached, but you may need compensation sooner.

If you are close to trial, a focus group or mock jury may help you decide how to proceed. Non-binding arbitration can also allow to test-drive your case.

You’re Trying to Get to Settlement

Remember that almost all cases eventually settle. Usually, cases settle before trial, but occasionally they decide after trial, while on appeal, or after an appeal and re-trial. Given all the stress and expense of litigation, sooner is always better than later.

Before you reject the idea of settlement, consider mediation. Mediations can occur at any point. In early stages, you can suggest mediation if the insurer doesn’t. Watch out, though; be careful about providing massive amounts of information beyond what was in your initial demand. You want to be sure the defense is there because they want to settle, not just to get easy access to information outside of court discovery processes.

Some jurisdictions ask parties to attend an “early neutral evaluation” where a professional neutral gives parties a rational assessment of their case. Frequently, with this guidepost in hand, the parties mediate a settlement on the spot.

Most mediations occur close to trial. Parties often try to settle after discovery has closed but before incurring costly expert witness expenses.

Do you want to entrust resolution of your case to twelve strangers who qualify to judge your case because they have driver’s licenses? Mediation allows you to take control of the settlement process with neutral professional assistance.

Chances are, your case is one of the 97% which eventually settle. Use this book to help get you there.…