This is an embarrassment to the industry. The claim adjuster, supervisor and the manager that supported this denial should be fired. Total lack of ethics and application of common sense toward statutory provisions.
She did so on the very day of the accident. When she told the agent she told the company. Isn’t that the very meaning of “agency”? Am I missing something here?
unless I am mistaken this basicly sets a very adverse precedent on the time limitation. It’s an unwinnable case that potentially throws out the time limitaion for this statute.
The Supreme Court in NY is the trial court. Its decision does not establish binding precedent. The appellate courts in NY have traditionally required strict notice to the carriers — regardless of actual prejudice to the carrier. They have been among the strictest in the nation. The NY high court indicated in dicta last year that they may revisit the notice requirement, but when it had the opportunity to overturn the strict notice requirements, did not. If appealed, this may be the case where the notice requirement does get overturned (or at least limited to certain fact situations).
As far as a black eye to the industry, the claims people appear to have simply been following the law in NY. Strange as it may sound, people should be fired for breaking the law, not for following it.
If the agent is the policyholder’s agent and not the carrier’s agent, notice to the agent will not be notice to the company in most states. Bad information from your own agent just results in an errors and omissions claim against your agent, not an action against an (arguably) innocent third party.
Sorry guys, but I agree that taking this case to trial was a bone-headed move by the adjuster, supervisor, and manager.
Based upon the scenario as reported; that the insured was incorrectly rebuffed at the agent level (and I’m betting that Travelers paid the agent a commission, not the insured), this was a sure loser at the trial court level. Especially since the insured went to the trouble to ultimately identify the hit and run driver so that she could comply with the agent’s instruction on claim reporting.
Sure, Travelers will now appeal. But, by punishing an insured for incorrect information disseminated by someone in their agency network (and who more than likely was paid for their work in the form of a commission on premium from the insurer, and not a fee from the insured), they have opened the door for another appellate court review of the policy provision. The old saying “Bad cases make for bad case law” looks like it might become applicable here.
If Travelers is lucky, the appellate court will rule that notice to the agent was notice to Travelers, or that the negligence of the agent in giving out bad information stayed the 90 days until the insured could comply with the erroneous instruction. It sounds, from the article, like that is the reasoning behind the judge’s finding. If they are lucky, the appellate court won’t address the 90-day rule.
I just returned from vacation and reviewed this article and the press release posted on the Web site of the plaintiff’s attorneys at Anderson, Kill & Olick.
The incompetence of those at Travelers involved in this case is beyond belief. The policyholder tried to file a claim the day of the accident, according to the press release, but Travelers told her she needed to provide information from the hit-and-run driver involved in this accident. Can you imagine?
When the policyholder was somehow able to obtain the information of the hit-and-run driver and provide it to Travelers, her claim was denied due to late notice. This is the equivalent of Travelers telling her to deliver the broomstick of the wicked witch. Even after she did this, they still denied her claim.
On top of this, according to the Anderson, Kill & Olick press release, Travelers attorneys also accused her, without substantiation, of extortion.
It sounds like Travelers is not running a very tight ship and this policyholder fell through some huge corporate cracks and is still falling. Travelers should conduct an internal investigation to find out how this could have happened in the first place and why this nonsense has gone on as long as it has.
I think a lot of industry elders have noticed a very strong trend of getting rid of expereeinced adjusters under the pretense they can’t adapt to automation, continued travel requirements as well as changing of policies and procedures.
Most the experienced adjusters are replaced with trainees or inexpereinced adjusters who follow a “template or box” underwriting approach. These mindless clones follow this approach in which the guidlinses are established by some HO type 20 states away. This approach works great if your claim happens to fall within the proscribed “box”. It’s an abomination if it does not. This approach ensures that any claim that falls outside of the box will be litigated and more times than not establish a bad precedent as well as create an angry claimant or insured.
The newbie adjuster that handled this travelers claim is a perfect example. He/She probably has 1-2 years in the industry and the computer advised to deny this claim since all the info had not been received. Then when it was recieved that computer advised that the statute had run.
When refered to supervisor. This 4 year veteran advised (after extacting his/her tounge from the boot of the manager that is was licking) that yes indeed the statute had run and “we owe it to our stockholders and policyholders to deny wrongful claims”.
Once it made to to the Litigation level another bootlicking sheep decided that “in for a penny, in for a pound” should apply. No one with any sense remains so you have a bunch of yes men supporting an incredibly stupid decision and really believing they are right.
This is a case where the NY DOI really needs to audit this file and basicly look at all of the litigated travelers files. The pattern would become apparent.
Mr. Obvious summed this up right. It’s a black eye to the industry and a refelction on just how little insurance knowledge remiains in the standard market companies.
If I am reading the article correctly, and assuming that the article contains all of the facts, then the ball was dropped first at the agency level, where the CSR wouldn’t take the report, or pass the report on, until the insured came up with the hit & run auto’s info. Which of course begs the question; is No-Fault deniable in NY on hit & run accidents if the claimant can’t identify the adverse party? Because that is the theory under which the agency CSR was operating. I think we can all agree that this was not corrcet. This is where it all started.
I’ve got to believe that way before suit was filed, the insured had an attorney. Which means that at Travelers, as I understand it, the claim was seen by the adjuster, the supervisor, and the local manager before the eventual final denial of coverage resulted in a suit being filed. At the big carriers, where No-Fault adjusters are often the newbies, the supervisor should have the experience to realize that this claim wasn’t going away. Anyone who would doggedly pursue the hit & run info for a year, and hire an attorney when her claim was denied, certainly wasn’t going to give up. This was not your run of the mill late reporting. This was a possible E&O claim against the agency. If the supervisor was promoted to his/her position without that level of expertise necessary to recognize the situation presented by this claim, then this is where the ball was dropped for the second and third time. Once, when the person who became the supervisor was promoted, and again when the actual aspect of the claim that created the exposure to Travelers, potential liability for the acts of the CSR, should have been recognized.
After that, it was all downhill. It almost sounds like one of those football plays where the quarterback fumbles, and then there is a succession of fumbles as everyone on the offense tries to run with the ball before making sure that they’ve actually recovered it first. In the end, the lumbering defensive lineman, the one who no one ever expects to do anything but knock heads, is the one in the end zone with the football.
In football, its called “fundamentals”. In claims, its called “Best Practices”. But Best Practices requires, in my opinion, “Best People”. Not “best people for the money we are willing to spend due to cuts in claims staffing because computers will do most of the work even though that means fewer adjusters having to look at more claims meaning turnover is high and retention of experienced adjusters is low”.
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This is an embarrassment to the industry. The claim adjuster, supervisor and the manager that supported this denial should be fired. Total lack of ethics and application of common sense toward statutory provisions.
A hefty fine is in order here.
She did so on the very day of the accident. When she told the agent she told the company. Isn’t that the very meaning of “agency”? Am I missing something here?
unless I am mistaken this basicly sets a very adverse precedent on the time limitation. It’s an unwinnable case that potentially throws out the time limitaion for this statute.
The Supreme Court in NY is the trial court. Its decision does not establish binding precedent. The appellate courts in NY have traditionally required strict notice to the carriers — regardless of actual prejudice to the carrier. They have been among the strictest in the nation. The NY high court indicated in dicta last year that they may revisit the notice requirement, but when it had the opportunity to overturn the strict notice requirements, did not. If appealed, this may be the case where the notice requirement does get overturned (or at least limited to certain fact situations).
As far as a black eye to the industry, the claims people appear to have simply been following the law in NY. Strange as it may sound, people should be fired for breaking the law, not for following it.
If the agent is the policyholder’s agent and not the carrier’s agent, notice to the agent will not be notice to the company in most states. Bad information from your own agent just results in an errors and omissions claim against your agent, not an action against an (arguably) innocent third party.
Semper Gumby
That is a great tag name you came up with!
Sorry guys, but I agree that taking this case to trial was a bone-headed move by the adjuster, supervisor, and manager.
Based upon the scenario as reported; that the insured was incorrectly rebuffed at the agent level (and I’m betting that Travelers paid the agent a commission, not the insured), this was a sure loser at the trial court level. Especially since the insured went to the trouble to ultimately identify the hit and run driver so that she could comply with the agent’s instruction on claim reporting.
Sure, Travelers will now appeal. But, by punishing an insured for incorrect information disseminated by someone in their agency network (and who more than likely was paid for their work in the form of a commission on premium from the insurer, and not a fee from the insured), they have opened the door for another appellate court review of the policy provision. The old saying “Bad cases make for bad case law” looks like it might become applicable here.
If Travelers is lucky, the appellate court will rule that notice to the agent was notice to Travelers, or that the negligence of the agent in giving out bad information stayed the 90 days until the insured could comply with the erroneous instruction. It sounds, from the article, like that is the reasoning behind the judge’s finding. If they are lucky, the appellate court won’t address the 90-day rule.
If these bone heads try to appeal this one they will just end up with more bad publicity. They should either settle or fold up that big red umbrella.
I just returned from vacation and reviewed this article and the press release posted on the Web site of the plaintiff’s attorneys at Anderson, Kill & Olick.
The incompetence of those at Travelers involved in this case is beyond belief. The policyholder tried to file a claim the day of the accident, according to the press release, but Travelers told her she needed to provide information from the hit-and-run driver involved in this accident. Can you imagine?
When the policyholder was somehow able to obtain the information of the hit-and-run driver and provide it to Travelers, her claim was denied due to late notice. This is the equivalent of Travelers telling her to deliver the broomstick of the wicked witch. Even after she did this, they still denied her claim.
On top of this, according to the Anderson, Kill & Olick press release, Travelers attorneys also accused her, without substantiation, of extortion.
It sounds like Travelers is not running a very tight ship and this policyholder fell through some huge corporate cracks and is still falling. Travelers should conduct an internal investigation to find out how this could have happened in the first place and why this nonsense has gone on as long as it has.
MV
I think a lot of industry elders have noticed a very strong trend of getting rid of expereeinced adjusters under the pretense they can’t adapt to automation, continued travel requirements as well as changing of policies and procedures.
Most the experienced adjusters are replaced with trainees or inexpereinced adjusters who follow a “template or box” underwriting approach. These mindless clones follow this approach in which the guidlinses are established by some HO type 20 states away. This approach works great if your claim happens to fall within the proscribed “box”. It’s an abomination if it does not. This approach ensures that any claim that falls outside of the box will be litigated and more times than not establish a bad precedent as well as create an angry claimant or insured.
The newbie adjuster that handled this travelers claim is a perfect example. He/She probably has 1-2 years in the industry and the computer advised to deny this claim since all the info had not been received. Then when it was recieved that computer advised that the statute had run.
When refered to supervisor. This 4 year veteran advised (after extacting his/her tounge from the boot of the manager that is was licking) that yes indeed the statute had run and “we owe it to our stockholders and policyholders to deny wrongful claims”.
Once it made to to the Litigation level another bootlicking sheep decided that “in for a penny, in for a pound” should apply. No one with any sense remains so you have a bunch of yes men supporting an incredibly stupid decision and really believing they are right.
This is a case where the NY DOI really needs to audit this file and basicly look at all of the litigated travelers files. The pattern would become apparent.
Mr. Obvious summed this up right. It’s a black eye to the industry and a refelction on just how little insurance knowledge remiains in the standard market companies.
If I am reading the article correctly, and assuming that the article contains all of the facts, then the ball was dropped first at the agency level, where the CSR wouldn’t take the report, or pass the report on, until the insured came up with the hit & run auto’s info. Which of course begs the question; is No-Fault deniable in NY on hit & run accidents if the claimant can’t identify the adverse party? Because that is the theory under which the agency CSR was operating. I think we can all agree that this was not corrcet. This is where it all started.
I’ve got to believe that way before suit was filed, the insured had an attorney. Which means that at Travelers, as I understand it, the claim was seen by the adjuster, the supervisor, and the local manager before the eventual final denial of coverage resulted in a suit being filed. At the big carriers, where No-Fault adjusters are often the newbies, the supervisor should have the experience to realize that this claim wasn’t going away. Anyone who would doggedly pursue the hit & run info for a year, and hire an attorney when her claim was denied, certainly wasn’t going to give up. This was not your run of the mill late reporting. This was a possible E&O claim against the agency. If the supervisor was promoted to his/her position without that level of expertise necessary to recognize the situation presented by this claim, then this is where the ball was dropped for the second and third time. Once, when the person who became the supervisor was promoted, and again when the actual aspect of the claim that created the exposure to Travelers, potential liability for the acts of the CSR, should have been recognized.
After that, it was all downhill. It almost sounds like one of those football plays where the quarterback fumbles, and then there is a succession of fumbles as everyone on the offense tries to run with the ball before making sure that they’ve actually recovered it first. In the end, the lumbering defensive lineman, the one who no one ever expects to do anything but knock heads, is the one in the end zone with the football.
In football, its called “fundamentals”. In claims, its called “Best Practices”. But Best Practices requires, in my opinion, “Best People”. Not “best people for the money we are willing to spend due to cuts in claims staffing because computers will do most of the work even though that means fewer adjusters having to look at more claims meaning turnover is high and retention of experienced adjusters is low”.