One wonders why an insurer is afraid that an opposing attorney will use written procedures to “catch” the insurer in a minor deviation. First, the deviation must result in material damage to the claimant. Second, why is the insurer relying on an opposing attorney to identify a deviation? Appropriate internal controls should identify the problem first and fix it. Reliance on discovery and attorneys is both expensive and a great way to turn a poorly handled claim into a big class action headache. Third, in almost every instance, the insurer will have received some sort of complaint about the claim handling long before the lawsuit arrives. Appropriate management would evaluate handling upon receipt of the complaint and, if appropriate, apologize and make amends.
Previously as a collection manager our guidelines were clearly noted for procedures. When working as a claims adjuster the guidelines are in extremes from company to company. This is a great wakeup call to any size business, guidelines are needed no matter how big the fire
As a public adjuster in California, I frequently see the same carriers systematically ignore Fair Claims Practices. 30 day status letters are largely ignored, settlement checks are sent without any explanation of payment or denial letters are never sent.Many insurance agents fail to duly report a loss to the claims department preferring instead to tell their insured without any investigation that the claim is not covered.
The department of insurance when asked to assist will usually send a boilerplate letter stating that they can not get involve themselves in insured-carrier litigation
Whether written or memorized, there are specific guidelines we as adjusters go through to conclude a claim. After forty five years in claims, my guidelines are in my head. I know to proceed step by step in whatever arena shows up. There are different procedures involved and unless you have the unfortunate of being in a rut handling just one type of claim, you may never have the advantage of multiple procedures.
In West Virginia, the Unfair Claims Practices section of the Unfair Trade Practices Act, 33-11-4(9)(c), requires carriers to have written claim handling guidelines. However, the act now only applies to first party claimants. A 3rd party may only pursue such a claim in WV in an administrative action before the Insurance Commissioner.
Jim McQueen
Baker Davis & McQueen
Huntington, West Virginia
Insurance companies stopped training adjusters in the early 80’s, and claims handling has steadily declined. Most adjusters “learn” to handle claims by listening to the person on the phone at the next desk.
The bad faith issue did not have to happen. If you lose at court, pay the judgment in 30 days. Why is it so difficult to just do the right thing? The claimants are not ALL the enemy, and should not be treated as such.
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One wonders why an insurer is afraid that an opposing attorney will use written procedures to “catch” the insurer in a minor deviation. First, the deviation must result in material damage to the claimant. Second, why is the insurer relying on an opposing attorney to identify a deviation? Appropriate internal controls should identify the problem first and fix it. Reliance on discovery and attorneys is both expensive and a great way to turn a poorly handled claim into a big class action headache. Third, in almost every instance, the insurer will have received some sort of complaint about the claim handling long before the lawsuit arrives. Appropriate management would evaluate handling upon receipt of the complaint and, if appropriate, apologize and make amends.
Previously as a collection manager our guidelines were clearly noted for procedures. When working as a claims adjuster the guidelines are in extremes from company to company. This is a great wakeup call to any size business, guidelines are needed no matter how big the fire
As a public adjuster in California, I frequently see the same carriers systematically ignore Fair Claims Practices. 30 day status letters are largely ignored, settlement checks are sent without any explanation of payment or denial letters are never sent.Many insurance agents fail to duly report a loss to the claims department preferring instead to tell their insured without any investigation that the claim is not covered.
The department of insurance when asked to assist will usually send a boilerplate letter stating that they can not get involve themselves in insured-carrier litigation
Whether written or memorized, there are specific guidelines we as adjusters go through to conclude a claim. After forty five years in claims, my guidelines are in my head. I know to proceed step by step in whatever arena shows up. There are different procedures involved and unless you have the unfortunate of being in a rut handling just one type of claim, you may never have the advantage of multiple procedures.
In West Virginia, the Unfair Claims Practices section of the Unfair Trade Practices Act, 33-11-4(9)(c), requires carriers to have written claim handling guidelines. However, the act now only applies to first party claimants. A 3rd party may only pursue such a claim in WV in an administrative action before the Insurance Commissioner.
Jim McQueen
Baker Davis & McQueen
Huntington, West Virginia
Insurance companies stopped training adjusters in the early 80’s, and claims handling has steadily declined. Most adjusters “learn” to handle claims by listening to the person on the phone at the next desk.
The bad faith issue did not have to happen. If you lose at court, pay the judgment in 30 days. Why is it so difficult to just do the right thing? The claimants are not ALL the enemy, and should not be treated as such.