While it might seem pretty straightforward, anyone who’s actually dealt with insurance companies knows that their least favorite thing to do in this world is pay out on claims. In fact, studies have found that 17% of claims made to HealthCare.gov insurers and 18% of claims made to private insurers are denied—with some insurance companies rejecting nearly 50% of all claims.
The simplest trick an insurance company can play is to drag their feet on your claim—there’s a reason the phrase “deny and delay” has become linked to the insurance industry as a whole. This tactic works because your insurer knows you’re desperate for a settlement on your claim; that’s the whole point of insurance. The longer they make you wait, the more likely you’ll accept whatever they offer you, even if you know it’s much less than you’re entitled to.
Documentation overload. Insurance companies sometimes request huge amounts of (sometimes unnecessary) documentation that takes a lot of time to procure and organize.
Claiming no response. Your insurer asked for something, and you provided it. Weeks later they claim they never received it, and ask that you submit it again.
Love bombing
Insurers are often extremely nice to you when you initially start dealing with them. They express sympathy, use the words “I’m sorry” in the context of your injuries or loss, and generally sound warm and friendly. That’s nice, and may even be genuine. But it’s also a tactic they use to delay or eventually find reasons to deny your claim.
Another reason an insurance adjuster or other employee might apologize to you? Because it can gently goad you into expressing regrets of your own which can then be used against you. Any expression of apology or regret could be interpreted as an admittance of fault. And establishing a friendly, sympathetic rapport with you could be a tactic to get you to say more than you should by speculating on causes or your responsibility in a claim.
Insurers will also sometimes demand that you submit a recorded statement, often very quickly after the incident covered by the claim. They will sometimes state that this is best for you, as it will get the claim moving more quickly. But a rushed recorded statement can also lead to a denied claim—if you’re wrong or inaccurate about anything in your statement, this could be used as a basis for denial.
Lawyer up. Hiring a lawyer to help you deal with insurance claims might seem like overkill, but you should always have a lawyer with you when speaking with insurers. An experienced attorney can ensure you don’t say anything that could hurt your claim.
Be suspicious. If an adjuster or other representative of the insurance company is overly friendly, don’t fall for it. Their sympathy might be genuine, but it can still get you into trouble if you let your guard down.
Rushing
This is usually designed to reduce the payout—that easy, fast settlement is probably for a lot less than the amount you’re actually entitled to—and to force errors on your part. By rushing to pull together information, you’ll probably make mistakes that can then be used to deny the claim.
Slow down. Ignore pressure to respond immediately or by arbitrary deadlines. Take your time, gather information, and respond when you’re ready. An attorney can help by acting as a buffer between you and the company.
Lowballing
If your insurer doesn’t think it can totally deny your claim, it may offer you a lowball settlement. You shouldn’t accept an insurance company’s calculations as gospel. In fact, the most important piece of information you can have about the claims process is that you are allowed to hire your own insurance adjuster. A public insurance adjuster works for you, not the insurance company, and will often arrive at a much higher figure for your claim.
Hiring your own adjuster also insulates you from internal delays, as you won’t have to wait on your insurer’s processes or play phone tag with their adjuster. In addition to an experienced lawyer, a public adjuster can also ensure that you have all the support and knowledge you need to navigate the often murky world of insurance claims.
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