What to do if your insurance agency refuses to payout

Friday, August 24, 2012

Over the last decade, insurance companies have strengthened their settlement approach to encourage low payouts and discourage litigation. They say their actions are in reaction to fraud. Their critics say they’re focused on profits and not the consumer. Either way, it’s possible you’ve been unjustly denied payment on a claim. Follow these steps to make things right.

Document your claim.

Starting with first contact, your insurance company has documented every interaction with you, including recording your calls. Make sure you have the documentation to tell your story. Write down details of the accident; get witnesses to write down their story; get a copy of the police report. Document conversations with the insurance company, the witnesses, other parties, and your doctor. Include when and where the conversations happened. Take pictures of the vehicle damage, the accident scene, and visible injuries. Get your doctor’s description of the injuries. Include dates and times on everything.

Review your policy.

Your insurance policy is a contract between you and your insurer, and is the basis of any decision, whether from them, an arbitrator, or a court. Read your policy and find where it supports your claim; note which section it is, the “policy in effect” dates, persons covered, and amounts covered.

Contact your agent and insurance company.

Ten percent of insurance claims are denied unfairly, but only one percent of people filing claims ever question the results. For those who do contest, the majority get better settlements. Tell your agent you’re not satisfied, but be careful not to inadvertently agree to accept their denial. DON’T SIGN ANYTHING. Ask for a written explanation of your denial. If it’s because you didn’t file a form on time, or another administrative issue, don’t give up. An otherwise valid claim can’t be denied on an administrative error, unless they can show that error caused them damage.

If you get nowhere with your agent, go directly to the insurance company. Work your way up the supervisory ladder; restate your case and DOCUMENT EVERYTHING. Make notes: who you talked to, what you told them, what they told you, and the time and date it happened.

Contact your state agency.

Every state has an agency that watchdogs the insurance companies. If you’re insurer treats you unfairly, contact your state department of insurance for free help. Start by searching their website for a way to file a complaint or to find a mediator. Follow up on your actions, whether it’s filing a form or making a phone call. Document your follow-up, who you contacted and how, and the date.

Contact an arbitrator.

If you still can’t get a fair settlement, contact an outside arbitrator. The Insurance Information Institute, recommends contacting the American Arbitration Association. An arbitrator will examine your situation and deal with the insurance company. It’s not free, but it’s cheaper than a lawsuit.

Contact an attorney.

After all this, if you’re still left with no payout or a ridiculous offer, seek the help of an attorney that specializes in automobile insurance. Your state bar association can provide free referrals and identify qualified litigators for your case. Get the attorney’s fee schedule in writing so you know what you’re paying, what the attorney will take out of the settlement, and what the cost will be to you if you lose in court. And, again, document everything.

Unfortunately, hindsight is always 20/20. The results may be that you learn your policy wasn’t sufficient or your insurer didn’t have your best interests in mind. Take the lessons learned and be sure you understand your coverage before you sign on the dotted line in any US region.

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