Purchasing an insurance policy can make you feel safe and protected against various risks. But while you do not obtain a financial advantage in return for the premiums you pay, the moral benefits offset the risk expectation.
Let’s be honest: insurance companies are in this business for money and not your moral benefits. That is why it is typical for them to deny, reduce, or delay customer claims.
So, what does this mean for policyholders? Well, your insurance provider may choose to deny or delay your payment to retain its profits. If the carrier repeatedly delayed payments and stalled the cases, you should contact a knowledgeable attorney who can help speed up the process.
The thing is — when you understand the stalling tactics, you can better navigate the settlement discussion with your provider. And here is how you should handle stall tactics and attempts to minimize claims.
Let’s start with establishing who insurance adjusters are and what they do.
The fundamental goal of an insurance or claims adjuster is to determine the level of the provider’s liability by investigating claims.
The investigation comprises of four basic steps:
1) Interviewing the policyholders and witnesses;
2) Consulting with police officers;
3) Checking health records;
4) Inspecting the material damage.
Given the nature of their work, claims adjusters have various motivations for using stalling tactics. The following are some of the reasons why providers often stall on payouts:
1) Corporate Policy: In some cases, common stall tactics can be a part of the corporate policy for a given insurance agency. It may sound bizarre, but some insurance companies choose this approach to maximize their profits and underplay your case.
2) Discouraging Techniques: This is a classic example of psychological pressure. There is a chance that stalling might result in a person giving up on a claim or settling for a minimized payment.
3) Evidence Expiration or Destruction. After a while, evidence can disappear. Testimonies can be proved inaccurate, witnesses may move, or documents may be misplaced. That is why some providers use stalling tactics, hoping that some valuable evidence will get lost in the process.
4) Individual Motivation: Some adjusters tend to take their time to provide a final response for a claim due to personal reasons and biases.
5) Statute of Limitations: Policyholders can miss the deadline and lose a chance to start formal proceedings. Since the time limit varies depending on a claim and a state, the case might stall long enough for the statute of limitations to kick in.
Policyholders may have to deal with any or all of these stalling approaches. That is why it is helpful to understand the most popular techniques the adjusters use.
Unfortunately, it is common for insurance providers to employ various bad faith strategies to delay or deny payments.
Here are the most popular techniques:
Delaying the processing and investigating are the attempts to starve policyholders into accepting lower settlement offers.
Four typical signs can help you detect deceptive techniques and be used as evidence of bad faith during legal proceedings. Here are some specific examples:
1) Receiving a Fast Offer: That is a telltale sign every policyholder should be aware of when receiving prompt feedback from the insurance company. It often takes a reasonable time to evaluate a claim thoroughly. So, an early offer can be considerably lower than an actual settlement sum.
2) Making Excessive Demands: A classic example is requesting unrelated records without clear justification for them. Naturally, there are specific documents you will have to provide when making a claim, but unreasonable demands for paperwork or other documentation should raise a red flag.
3) Altering the Policy: At this point, you know that some insurance providers are less reputable and will try to get out of their legal liabilities. So, looking for loopholes in the policies is a common approach for them. Once they find these loopholes, they can start fact-checking and cross-referencing the information you provided when purchasing the policy.
4) Making Lowball Offers: Receiving an unfairly low offer is another red flag. The figures you see are typically negotiable, so you need to talk to your lawyer and get a second opinion to ensure an unbiased assessment before taking any offers.
Regardless of the type of claim you’ve made, the processes of fighting back are generally the same. Here is what you can do to negotiate your claim directly with the provider:
1) Determination: That is your best bet. You need to send emails and make regular phone calls and ask about the progress and case specifics.
2) Send a formal demand letter: Another way to demonstrate that you are serious about getting your case processed. This letter can help you in case you decide to start legal proceedings.
3) Do not be afraid to escalate: You have a right to speak to a supervisor and repeat all of your questions. If you cannot reach a supervisor, use an available phone number and try making the same request again.
4) Bring up the bad faith: Your policy is essentially a contract, and it means that the provider has specific obligations under its terms. But let’s be honest: bad faith is not an exact science. And it is no secret that the attorney-client relationship does not always go swimmingly. So if you decide to take it to court, providing evidence of bad faith might come in handy.
5) Start legal proceedings: If none of the above worked, you need to start arbitration proceedings. Naturally, the type of legal action depends on the policy you own. Consult your lawyer for more information. But before you take any legal action, consider stating your intentions and willingness to fight back legally to the provider. It might work wonders.
And lastly, let’s take a look at a couple of frequently asked questions on this matter.
You can rest assured that the provider cannot drop you if the policy is older than 60 days. However, there are exceptions. It is legal for the provider to drop you if the following is true:
1) You haven’t paid your premiums;
2) You misrepresented yourself on the application; or
3) Your license has been suspended.
While there is no due deadline for the claims adjusters to respond to the claim, it is common to contact policyholders within the first couple of days of an incident. Most U.S. states legally oblige providers to address the claims shortly after they were filed. For instance, California requires providers to address the filed claims within 40 days.
Victoria is a Content Writer at American REIA, covering the latest industry news and various insurance topics, including auto, home, health, and life insurance.
Date added: February 8, 2023