Mark A. SteinbergInsurance Laws For many people, insurance companies exist simply to provide peace of mind. People pay their monthly premiums for car insurance, home insurance, or life insurance and hope that they never have to be in a position where they need help from their insurer. However, the peace of mind comes in from the idea that should an accident and injury—or even death—occur, the insurance company will step in to help.
Unfortunately, it’s a regular occurrence for people with insurance policies to find that when the time comes, the insurance company decides it doesn’t have to provide coverage after all, despite regular monthly payments from a customer. This can be a confusing, vulnerable situation for people, which unethical insurers sometimes rely on.
Of course, there are valid reasons for an insurance company to refuse to pay a claim or even demand repayment of a claim that’s already been paid. Insurance fraud, especially in injuries, happens all over the world. People have successfully fooled insurance companies into paying out for false injuries, so these insurers are often paranoid about paying out for a false claim. However, in other instances, a legitimate accident victim may find that an insurer has decided not to honor a claim despite a real and painful injury. Sometimes, this is even for deliberate, malevolent reasons and may involve deception or distortion of facts and records to avoid paying a legitimate claim.
Intimidation Tactics
Insurance companies have years of experience dealing with their own policies and deciding when to honor a claim and when to refuse it. Unfortunately, that doesn’t always translate to the correct or ethical decision, and sometimes insurers exploit their position. They know, for example, that most people have little legal experience, especially with lawsuits. They also know that most Americans don’t necessarily have the “financial war chest” required to wage a long, drawn-out legal battle against a big corporation with an army of lawyers. Because of these factors, some less ethical decision-makers at insurance companies know that if they put enough pressure on someone complaining about a denial, the sheer legal force arrayed against such a person may make them buckle under.
However, just because an insurance company decides to deny a claim, that doesn’t mean the decision is final. And just because an insurance company has a significant legal mechanism buttressing it doesn’t mean that a win in court is guaranteed.
Experienced attorneys can help claim denials in various areas, such as personal injury, workers compensation, and even social security disability insurance. In some cases, such as with a personal injury or wrongful death claims, they work on a contingency fee, only collecting payment for legal services if they win the case or negotiate a settlement. Once an insurance company knows that someone has legal representation and even a willingness to go to court, the public nature of such a lawsuit is often something they would like to avoid, and negotiations—or even out-of-court settlements—can begin.
And of course, if it goes to court, you know you have an attorney in your corner.
People have successfully fooled insurance companies into paying out for false injuries, so these insurers are often paranoid about paying out for a false claim.
A claim may or may not occur during the term of a policy. Even when the contingency covered under the policy does occur, the amount of the claim may be the full sum insured or less and in some cases, the amount may not be known for quite some time in the future.
The basic concept of insurance is that one party, the insurer, will guarantee payment for an uncertain future event. Meanwhile, another party, the insured or the policyholder, pays a smaller premium to the insurer in exchange for that protection on that uncertain future occurrence.
Before digging into what to do to scare an insurance adjuster, it's useful to know a little about how they try to scare those who file a claim. One of the most common scare tactics they use is to delay a decision on your claim. They know that when you're dealing with a severe injury, time is not your friend.
Unfortunately, insurance companies are notorious for using complicated verbiage that is nearly impossible for policyholders to understand what is covered and excluded. Insurance companies are aware that policyholders don't understand the complex and lengthy legal text packed into policy pages.
Most pure risks can be divided into three categories: personal risks that affect the income-earning power of the insured person, property risks, and liability risks that cover losses resulting from social interactions. Not all pure risks are covered by private insurers.
An uninsurable risk could include a situation in which insurance is against the law, such as coverage for criminal penalties. An uninsurable risk can be an event that's too likely to occur, such as a hurricane or flood, in an area where those disasters are frequent.
Three main types of uncertainty have been identified by Klir and Yuan [1]: Fuzziness, discord, and nonspecificity, the latter two being unified under the term ambiguity ( Fig. 1).
Formulated by the German physicist and Nobel laureate Werner Heisenberg in 1927, the uncertainty principle states that we cannot know both the position and speed of a particle, such as a photon or electron, with perfect accuracy; the more we nail down the particle's position, the less we know about its speed and vice ...
Reading media stories that focus on worst-case scenarios, spending time on social media amid rumors and half-truths, or simply communicating with anxious friends can all fuel your own fears and uncertainties.
In insurance, there are 7 basic principles that should be upheld, ie Insurable interest, Utmost good faith, proximate cause, indemnity, subrogation, contribution and loss of minimization.
In the insurance world there are six basic principles that must be met, ie insurable interest, Utmost good faith, proximate cause, indemnity, subrogation and contribution. The right to insure arising out of a financial relationship, between the insured to the insured and legally recognized.
Life insurance is a very difficult product to sell. Simply getting your prospect to acknowledge and discuss the fact they are going to die is a hard first step. When and if you clear that hurdle, your next task is creating urgency so they buy right away.
One of the challenges in the insurance claim process has to do with claim settlement i.e. late settlement or repudiation by the insurer. This leads to bad customer experiences and in the long run loss of business when the customer takes his or her business to a competitor.
Introduction: My name is Jonah Leffler, I am a determined, faithful, outstanding, inexpensive, cheerful, determined, smiling person who loves writing and wants to share my knowledge and understanding with you.
We notice you're using an ad blocker
Without advertising income, we can't keep making this site awesome for you.
Mark A. SteinbergInsurance Laws For many people, insurance companies exist simply to provide peace of mind. People pay their monthly premiums for car insurance, home insurance, or life insurance and hope that they never have to be in a position where they need help from their insurer. However, the peace of mind comes in from the idea that should an accident and injury—or even death—occur, the insurance company will step in to help.