Don't Play the Claim Game

Insurance “games”? Insurance is serious business, right? You purchased your insurance to gain the peace of mind that will provide against unforeseen loss. After all, insurance companies advertise the warm reassurance of protection for you and your family.

Certainly, many claims are paid promptly and fully. Certainly, some claims are without merit and are properly denied. What is unacceptable, however, are the insurance company's claims handling procedures that are used for the sole purpose of delaying and denying legitimate claims.

What are insurance company "claims games", then?

Any insurance company's claim handling activity that is motivated by the goal of improperly delaying or denying a claim payment may be part of a “game” that you may not be prepared to “play”. Those of you who have encountered an insurance company delay or denial may have unwittingly entered the process.

We understand that insurance companies are profit motivated corporations formed and managed with the goal of returning investments to company shareholders. The courts and regulators, however, have noted that certain insurance business involves a public trust. Thus, insurers must be held to a higher standard of conduct. Their actions affect the public.

What are examples of claims games?

The following activities are examples of insurance company claims games:

• taking statements from claimants while they are suffering the physical and emotional effects of their injury or loss,

• taking statements from claimants while they are under the influence of pain and other medication due to their injuries or mental capacity,

• requesting claimants to sign authorization forms disclosing private personal information,

• advising or suggesting to claimants that they do not need legal representation,

• attempting to settle a claim before the nature and extent of injury or property loss is determined,

• misrepresenting insurance policy provisions,

• failing to advise of insurance policy provisions,

• portraying itself as the claimant’s friend, counsel, or advisor,

• making inaccurate statements about the law,

• making inaccurate statements about the facts,

• requesting duplicate information,

• taking advantage of a claimant’s compromised physical and financial condition to secure an unfair settlement,

• requiring a lawsuit to be filed in order for a claimant to recover,

• using computer programs to determine the “value” of personal injuries,

• failing to fully investigate a claim by, for example, not interviewing witnesses

• any tactics that unfairly use an insurance company’s position of power and knowledge, to exploit the insured’s position of physical and financial vulnerability, weakness, or naiveté.

Anything that an insurer does to wrongfully deny a claim, delay a claim, take advantage of a claimant, frustrate the claimant, wear the claimant down, or exhaust the claimant’s resources is a game. In short, any insurance company claims tactic that is not designed to honestly and fairly evaluate and resolve a claim is a game. I represent individual claimants. I have seen the tactics. But I do believe that is possible to make an objective determination as to what is legitimate claims evaluation and what is pure game playing. What is going on in much of the area of insurance claims handling is gamesmanship.

A prime example of claims games is demonstrated in articles that appeared in Bloomberg and the Chicago Tribune. The stories discussed the tactics of a major insurance company that seeks to put people in its “Good Hands.” The articles revealed that a major overhaul of the insurer’s claims process involved putting on “Boxing Gloves” to deal with claimants. The company denied much of the story, but those of us who toil in the field know the Boxing Glove approach. Delay and Denial are their marching orders.

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