Getting the Inside Scoop on Insurance Company Claims Practices

(Note: This guest blog is by Vivian Persand, an attorney with Merlin Law Group in the Coral Gables office).

Last week, I wrote about some of the things you can expect to see, and not see, when Insurers like Safeco and Liberty Mutual respond to discovery requests. This week, I want to explain one of the steps you can take to combat these evasive discovery tactics. Some of the most effective and successful methods have been used across the country by large and small firms alike. What makes these plaintiffs’ law firms stand out is not the type of claim they pursue, the amount of the claim or the kind of insured they represent, but their commitment to not letting insurers get away with stonewalling discovery tactics. These attorneys go the extra mile, invest wisely, and do their homework. Sure, it might take some time; it’s going to take extra effort, and, naturally, nothing is free. But in the end, plaintiffs’ attorneys who obtain adjuster’s diaries, employee training manuals, and documents showing incentives for employees to put money into their own pockets instead of the insureds’ pockets, are going to go a long way in proving how their insured’s claim was improperly handled by the insurer from day one. This type of evidence can show your judge how the insurer never really intended to pay anything near a fair amount on your insured’s perfectly legitimate claim, if anything at all.

So how do you battle devious discovery tactics? First, do you have an expert? Let me guess - you’re thinking “sure, I have a great roof engineer who put together a detailed report with pictures and a thorough calculation of damage to the property….” Well, that’s not the kind of expert I’m thinking about. Get yourself someone who knows the insurance business – someone who knows the tricks of the trade - someone that is going to stump those smart and cunning defense attorneys. Find an expert who has some particular knowledge about the insurer you are up against. If it’s State Farm, you might want to give Steve Strzelec a call. If it’s Safeco or Liberty Mutual, consider Charles Miller.

Now, what can folks like the masterful Mr. Strzelec and the very capable Mr. Miller do for you? First, they can educate you on what you can and should be looking for and why it is critical to your case. You must first become educated about your client’s insurer and its internal policies that affect the way your insured’s claim was handled. Let your expert teach you about the types of policies and procedures that the insurer implemented to decrease payments on claims in general and to provide incentives to employees for paying less. Is each adjuster required to turn over a certain percentage of his/her claims to SIU? Is each adjuster required to turn over a certain percentage of his/her claims to the subrogation department? What type of monetary bonus does an adjuster get for meeting the SIU referral goals? How much does an adjuster get for each claim referred to subrogation? These types of internal policies will almost certainly reflect the menial amount paid on your insured’s claim, and whether your insured’s claim was turned over to SIU or subrogation merely for the purpose of meeting the adjuster’s quota. Once you learn about the specific procedures for the insurance adjuster or claims handler, work with your expert to draft specific discovery requests which target the policies and programs (by name, no less) that will help you demonstrate to the judge and jury how your insured’s claim was improperly and unfairly handled by the insurer.

Once you have served your carefully tailored discovery requests, get ready for the “overbroad, unduly burdensome and not likely to lead to the discovery of admissible evidence” objections. And prepare yourself for the production of a plethora of useless documents, as discussed in last week’s blog. But never fear - this is where your expert comes to the rescue, again.

In a number of cases across the country, expert affidavits have been instrumental in the discovery battle against insurers, including Safeco and Liberty Mutual. Charles Miller, for example, has provided both deposition and affidavit testimony regarding claims practices for insurers, including but not limited to, Safeco and Liberty Mutual. The overriding theme in his affidavits is how the insurer intentionally and brazenly implemented practices and policies to cheat insureds.

In one of his affidavits in a case against Safeco, Mr. Miller’s affidavit reflects, in part, as follows:

Based on my thirty plus years of knowledge and experience regarding insurance company claims handling it is my opinion that the documents and information requested…are highly relevant to the operations of a claims department including the handling of individual claims such as this one…The documents and information that I reviewed with regard to several other insurers describe their respective programs to reduce claim payments in order [to] improve corporate profitability. Such programs are improper when it comes to the handling of insurance claims [footnote omitted]. Programs which emphasize profit in the handling of claims put the claims handler in a conflict of interest, wherein the claims handler can either fulfill the insurer’s full obligation to its insured or act in the insurance company’s interest because the claims handler will be financially or otherwise rewarded if he/she does so. In my opinion, and based on my experience in reviewing handling thousands of claims files, when placed in such a conflict claims handlers will handle a claim in a manner that benefits the insurance company to the detriment of the policyholder.

In a case against Liberty Mutual, Mr. Miller’s affidavit reflected, in part, the following:

Through consultation with consultants like McKinsey and Accenture, insurers have sought to turn their claims operation into profit centers by seeking to reduce claims payment through artificial measurements such as leakage coupled with goals to reduce average paid claims and/or the combined ratio.

Mr. Miller artfully creates a very real and accurate picture for the judge and jury. What picture is that? The reality of the situation – the insurer will stop at nothing, will spend as much as it takes and will consider any opportunity to devise unprincipled, cost-cutting methods aimed at giving its insureds the shaft. So once your expert has taught you the particulars of the insurer’s internal procedures, and once you’ve applied what you learned to drafting carefully constructed discovery, don’t stop there. Take it to the next level. Work with your expert to prepare an expert affidavit that will provide the court with a thorough, precise and undeniable explanation for why the internal documents you seek are directly relevant to the claim(s) at issue.

So, what’s your “take away” from today’s blog? Your expert is your friend. Allow your expert to enlighten you and maximize the skills he has to offer. Be like the insurer – be creative and stop at nothing to get your hands on the discovery to which you are entitled and that may very well prove your case.

Your expert is one of many effective and powerful weapons at your disposal. Next week, I will write about how discovery motions and perseverance can win the case.

Happy Friday!

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Comments (6) Read through and enter the discussion with the form at the end
Stephen End - June 18, 2010 10:57 AM

Reading your view on the need for experts for your cases..... on how the deck is completely stacked against the insured...and all the tricks that the carrier likes to utilize to prevent proper reimbursement for losses....reads like a novel.

The only question....Is the insured going to prevail in their claim or is the carrier simply going to underpay and get away with it? I guess that depends on how well prepared they are to do "battle" with the carrier...clearly your law firm with their various experts are necessary in an environment where carriers have no incentive or interest in making their customers whole.

Insurance Veteran - June 18, 2010 11:51 AM

Seems like financial incentives to insurers' employees place undue hardship on an insured seeking fair indemnity. Is the reverse true then of adjusters paid based on the value of the claim? As I'm sure you are aware during CAT season adjusters are paid more if the claim is higher. What incentive is there to short change the insured then? Seems the opposite would prevail.

Mark Phillips - June 18, 2010 11:54 AM

Well said and described Vivian. This mirrors much of my personal real life claims adjusting and large loss adjusting in the past 15 yrs.

Reference my most current "expert challenges" and holdings found in a well-delayed and bad faith scenario in Vision 1 HOA vs. Aspen and James River (Hurricane Wilma) - a case finally settled for global settlement earlier this year in which my affidavit and other professional expert affidavits and depositions finally poured the light on the inappropriate and delayed adjusting standards, and ultimately an alarming "fabricated signature," namely mine, on my first letter of Reserve advisement to James River, stating a loss reserve of $6.2 millioin based on my five days of on-site damage inspections with experts and public adjuster. The insured finally got paid, albeit not all they should've, had the case been handled fairly and promptly. I would love to have seen the company's adjusting and scope notes on this one.

Vivian Persand - June 18, 2010 3:42 PM

Hi Stephen - thank you for taking a few minutes to read my blog and post a comment

Vivian Persand - June 21, 2010 9:38 AM

Hi Mark, glad you took a moment to post. I would like to hear more about the case you were involved in. If you have a minute, please send me an email: vpersand@merlinlawgroup.com

Art Thompson - June 25, 2010 10:23 AM

Having worked on both sides of the insurance claims process, I am always amazed at the views from individuals that have never walked in the others shoes. I can tell you 1st hand that after a hurricane there are by volume of the number of adjusters working for carriers vs. the PA's working for the homeowner there are more IA's causing underpaid claims and re-opened files. Insured's hire PA's to inspect and write the estimate as they know the PA's are insurance professionals and needed by the public to interpret policy and understand the claims handling process. In a recent article I read someone made the comment that 95% of "All Public Adjusters" are thieves. This statement shows their lack of professionalism and knowledge of the subject. As a matter of fact the OPPAGA report conducted by the state only found 5% of PA's in Florida had any complaints on their license. Of course I don't condone the PA's conducting unscrupulous activity, but this isn't a case of one bad apple spoils the bunch. I have worked clean up behind insurance adjusters for the carrier and have seen the good jobs done as well as the bad ones. The key is to "Pay for All Damages".. I suggest anyone in this business attend training seminars and the Wind Conference so you can get the other sides point of view before throwing out negative statements and accusations without merit. I have a good reputation as a PA and have worked successfully and professionally with many insurance carriers on behalf of my clients. Quit all this finger pointing and he said she said. Share all information during the process so all parties are playing on the same "level" field so we can get the insured what is due to them. If the carrier really desires to lower their costs of reopened claims, including mediation, appraisal and even litigation answer this: Why is it that the carrier will pay attorney fees, engineering fees, architects fees and other professional fees needed to evaluate a re-opened claim, but if a PA re-opens a claim and legitimately shows the carriers payment did not cover the cost to repair the damages from th loss why are their fees not covered under an RCV policy? If the PA fees were recoverable on a "re-opened" claim can you imagine how much more scrutiny the insurance carriers would put on their adjusters in the field to do a complete and thorough inspection and scope of loss the first time through? How many adjusters reading this have inspected a residence in under 30 minutes? I know this not something you want to admit to, I myself was trained by an independent adjuster that showed me many shortcuts and time saving scoping techniques leaving the details out for the clean up crew or the mediation and appraisal department. There is bad on both sides of every industry so quit pointing fingers and look in the mirror. Clean up your side of the fence as I am trying to help to clean up mine.

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