Tag Archives: Claims Management

Adjustment of Claims is 100 Percent Policyholder Service–Is The Insurance Industry Providing This Service?

Property claims adjusters are supposed to promptly evaluate damage, investigate coverage, and provide full benefits to policyholders. Adjustment is about giving the customer the service promised and paid for when the policy was purchased. This service is not paid with "indemnity dollars," but with insurance company claims expense dollars, which insurance companies must spend to … Continue Reading

Policyholders Routinely Burned by Citizens Property Insurance Corporation

It’s no secret that Citizens Property Insurance Corporation routinely treats policyholders like numbers on a page. Despite its title as the state’s largest property insurer, Citizens consistently gets the most complaints from policyholders, earning a reputation as the worst property insurance company in the state — and in a state like Florida, that’s really saying … Continue Reading

Insurance Company Profits Soar Despite Alleged Insurance Fraud “Epidemic”

Insurance companies and insurance industry advocates consistently point to insurance fraud as a reason for higher insurance premiums. But, if insurance fraud is such a problem, why are property insurers still reaping massive profits? With profits like these, is there really justification for consistently raising premiums? Revenues Profits Rank Company Fortune 500 rank $ millions … Continue Reading

Avoiding Bad Faith Accusations: Practical Suggestions From a Veteran Commentator

Dennis Wall is a veteran commentator on various claims practice issues and on advice to avoid bad faith accusations. In Hurricane Report: Acting in Good Faith,I found his point regarding what every insurance company should do when faced with partial payment situations following catastrophes to be dead-on: The clear lesson from these recently enacted and revised … Continue Reading

How and Why An Insurance Company Might Make Money By Dissuading Policyholders From Hiring an Attorney

In several of my older posts, I wrote about different ways some insurance companies have tried to make a profit by changing the way a claims handling department is operated. The following posts touched upon ways that claims handling employees can be compensated for meeting different types of goals set up by the insurer that, … Continue Reading

Insurers Track Overpayments

A very fine insurance defense attorney, Brian Hunter, made a comment to yesterday’s post, Do Insurance Companies Overpay Claims? with the following observation: "Second, not only can claims be overpaid, they can be underpaid…." Assuming this is true, and it probably is based on the law of averages, how can we have any meaningful data? … Continue Reading

Do Insurance Companies Overpay Claims?

A blog, Overpaying Insurance Claims, caught my attention. The premise was described as follows: I recently began questioning how much money insurers hand out needlessly because their adjusters don’t have enough training or are so overloaded with work that they can’t possibly handle all of the files they are assigned due in part to a claim … Continue Reading

Flood Adjustment Methods Discovered in Qui Tam Case

Slabbed has been dogged regarding its reporting on the Mississippi qui tam litigation involving State Farm. A recent post, Rigsbys file “Motion to Reconsider Scope of Proceedings in Light of Evidence Adduced in Discovery” – ask Court for additional time to conduct Discovery into “the Scheme,” provides some insight regarding the flood adjustment techniques required … Continue Reading

The Big Picture in Discovery of Insurer Claims Practices

In recent conversations with attorneys representing homeowners against insurance companies in claims practice disputes, a number of recurrent themes in discovery arise. Insurers typically raise relevancy, privacy, trade secret and burden objections when policyholders attempt to find internal documents explaining the how, what, and why of an insurer’s claims procedures. Policyholder counsel must make motions … Continue Reading

Don’t Forget to Consider the Severity of Your Claim: Part II

Last week in Don’t Forget to Consider the Severity of Your Claim, I wrote about what severity means in the insurance context. We also started to talk about how severity can affect whether the insured’s claim was handled fairly by the insurer. Let’s hear a little more about what some of these carriers have to say … Continue Reading

Don’t Forget to Consider the Severity of Your Claim

Many of you probably think that I am referring to the extent of damage of a claim or a claim involving a total loss. The word “severity” naturally conjures up the thought of something that is serious or grievous. But I’m actually writing about something many of you probably don’t know all that much about. … Continue Reading

Is BP Hiring Ignorant Claims Handlers with Little Dollar Authority to Pay Claims?

Dimechimes ClaimSmentorĀ had an interesting post on its blog which partially supports my opinion that the BP claims process has an insufficient number of qualified people attempting to figure out and pay the full amount owed to those damaged by BP. An Open Letter to Admiral Thad Allen, President Obama, White House News Correspondents, ESIS Insurance, … Continue Reading

State Farm Recognizes that Good Faith Requires It to Inform and Assist the Policyholder to Fully Obtain All Benefits

This is a continuation of State Farm Agrees With Chip Merlin Regarding Claims Handling Obligations and State Farm Claims Handling Standards. These are some of the standards, which are the recognized insurance industry obligations of good faith claims handling, that State Farm teachs to its claims adjusters.… Continue Reading

State Farm Claims Handling Standards

State Farm has a First Party Coverage Seminar which sets forth the claims handling standards that are fairly standard throughout the insurance industry. The instructor’s manual to this seminar should be studied by insurance coverage counsel. It sets forth very explicit claims adjustment standards and even explains the purpose for many of them. I will … Continue Reading

Should Insurance Companies Have Claims Manuals Explaining Procedures and Standards for Adjustment?

This question was the topic of an article in Claims Magazine, Putting Procedures in Writing: Is a Claim Manual an Asset or a Liability?  From a policyholder’s advocate viewpoint, I think an insurer would be crazy not to have a claims manual or claims procedure guidelines. Most state unfair claims trade practice laws generally require … Continue Reading

Allstate Loses Claims Core Process Redesign Trial

Allstate Insurance Company lost a bench trial involving the claims practices employed in its Claims Core Process Redesign program first implemented in the 1990’s. The findings by the trial court are significant because the Court indicated that those claims practices violate standards which are routinely violative of unfair trade and claims practices in most of … Continue Reading

TWIA Receives Litigation, Media and Regulatory Critical Analysis for the Manner it Treats Customers During Adjustment

Does anybody think that TWIA is doing a "good job" of adjusting hurricane claims other than the private member insurance companies on TWIA’s Board of Directors? In a prior post, TWIA Insurance Claims Under Investigation by Regulators and Media, I noted that the Texas Department of Insurance attorneys are conducting an investigation into activities of … Continue Reading

Claims Management by Computer: Analytical Data Mining and Claim Oversight is a Trend

Claims management and operational review for claims efficiency are truly sciences. The study and management of these are becoming increasingly computerized and intertwined with analytical data mining. I had dinner with a public and independent adjuster this week, where we discussed the process of litigation case handling and standards within my own law firm. As we were … Continue Reading
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