Inside Information From Industry Veterans
How Insurance Companies Settle Cases covers the spectrum of settlement concerns from estimating bodily injury damages and investigating coverage to claims denials and action letter outlines. Speed the processing of your claims and reduce your frustration with insurance companies. This book offers:
- Insurance company settlement techniques to watch out for
- Aspects of claims frequently questioned by insurance companies
- Insurance policy defenses and coverage issues
- How to communicate with insurance companies
- Duties owed by insurance companies
- How to deal effectively with adjusters
- How insurance companies process claims
- Adjusters’ most popular negotiating techniques
- How reserves and indexing systems work
- What insurance companies look for in their investigations
- How insurance companies seek to limit coverage
Knowing how insurance companies operate can help you obtain fair settlements faster. By learning what counts with the home office and what doesn’t, you can present your case in its best light with minimum wasted effort, and make both you and your case stand out.
The book is filled with settlement information from an insider that you can put to use today. A few tips include:
- “Adjusters will frequently offer two-thirds or one-half of the demand received from the plaintiff’s attorney” Section 240
- “A local claims manager has about $50-100,000 discretionary settlement authority. He will usually extend $20-30,000 discretionary settlement authority to his claims supervisors, and $10-15,000 to the office claims staff.” Section 240
- The prudent plaintiff’s attorney will ask the insurance company point-blank, in the very beginning stage of the relationship, “Are there any coverage issues? Are there any liability issues?” Section 702.1
- “Avoid Monday mornings and Friday afternoons as this is the busiest time for adjusters. These are the times they will be least receptive to attorneys’ phone calls or requested meetings.” Section 780
- “99% of the plaintiff’s attorneys don’t know about the supplementary coverages which are due and payable in excess of the policy limits.” Section 240
- “A natural trap that many attorneys fall into is to negotiate the value of their case against the policy limits. If the plaintiff was 20% at fault in a comparative fault jurisdiction and policy limits are $100,000, many attorneys will ask for $80,000. They should instead value the case without regard to the policy limits.” Section 740.1
- “Nurses in hospitals and clinics keep the best documentation on observed pain of a given patient. Use their notes to screen out phony claims of soft tissue injuries.” Section 240
- “An undocumented demand is not worth the paper it is written on. The insurance industry loves all claims documented, and loves paperwork. Why? Because that’s the way it has always been done.” Section 702.7
- “The general rule of the claims adjusting industry is that 30 days is the usual and customary time limit in which to request an insurance company to respond to a settlement demand. This is because the claims industry is set up on a 30-day diary system.” Section 702.7
- “Usually when an attorney puts a time limit of ten to thirty days on his demand letter, the paperwork requirements are set aside, and settlement authority is granted by telephone. The idea is that the paperwork can be done on or after the date the case is settled, rather than before.” Section 240
How Insurance Companies Settle Cases reveals how insurance companies evaluate and negotiate claims, and answers the following questions:
- How do insurance companies value cases?
- What do adjusters need to settle a case?
- Who makes the real decisions on insurance cases?
- How do insurance companies value pre-existing injuries?
- How do I prove my client really suffers from a soft tissue injury?
- What is the structure of most claims departments?
- How do I learn policy limits and get a copy of the insurance policy?
Direct answers to every one of these questions are given in Section 240 of How Insurance Companies Settle Cases, and the book is chock-full of more insurance company secrets.
REVISION 26 HIGHLIGHTS
This edition of How Insurance Companies Settle Cases brings you updated material on:
- Evaluating an insurer’s conduct for bad faith.
- Website addresses for obtaining insuranceagentlicensingdatain various states.
- Agent or broker liability; intermediate brokers; broker’s standard of care.
- Insurer’s heightened obligation to investigate before rescinding policy for misstatements on applications not on ACORD forms.
- Limits on the information an insurer can request in an EUO.
- Employee compensation and bonuses tied to insurance company’s financial success.
- California’s Howel reduction in recoverable medical expenses.
- Validity of non-waiver agreements when some policy benefits are undisputed.
- Applicability of standard form insurance to cyber theft claims.
- State statutes requiring disclosure of policy limits.
- State statutes requiringplainandconspicuousnoticebeforereductionsincoverage areeffective.
- Insurer settlement error: failure to provide all medical records to reviewing physician.
- Insurer settlement error: offering policy benefits only as part of a settlement offer.
- Insurer’s failure to set litigation expense reserves.
- Insurer’s attempts to withhold the claims file based on attorney-client privilege.
- Extraordinary bad faith claims: Reimers v. Everest Indemnity Insurance Co.; Davis v. Fidelity Nat’l Title Ins. Co.