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 27 HIGHLIGHTS
This edition of How Insurance Companies Settle Cases brings you “insider information” on:
- 14 key indicators of wrongfully denied claims. §110
- The broker’s job. §133
- Correcting policy mistakes. §183.
- Disclosure of auto policy information to third party claimants. §240.
- Duties of excess insurer when notified of claim being handled by primary or umbrella insurers. §305
- Late reporting problems by the insured. §331
- Attorney-client privilege and outside legal opinion. §430.12
- Business pursuits exclusion and ride-sharing services. §440.6.11
- Duties of excess insurer directly above another excess or umbrella carrier. §440.8.3
- Insurer’s obligation to pay attorney fees as part of a judgment. §468
- Property insurance: valued policy laws. §491.8
- Client Handout: Using Auto and Liability Coverage to Increase Insurance Benefits for Medical Care. §4170
- Sophistication of policyholder as a defense to bad faith conduct. §503.3
- Tips for negotiating medical lien claims. §581.1
- Issuance of insurance policies by Managing General Agents. §664.5
- Delegation of claims handling to Third Party Administrators. §810A
- Chart: Each State’s Position on Third Party Private Right or Direct Action for Bad Faith. §1553
- Chart: Statute of Limitations for Insurance Breach of Contract and Bad Faith Actions in All States. §1566.2
ABBREVIATED TABLE OF CONTENTS
CHAPTER 1 INTRODUCTION TO THE CLAIMS GAME
CHAPTER 2 THE FUNDAMENTALS
CHAPTER 3 CREATING THE CLAIMS FILE
CHAPTER 4 INVESTIGATING COVERAGE
CHAPTER 4A RESEARCHING OPPOSING INSURANCE DEFENSE COUNSEL
CHAPTER 5 THE FACTUAL INVESTIGATION
CHAPTER 5A HOW TO CHECK THE FINANCIAL HEALTH OF DEFENDANT’S INSURER
CHAPTER 6 USING INSURANCE CONSULTANTS AND EXPERTS
CHAPTER 7 SETTLEMENT NEGOTIATIONS AND COMPROMISES
CHAPTER 7A HOW TO SUCCEED AT SETTLEMENT CONFERENCES
CHAPTER 7B COMMON NEGOTIATING MISTAKES
CHAPTER 8 TECHNIQUES NOT FOUND IN CLAIMS MANUALS
CHAPTER 8A CLAIM COMPLAINTS: THE ART OF BEING A SQUEAKY WHEEL
CHAPTER 9 CLAIMS DENIALS
CHAPTER 9A CLAIM EVALUATION SOFTWARE
CHAPTER 10 ACTION LETTER OUTLINES
CHAPTER 11 RELEASES AND COVENANTS
CHAPTER 12 HOW TO ESTIMATE BODILY INJURY SETTLEMENTS
CHAPTER 13 UNDERINSURED MOTORIST COVERAGE
CHAPTER 14 HOW TO TAKE A CLAIMS REPRESENTATIVE’S DEPOSITION
CHAPTER 15 BAD FAITH—BAD NEWS
CHAPTER 15A EXTRAORDINARY BAD FAITH CASES
CHAPTER 15B COMMON CLAIM MYTHS
CHAPTER 16 SETTLING THE $5,000 TO $75,000 BODILY INJURY CLAIM
CHAPTER 17 UNINSURED MOTORIST CLAIMS
CHAPTER 18 THE CLAIMS DEPARTMENT AND THE CLAIMS MANUAL
ABOUT THE AUTHOR
Mr. Frangiamore is a principal of 2nd Insight, Inc., a consulting firm that provides expert witness services and testimony in a wide variety of insurance related cases. He is a former unit claims manager for Nationwide/Wausau Insurance. While at Nationwide/Wausau, Mr. Frangiamore was responsible for the supervision, litigation, and settlement of most of the major West Coast environmental claims and litigation. He also served as manager of the California construction defect unit, which handled insurance claims involving some of the largest residential and commercial construction projects throughout the State of California. Mr. Frangiamore had been retained by many major law firms who represent insurers, policyholders, and insurance brokers. He has testified in depositions and trials in many insurance coverage and claim handling disputes both in state and federal courts. Many judges, private mediators, special masters, and attorneys recognize Mr. Frangiamore as one of the most effective negotiators of complex insurance claims in the country.
Mr. Frangiamore graduated from Union College in Schenectady N.Y in 1981 with a bachelor’s degree in political science; and from Golden Gate University with a Juris Doctor in law 1985. Mr. Frangiamore has been admitted to practice law in California (active) and Washington State (inactive).