WASHINGTON, Feb. 28, 2016 — In all fairness, while there are some people who are outright fraudulent, there are others who exaggerate injuries and losses to take advantage of insurers. For this reason, insurers should investigate claims. But they should also pay what they owe.
Unfortunately, in too many instances when problems arise, insurance claims adjusters go overboard with their investigations; or worse, claim they are merely being fair. The reality is they are watching out the insurance company’s bottom line.
Long ago, if a disaster struck, we knew insurance was there to protect us. We felt secure. We felt safe. Insurance was once something we could simply rely upon to be there when we need it.
In today’s crazy world of automobile collision claims, however, the situation is too often quite the opposite. Insurance companies now routinely fight claims rather than fairly investigate them, and insurance adjusters justify the delays, denials and reductions in compensation for the flimsiest of reasons. Sometimes, what they say is outright unfathomable.
Auto insurance usually includes “uninsured motorist” and “underinsured motorist” protections. These protections provide a safety net for the policyholder if the at-fault driver in an accident either does not have enough insurance or has no insurance at all, or flees the scene and remains unidentified. We all pay premiums for these protections, and we rely on “our company” to take care of those situations.
Yet, even when dealing with our own insurer, major aggravation can follow once a claim is filed.
Insurance was, and for many still is, our key personal and financial safety net. For most of us, without insurance, the constant threat of financial ruin hovers over us if just one unaffordable loss should occur. Even one moderate disaster could be the cause of our complete financial ruin. A lifetime of savings could otherwise be wiped out by a single loss. How would we pay for all of the medical bills and recover from income losses due to an accident? Insurance was, and often still is critical for maintaining our financial wellbeing.
At one time not so long ago, insurance was also a profession. The insurance agent was similar to our banker, our priest or our doctor or attorney. Insurers were not just about making money. Our needs came first, above theirs, and our insurance agent was there to help.
But all of this changed in the early 1990s. Insurers, their agents and notably their field adjusters were gradually transformed from trusted advisers to profit centers, primarily geared toward profits that boggle the mind, profits so outrageous that, in all honesty, the business seems almost criminal.
Historically, insurers subscribed to two principles that guided their work. The first, the fiduciary principle, required prompt payment of claims. We relied upon this principle and still do today. We somehow intuitively feel it exists or that it should. When we have a significant loss such as a car accident, we rely on the insurance company to get us back to normal, to help make our personal down time as short as possible.
We also count on getting our car repaired so we can get to work, take the children to day-care or school, or run necessary household errands. We need our car to go to the doctor for related medical appointments. So we need our insurance to do what we paid them to do, to pay for the car repair and for the medical appointments, because we do not have the money readily available for those things. We rely on insurance.
The second principle that guided insurers was the indemnity principle. It means fair payment and full payment. It means, if it costs $5,000 to fix your car’s rear damage, they pay $5,000, not $4,100 because there was some rust on two inches of the bumper. The object is to restore you to the same financial position after the loss that you were in prior to the loss.
Delaying claims processing is in direct contrast to the “old” insurance fiduciary principle of prompt payment. Today’s insurance adjusters rarely answer the telephone. And despite our leaving multiple messages on their voicemail, they rarely return calls promptly. So we have to make do on our own.
Note that while your claim is being denied, the insurer is holding the potential claim money, realizing profits on the interest that money is earning in their bank. Every penny paid to you is a minus on their balance sheet. Note, too, they may cancel your coverage if your payment is even one day late.
With regard to delayed claims and outright claim denials, here are just some of the comments this author has collected from attorneys in Maryland and Virginia, made to them by insurance adjusters during the claims negotiation process:
“Your client is fat, she probably had lots of problems and this accident didn’t cause any of them.”
“Your client didn’t need surgery. Some people just want to get cut. He intentionally just wanted to have an unnecessary surgery.”
A motorist made a tight left turn and struck a pedestrian. The pedestrian suffered a brain injury, cuts and bruises on his legs and a fractured foot. The adjuster said “the pedestrian must have passed out and fallen against the back of the truck causing his own injuries.”
A drunk driver struck a vehicle, causing an 8-year-old child in the car to hit his face and lose four teeth. The adjuster said, “kids lose teeth all of the time, it’s not a big deal.”
A man’s wife was killed in a car accident. After two years he returned to dating. Unbelievably, his girlfriend was then killed while riding as a passenger in his car. The insurance adjuster said, “The man’s anguish after the death of his wife was so high that it couldn’t get much worse.”
A woman made a claim against her boyfriend — who caused an automobile accident, injuring her — because she needed her medical bills paid and her wages reimbursed. The adjuster asked, “Didn’t the woman truly love her boyfriend, and why is she suing him?”
An adjuster refused to pay a man for the wages he lost when he had to take time from his job to attend doctor’s appointments and therapy. The adjuster offered, “The man should have gone during his lunch hour.” (Note that it is mostly impossible to travel back and forth, and spend any reasonable time for the administration of therapy in an hour.)
In reviewing medical records for a woman who decades prior had a sexually transmitted disease, a claims adjuster made a condescending comment, as if the adjuster, a male, was at a frat party. The woman’s attorney pointed out that her accident injuries were not a result of a disease.
One attorney offered the following observation:
“I have also come to believe that this is a good field to seek employment for misanthropes who are not bothered by efforts to belittle and bring down fellow human beings. For those who have never outgrown the mindset of a mean child who pulls the wings off of bugs while they are still alive, this can be a field where they can earn a paycheck for having a mentality like that.”
I tell my clients that the reason I have a job is that the insurance companies do not do what they should.
Many insurance adjusters should be ashamed of themselves. Fiduciary and indemnity principles are mostly gone in today’s insurance claims world.
Serious injury? You need an attorney to level the playing field.
Paul A. Samakow is an attorney licensed in Maryland and Virginia and has been practicing since 1980. He represents injury victims and routinely battles insurance companies and big businesses that will not accept full responsibility for the harms and losses they cause. He can be reached at any time by calling 1-866-SAMAKOW (1-866-726-2569), via email, or through his website.
His book “The 8 Critical Things Your Auto Accident Attorney Won’t Tell You” can be instantly downloaded, for free, on his website: http://www.samakowlaw.com/book.