Case Denied: B A D F A I T H

No this is not about "Religion!"  It is however about "Relationships."
Remember that PROMISE the Insurance Company sells you in exchange for your money and calls it a Premium?  Well "Bad Faith" is also a legal term used in Insurance Claims when your Insurance Company wrongfully and with possible "Malice" and a few other legal terms denies your claim.

Most insurance policies both Homeowners and Commercial have extended coverage for "legal liability" and in the event that you are sued, they (insurance company) should defend you.  There is a legal saying in this regard concerning you insurance policy that states "There is a Greater duty to Defend than to Indemnify!"  In essence even if there is a question as to coverage the Insurance Company will and should  provide you with a defense.  If the Insurance Company after starting your defense feels there is no coverage for your claim they can file a Declaratory Relief action with the courts.  This involves presenting your case to a Judge and asking the Judge to make a ruling on the merits of the claim and if in fact there is or is not coverage.  If the Judge rules no coverage, the Insurance Company will continue the defense but issue a Reservation of Rights letter informing the policy holder that if liability is found against them, the insurance company may not be paying for the claim.  This of course sets up all kinds of legal situations and it is highly recommended that before you proceed down this path you hire an attorney.
The Bad Faith part of the lawsuit against the carrier comes in when the claim and or the coverage or both is Denied by the Carrier.  If the policy holder (you) does not agree with the findings and you feel the insurance company acted in "Bad Faith" towards you, you can file a Bad Faith Lawsuit.  If you win this lawsuit, along with damages you are also awarded "Punitive Damages."  Punitive Damages normally set by the Judge or Jury are equal to a percentage of the worth of the company you are suing.  This award can be in the millions of dollars or as little as one dollar, so Bad Faith lawsuits are taken very seriously by the Insurance Company.

Here is the Definition of "Bad Faith" as found in Wikipedia: 
 "An insurance company has many duties to its policyholders. The kinds of applicable duties vary depending upon whether the claim is considered to be "first party" or "third party." A common first party context is when an insurance company writes insurance on property that becomes damaged, such as a house or an automobile. In that case, the company is required to investigate the damage, determine whether the damage is covered, and pay the proper value for the damaged property. Bad faith in first party contexts often involves the insurance carrier's improper investigation and valuation of the damaged property (or its refusal to even acknowledge the claim at all). Bad faith can also arise in the context of first party coverage for personal injury such as health insurance or life insurance, but those cases tend to be rare. Most of them are preempted by ERISA.[5]

Third party situations (essentially, liability insurance) break down into at least two distinct duties, both of which must be fulfilled in good faith. First, the insurance carrier usually has a duty to defend a claim (or lawsuit) even if some or most of the lawsuit is not covered by the insurance policy. Unless the policy is expressly structured so that defense costs "eat away" at the policy limits (a so-called "self-consuming" or "burning limits" policy), the default rule is that the insurer must cover all defense costs regardless of the actual limit of coverage. In one of the most famous decisions of his career (involving Jerry Buss's bad faith lawsuit against Transamerica), Justice Stanley Mosk wrote: "[W]e can, and do, justify the insurer's duty to defend the entire 'mixed' action prophylactically, as an obligation imposed by law in support of the policy. To defend meaningfully, the insurer must defend immediately. [Citation.] To defend immediately, it must defend entirely. It cannot parse the claims, dividing those that are at least potentially covered from those that are not."[6]"

DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

Introduction: New Book CASE DENIED ADJUSTERS

Case Denied

ADJUSTERS

By JW Mica

This is a work of fiction.  Names, characters, places, and incidents either are the product of the author’s imagination or are used fictitiously.  Any resemblance to actual persons, living or dead, events, or locales is entirely coincidental. 

JW Mica

All Rights Reserved
 

What major industry other than Insurance charges you a premium for a promise and then tries hard to break that promise?  What if you knew the person making a life and or death decision regarding you and your future only had a High School Education?  What if that same person, known by most as “adjusters” only had about two weeks training before being given a case load in excess of 100 files and told to resolve them as new claims to the tune of about five per day were coming to their desk?  What if these adjusters were sitting at desks in rows that resembled an assembly line and were more concerned with breaks and lunch and quitting time than the proper handling of your claim?  What if these adjusters spent more time in meetings and socializing after work at the local pub, then trying to get caught up on their work and become more proficient at their job?  What if these adjusters could recommend denial of your claim, or tell medical professionals that they could not do the medical procedure that Doctors had recommended?  What if these adjusters could actually use their preconceived ideas about you, and prejudices’ in deciding when and how much to pay for your claim?  Do you really think that the insurance companies with slogans like “the Good Fingers people” or “like a Next Door Neighbor” or “the Stone” or “we got your Back” has any actual merit or semblance of reality when it comes to handling your insurance claim?  Cute icons, like Cartoon Characters, or the Blue Panther, are in place to make you the consumer feel more confident about the insurance company that is looking to take as much of your money as they can, and give back as little as possible.  How would you feel if you knew the Insurance Company that you were paying your hard earned money to was using that money to not only promote Political Candidates that you would never consider endorsing, or on elaborate meetings and parties that make the recent IRS events seem like a beach party?  What if that “security blanket” that you thought the insurance company was providing you was in reality nothing more than an elaborate scam trying to separate you from your money with a simple promise that they never intended to keep?  And then you must ask the question, how the insurance company makes me feel that I need insurance, and the simple answer is “FEAR”!  Get consumers to purchase as many things as they can, live the life they have always wanted, then implant the fear that without insurance they could lose it all.  Without fear, and manipulated by and with over reacted news coverage, most rational people would see through the fog of lies and misinformation that is presented on a daily bases.  Suggestion would be to limit your ownership to things you can protect without insurance and if you buy insurance do your homework and find out as much as you can about that company.  It will not be easy as they work hard to hide behind a wall of fabricated facts and so called real life testimonials from Hollywood actors!  In this book your will follow my path from college to sales jobs to adjusting with several major insurance companies. You decide your fate and future and don’t let some big insurance company fear you into submission!  Just as with the percentage of fraudulent claims that are reported, so goes the percentage of “bad” or “fringe” adjusters.  For the most part most insurance claims are above board as are most adjusters.  I have worked with hundreds of adjusters and would trust my life with most of them!  Not all of them, but most of them!  This book is actually dedicated to all those hard working, honest and well educated adjusters that are out there.  Unfortunately many of them are now either retired or out of work!  As I said at the introduction, this book is fiction, and I will add that any resemblance to actual people, companies, places, events or things is purely a coincidence and most likely the product of the authors’ imagination.




DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.