The "Insured" is the Enemy!

When I first got my feet wet in the Adjusting Profession I was taught (actually in the Claims Manual) that the Insured was to be treated like an "advisory" and not to be trusted.  That was the primary reason that we would ask for receipts for everything claimed stolen or destroyed, and if we found the Insured had lied or fibbed or exaggerated on one item, the entire claim was rejected based on Fraud.  This of course was back in the mid 1970's and what I believe was the start of "Bad Faith."

Fast forward to the 1980's when insurance companies were making so much money they did not care what they paid out in claims.  This became the era of "Customer Service" or in other words how much money do you want to go away happy.

1990's started to see problems with the Stock Market, Insurance companies were not making as much money and claims became a way (according to the CEO's) where the company could save money.  Thus the New Training:

     Look for "denials" first which some called the "Silver Bullet"!  Yes a way to deny the claim right out of the box, before the carrier started incurring "costs" for handling and resolving the claim.  The best claim was a denied claim on the first call. Hopefully a good Agent would deny the claim first, but if the customer had doubts the claims representative would seal the deal.

Now into the 2000's and denials are running much higher then paid claims.  No such thing as a Nuisance Value claim, just deny it and see what the Insured/Claimant does.  Companies would rather pay staff Attorneys to fight the claim versus offering any money to settle.

Lesson:  Don't take initial denial as the final word!  Also be sure to read your policy very carefully before you even call your agent or the carrier.  Know what it says about what is and what is not covered.  Study the denial section, and when your claim is denied, ask the carrier to put it in writing citing the exact section of the policy that they have relied on to deny your claim.  Remember the Agents and Adjusters (Staff) (not Public Adjusters) are trained to look for denials first, ask questions later.  

Send in your Case Denied, Claims Denied stories!

Jeff

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