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

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.

New Book / New Story

Started work on my "fictional" book; Case Denied / Cost Benefit Analysis; your life depends on it!

Basic premise is often times it is more cost effective for an insurance company if the injured person dies as opposed to medical treatment for life.  For example;
  Young man hurt at work, if he died as a result of the accident the Death Benefit would most likely be around $150,000 depending of course on the State in which it took place.  On the other hand if this same young man was severely injured to the extent that he would require extensive medical care for the remainder of his life (lets say 40 years) this could cost the insurance company millions of dollars!

In comes the Insurance Adjuster/Investigator who once determines the actual cost for the carrier to provide for this injured worker, is then given the order to terminate that persons life.

Story starts with an independent adjuster who investigates death claims (as opposed to other multi-line claims) and starts to see a pattern with certain carriers and certain types of catastrophic injuries that ultimately led to the death of the injured person.  Once the adjuster starts asking questions and follow back on information obtained a conclusion is formed that these deaths are not accidental.  Once the carriers find out about this adjusters interest in these cases, things get much more complected for this adjuster.

Should have some ink on paper so to speak soon!

Jeff

PS   Keep in mind that not only insurance companies are concerned with the "bottom line."

Cost Benefit Analysis; your life depends on it!   How much are you worth? 




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.

Always file an "Appeal" if your Denial allows for it!

Recently heard about a claim a State resident made to the Attorney Generals office for Discrimination!  After a year the Attorney Generals office wrote back saying that they (on the surface) did not find any discrimination, however they went on to say that does not mean that they actually completed their investigation.  In essence they were just giving it a quick "once over" review.  The letter outlined steps to take if you did not agree with their decision.
Since their decision was not based on a real and in-depth investigation an Appeal letter was sent.

Jeff

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.

"Every Day a Friday" by Joel Osteen

Started reading "Every Day a Friday" by Joel Osteen (Lakewood Church, Texas) and wanted to suggest it to those that now or will someday be following this Blog.

Joel Osteen is a very Positive and Spiritually motivating speaker and author.

Let me know your thoughts on this book?

Jeff



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.

Too Report or not too Report a Claim!

Have you ever "not" reported a claim to your Insurance Company because you did not want have your policy cancelled?  Maybe you tried to read your policy and felt there was no coverage!  In my opinion you should report the claim and let the insurance company make their decision.  Most likely if you have to report your claim to an Insurance Agent they might deny it before it is presented to the carrier.  In that case again my opinion would be to make sure the agent reports it to the actual insurance company.

Then if your claim is denied, have the carrier put it in writing, and post your story here on "Case Denied!"

Jeff


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.

To Share is to Care!

While sharing your story will not change the past or the facts, it can possibly help or assist others with similar situations in there own life.

Please share your Claim/Case Denied Story with us!


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.

New World Order!

Do you accept a rejection or denial from the start or do you stop and think about it.  Have you filed a claim, requested something and been denied.  What was your first thought after receiving the denial?  Let it go, don't rock the boat, those people know more than I do?

The World is changing ever second of every day and you need to not only "survive" but ask questions and do not accept everything as "fact".  Check it out for yourself, follow up, do research and let others know of your situation and story!

We all have stories to report, and others are not reading your story to judge you, they are reading your stories to either assist you or learn from you.

Jeff


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.