Self-Inflicted Claim Wounds:
Fun as it is to blame and focus on
others for our insurance claim problems, policyholders cause self made
claim problems which inhibit, or even prevent, recovery on a valid claim.
Here is a list of examples I see in my litigation practice, the "shouda,
coulda, woulda's" which I call, "self inflicted claim
wounds." This article is written to help you recognize and avoid
wounding your own claim:
- Make the Claim: This seems
obvious, but there are many people out there who believe the event +
coverage = the claim. This is not true, every policy I know of
requires the insured to present their claim to the insurance carrier.
Do it in writing.
- Set up a File: I think most
people lead a double organizational life. Very meticulous records at
work, a mess of record keeping at home. This is a self inflicted
insurance wound. Starting now, set up and keep a file for your
policies, mailers, and so forth. After reviewing what you receive,
place it in the file with the postmarked envelope. Make notes of any
conversation with the agent or whomever on the file. If you make a
claim, start another file for the claim which includes things like
receipts, telephone records (make your calls from a cellular so you
have a record of even local calls).
- Personality Conflicts &
Threats: Claims are always wounded when there are threats and
personality conflicts. Adjusters know much more about claims than you,
and they are in a position of control. Treat your initial contact with
the adjuster as a job interview - professional and polite. Note how
long they are with you; ask about "all coverages" which
might apply to your claim. Gather information, give information,
document it in a non-threatening manner. When you disagree or are not
getting your way, send letters which start out, "please
reconsider your . . ." Communicate your difficulty without
threats, "We are living under difficult circumstances due to lack
of . . ." If you obtain legal advice, do not threaten with it.
Just say, "we really need your help, please respond in writing
- Underwork/overworking: Two
extremist approaches, underworking and overworking wound claims.
Underworking is the "too busy" sort who fail to respond to
calls, requests for documents, and make scheduling meetings an ordeal.
These often delay in presenting the claim, "Because I was too
busy." Underworking creates a record of someone who doesn't give
a damn, and creates opportunities for delay and even denial.
Similarly, the policyholders who approach a claim as the defining
moment in their life wound their claim. Overdocumentation (multiple
faxes in a short time), Threats, "If you don't . . .",
Videotaping interviews with contractors, etc. These actions invite
obstruction from the claim adjusters (who have discretion to help) and
paint a portrait of an unreasonable insured. Also, like the
perfectionist we encounter in life, the overdocumenter is so focused
on others' performance, that their own work, even simple responses,
are not done. Overworkers have claim problems and lose cases when they
go to court due to being unsympathetic.
- Accident vs. Wear & Tear:
Insurance covers accidents, not wear and tear. Proof of the inception
of loss is often where claims go bad before the homeowner even
realizes it. In the common example of a pinhole in a pipe, do not
adopt the adjuster's characterization that the pipe has a "wore
out, rusty pipe." Call it a pipe failure; point out that it was
not a drip, drip leak over time, rather a "burst." Roof
leaks are generally not covered if the roof "wears out." Get
on the roof (safely) and see what happened. Did kids get up there and
tear it up? Was the roof hit by a falling tree limb? Did an antenna
fall over and pierce it? Was the damage caused by driving rain, wind
or hail? Know how the accident happened, gather proof (pictures, piece
of the pipe, etc) and put it in your file.
- Inventory: Have some record of
the costly personal property and make sure it is covered. Room by room
video is OK if you want to revise it as things are bought, but not
necessary; I recommend costly heirlooms, paintings, the Rolex, and
similar items be noted in your File by description and value. If you
are giving an inventory for a loss; take time, room by room. If you
have camping gear never used, or no longer used, you are still
entitled to the value of it, or to gift it. This right is wounded when
you erupt, "I was going to throw it out, anyway."
- Dumb Bird on my Shoulder:
Insurance companies ideally pay money for covered claims, they do not
hire and manage restoration/construction activities. This is confusing
because they "suggest" contractors who offer to "work
for you." Clearly, a contractor sent by the insurance carrier
will not stand by you should a dispute occur between you and the
insurance carrier. Also, if you are not happy with the contractor,
expect to be told, (with the Karaoke echo machine on), "why did
you, you, you, hire him?" The management of contracting firms is
often the most problematic, beyond the scope of this paper. Be
careful, check licenses & references and control the money. POA
has resources in this regard, as does your state contractor board.
- Seek Proper Advice: Depending
on the size of the claim, the behavior of the adjuster, and the
progress of your claim, you might seek legal advice. Avoid the
temptation to take your Tax Accountant, co-worker, or bartender's
advice as you want information from an attorney doing insurance
coverage work, not a general practitioner or family lawyer, for
example. POA has resources in this regard, as does your state bar
Good luck with your claims and
avoiding self inflicted claim wounds!
Dale Washington is a POA
member-attorney practicing in Southern California.
Avoiding Self-Inflicted Claim Wounds
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