Many People Think Insurance Companies Deliberately Try To Avoid Paying For Legitimate Claims.

[Wade]

Former insurance executives have mentioned that it is common practice to automatically deny a particular percentage of claims, hoping that the insured will not stand up for themselves and force the insurance coverage organization to pay. This practice is not necessarily illegal in a lot of states. Have you been denied or delayed on an insurance coverage claim? Do you consider the law must stop insurance coverage firms from performing this?

[Sedgewick]

A friend of mine lost his business after a break-in and burglary; the insurance company started to make up dozens of reasons not to pay, after he had paid them for seven years. The first excuse was that the original forms where not written clearly and completely. They were filled out, except for his signature, by the insurance company's representative. Next they claimed the police report was not clear enough. Then the claimed his burglary alarm was not good enough(the insurance company recommended the brand). This carried on for two years while he had to pay for all the inventory he didn't have to sell. It took the police two hours to get to his store after the alarm, so he was cleaned out. Just recently my wife went to a dentist who gave her an estimate for the total work to be done that was over $18,000. Not a typo! She went to another dentist for a second opinion. Insurance company won't pay for the second set of x-rays and second exam, because it is too close in time to the first. Second estimate was for $2000.00 After Wilma, my insurance company never paid, they went out of business. I was eventually paid about 1/2 the cost of repairs by the State's Citizens Insurance. I wonder where all the money that was paid into that company went. After I got out of the Army, I bought a used Porsche 914. It was in good shape and I fixed it up even more. Got rid of the electronic injectors and put Weber carbs, a better exhaust, 911 master cylinder, new carpeting, new paint, new wheels and tires etc.  Evidently during the engine work a wire got frayed and a spark caused an engine fire.  The fire department was there in about 15 minutes, but there was serious damage to the car. The insurance company towed it to their "secure" holding site. They called me and told me the car was totaled. I asked if I could get some personal items out of the trunk(in the front). When I got there the radio / cassette player had been ripped out of the car, the trunk had been pried open by a crowbar(still jammed into the body of the car) and all my personal belongings were stolen(camera, martial arts uniforms, two swords and some other stuff). The seats and interior had been carved up with a knife like someone was looking for something hidden. There was more damage to the car from this than the fire. The insurance company offered me $600.00 for the car. I said no, just purchase another vehicle of the same year, similar mileage, and make the same upgrades as I did, and call the police to find out which of their employees broke into my car. They refused. I called the police and the local TV station. I then got an offer: If I don't press charges, I get $9000.00 That was about what the car was worth, so I took it.

[Brodrig]

I live in France, and certainly there everything is slanted to the benefit and advantage of the insurance company. Examples:We were burgled at the new house, while in the process of moving, and lost a wide variety of things from cds and videos to duvets, pillows and tablecloths to kitchenware. A fair amount had been bought ages ago in the UK, some as monthly subscriptions. Wherever it was bought, for little did we have invoices or shop tickets - in French, les justificatifs. Thus, we worked out a value for what was taken. 'L'expert' came and did an valuation. His valuation was lower, surprise surprise. The insurance company paid out on the full amount on the few things for which we had justificatifs, and for the rest we got 25% of the expert's valuation. Because the burglary took place before we had sorted our things out during moving from two different places, we still do not know yet the full extent of what was taken, and the insurance company will not accept further declarations.  Sheesh sheeshity sheesh.  Car insurance: for the previous three years, the premium had been gradually reducing bit by bit. This year, it wanged right up without any comment. I queried this. The insurance company came back with a revised premium almost exactly the same as the year before. Reason: nationally, the company has taken some knocks in the last year from bad drivers, so decided to up the car premiums for everyone to compensate for the cost of the few bad drivers. Thus everyone is penalised, while the bad drivers have comparatively easy ride and the company's shareholders are still happy. It is only customers who check and query their premiums who are not caught out by this. A $250 camera was stolen while in Barcelona(note: Barcelona is the kingdom of muggers and pickpockets, beware - every beautiful place has its bad points). First, the insurance company fusses and fusses that there is no 'proper' invoice - it was bought online so there was nothing but the email invoice/confirmation. They were ecstatic when I was able to give them the user manual, even if it is in Japanese! Then they would only pay out the original purchase price minus 20% as there was not a 'proper' printed invoice. We then found out that, with our insurance, when we buy a new camera worth as much as the stolen camera, there is another clause in the insurance terms that will allow us to have the other 20% of the original camera price - on presentation of its justificatif. Now, we had had to buy a $100 camera so we could take pix in Barcelona for work while we were there. And cameras in France are say $300+, while in the UK they are say $240 and in the States about $160. So we are going to have to pay out for another and more expensive camera in order to be able to receive the final 20%(in this case 50 euro, close to $50). [Note, due to terrorism etc, we cannot buy and have electronic items sent to us, so we are close to being stuck with French, rip-off prices.] And the camera we had originally bought has progressed in technology and is the equivalent available now costs more, so we are going to have to pay out more to get less back from the insurance company. You have to understand that their idea of replacement as new is S-T-R-I-C-T-L-Y tied to the original invoice/receipt, how ever many years ago the item was bought. It has nothing to do with current replacement value. What gets me, as well as the insurance companies are always the winners, is that insurance is compulsory - for cars, for houses. So you pay and pay. Either you get nothing back because you are lucky, or you are doubly unlucky because the insurance company fleeces you as well as the thieves. Now is this worse or better than the States? Here, it is a real mug's game. Sources: disgrunted insuree   salamanda's Recommendations BEWARE OF THE INSURANCE INSPECTOR 11 oz. White Mug Amazon List Price: $12.99 Londons Times Funny Animals Cartoons - Three Little Pigs And Homeowners Insurance - Mugs salamanda 75 months ago Please sign in to give a compliment. Please verify your account to give a compliment. Please sign in to send a message. Please verify your account to send a message.

[Spence]

Three times, three different companies, and I know of others. A friend of mine lost his business after a break-in and burglary; the insurance company started to make up dozens of reasons not to pay, after he had paid them for seven years. The first excuse was that the original forms where not written clearly and completely. They were filled out, except for his signature, by the insurance company's representative. Next they claimed the police report was not clear enough. Then the claimed his burglary alarm was not good enough(the insurance company recommended the brand). This carried on for two years while he had to pay for all the inventory he didn't have to sell. It took the police two hours to get to his store after the alarm, so he was cleaned out. Just recently my wife went to a dentist who gave her an estimate for the total work to be done that was over $18,000. Not a typo! She went to another dentist for a second opinion. Insurance company won't pay for the second set of x-rays and second exam, because it is too close in time to the first. Second estimate was for $2000.00 After Wilma, my insurance company never paid, they went out of business. I was eventually paid about 1/2 the cost of repairs by the State's Citizens Insurance. I wonder where all the money that was paid into that company went. After I got out of the Army, I bought a used Porsche 914. It was in good shape and I fixed it up even more. Got rid of the electronic injectors and put Weber carbs, a better exhaust, 911 master cylinder, new carpeting, new paint, new wheels and tires etc.  Evidently during the engine work a wire got frayed and a spark caused an engine fire.  The fire department was there in about 15 minutes, but there was serious damage to the car. The insurance company towed it to their "secure" holding site. They called me and told me the car was totaled. I asked if I could get some personal items out of the trunk(in the front). When I got there the radio / cassette player had been ripped out of the car, the trunk had been pried open by a crowbar(still jammed into the body of the car) and all my personal belongings were stolen(camera, martial arts uniforms, two swords and some other stuff). The seats and interior had been carved up with a knife like someone was looking for something hidden. There was more damage to the car from this than the fire. The insurance company offered me $600.00 for the car. I said no, just purchase another vehicle of the same year, similar mileage, and make the same upgrades as I did, and call the police to find out which of their employees broke into my car. They refused. I called the police and the local TV station. I then got an offer: If I don't press charges, I get $9000.00 That was about what the car was worth, so I took it. YuLiQigong 75 months ago Please sign in to give a compliment. Please verify your account to give a compliment. Please sign in to send a message. Please verify your account to send a message.

[dacey]

As for the law preventing it, there are laws, both state and federal, that make this a crime, and if the state won?t prosecute, the victim can sue.  Unfortunately, there are no laws that can prevent anything.  People break laws all the time, either because of ignorance or believing they can get away with it.  And in the case of insurance fraud(the kind your question covers) it is almost impossible to prove, and there are usually clauses in policies that create huge loop-holes.  Read up on some of the things that have happened and are still happening to victims of Katrina in Louisiana and Mississippi.  A lot of claims aren?t being paid because the companies wrote the policies in such a way that they could get out of paying in just such a disaster. ("Oh, your policy doesn?t cover flooding, and your house flooded before it blew away.")   Fortunately for me and my family, nothing like this has ever happened to us.  We are, and hope to continue to be, the average insured people who "waste money" paying premiums so that the companies will have the money to pay out when someone else has a loss.  I am thankful for such a waste of money, but if I ever suffered a huge loss, I would expect my insurance company to pay me according to what my I believe my policy guarantees.  And as for my money going to other people who have losses, I don?t mind at all, and I hope my turn never comes.  What I don?t like very much is that insurance executives are among the highest paid managers in any business.  This includes the executives for the companies that are reneging on Katrina damages.  I?d rather not be paying them so much.

[bernd]

Personally I believe if you have a legitimate claim denied and then fight and win the claim through arbitration or whatever method you should get a percentage extra. 

[Gordon]

Examples:We were burgled at the new house, while in the process of moving, and lost a wide variety of things from cds and videos to duvets, pillows and tablecloths to kitchenware. A fair amount had been bought ages ago in the UK, some as monthly subscriptions. Wherever it was bought, for little did we have invoices or shop tickets - in French, les justificatifs. Thus, we worked out a value for what was taken. 'L'expert' came and did an valuation. His valuation was lower, surprise surprise. The insurance company paid out on the full amount on the few things for which we had justificatifs, and for the rest we got 25% of the expert's valuation. Because the burglary took place before we had sorted our things out during moving from two different places, we still do not know yet the full extent of what was taken, and the insurance company will not accept further declarations.  Sheesh sheeshity sheesh.  Car insurance: for the previous three years, the premium had been gradually reducing bit by bit. This year, it wanged right up without any comment. I queried this. The insurance company came back with a revised premium almost exactly the same as the year before. Reason: nationally, the company has taken some knocks in the last year from bad drivers, so decided to up the car premiums for everyone to compensate for the cost of the few bad drivers. Thus everyone is penalised, while the bad drivers have comparatively easy ride and the company's shareholders are still happy. It is only customers who check and query their premiums who are not caught out by this. A $250 camera was stolen while in Barcelona(note: Barcelona is the kingdom of muggers and pickpockets, beware - every beautiful place has its bad points). First, the insurance company fusses and fusses that there is no 'proper' invoice - it was bought online so there was nothing but the email invoice/confirmation. They were ecstatic when I was able to give them the user manual, even if it is in Japanese! Then they would only pay out the original purchase price minus 20% as there was not a 'proper' printed invoice. We then found out that, with our insurance, when we buy a new camera worth as much as the stolen camera, there is another clause in the insurance terms that will allow us to have the other 20% of the original camera price - on presentation of its justificatif. Now, we had had to buy a $100 camera so we could take pix in Barcelona for work while we were there. And cameras in France are say $300+, while in the UK they are say $240 and in the States about $160. So we are going to have to pay out for another and more expensive camera in order to be able to receive the final 20%(in this case 50 euro, close to $50). [Note, due to terrorism etc, we cannot buy and have electronic items sent to us, so we are close to being stuck with French, rip-off prices.] And the camera we had originally bought has progressed in technology and is the equivalent available now costs more, so we are going to have to pay out more to get less back from the insurance company. You have to understand that their idea of replacement as new is S-T-R-I-C-T-L-Y tied to the original invoice/receipt, how ever many years ago the item was bought. It has nothing to do with current replacement value. What gets me, as well as the insurance companies are always the winners, is that insurance is compulsory - for cars, for houses. So you pay and pay. Either you get nothing back because you are lucky, or you are doubly unlucky because the insurance company fleeces you as well as the thieves. Now is this worse or better than the States? Here, it is a real mug's game.

[Moises]

I absolutely believe insurance companies do this... Personally I believe if you have a legitimate claim denied and then fight and win the claim through arbitration or whatever method you should get a percentage extra.  ChicagoTRS 75 months ago Please sign in to give a compliment. Please verify your account to give a compliment. Please sign in to send a message. Please verify your account to send a message.

[Claeg]

what chance does the law have of changing the medical-industrial complex bigger than the law.   Google Map No map found. lookouttexas 75 months ago Please sign in to give a compliment. Please verify your account to give a compliment. Please sign in to send a message. Please verify your account to send a message.

[halfdan]

I think that this happens often. As for the law preventing it, there are laws, both state and federal, that make this a crime, and if the state won?t prosecute, the victim can sue.  Unfortunately, there are no laws that can prevent anything.  People break laws all the time, either because of ignorance or believing they can get away with it.  And in the case of insurance fraud(the kind your question covers) it is almost impossible to prove, and there are usually clauses in policies that create huge loop-holes.  Read up on some of the things that have happened and are still happening to victims of Katrina in Louisiana and Mississippi.  A lot of claims aren?t being paid because the companies wrote the policies in such a way that they could get out of paying in just such a disaster. ("Oh, your policy doesn?t cover flooding, and your house flooded before it blew away.")   Fortunately for me and my family, nothing like this has ever happened to us.  We are, and hope to continue to be, the average insured people who "waste money" paying premiums so that the companies will have the money to pay out when someone else has a loss.  I am thankful for such a waste of money, but if I ever suffered a huge loss, I would expect my insurance company to pay me according to what my I believe my policy guarantees.  And as for my money going to other people who have losses, I don?t mind at all, and I hope my turn never comes.  What I don?t like very much is that insurance executives are among the highest paid managers in any business.  This includes the executives for the companies that are reneging on Katrina damages.  I?d rather not be paying them so much. Sources: News items, personal opinion Hermes 75 months ago Please sign in to give a compliment. Please verify your account to give a compliment. Please sign in to send a message. Please verify your account to send a message.