Insurance Company Claims Games

Scott Blumenshine

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Insurance “games”? Insurance is a serious business, right? You buy insurance for the peace of mind you are provided against unforeseen loss. Insurance company advertisements promise you and your family the warm fuzzies of protection.

And certainly, many claims are paid promptly and fully. Certainly, some claims are without merit and are properly denied. What is unacceptable, however, are insurance company claims handling procedures that are used for the sole purpose of delaying and denying meritorious claims.

What are insurance company claims games?

Any insurance company claims handling activity motivated by improperly delaying or denying a claim payment may be part of a “game” that you may not be prepared to “play”. Those of you who have encountered an insurance company delay or denial may have unwittingly entered the process.

We understand that insurance companies are profit-motivated corporations formed and managed with the goal of returning investment to company shareholders. However, the courts and regulators have noted that certain insurance businesses involve a public trust. For example, auto insurance policies are mandatory to establish some compensation for those injured on public roadways. Thus, insurers must be held to a higher standard of conduct. Their actions affect the public.

What are examples of insurance company schemes?

The following activities are examples of ways insurance companies delay and deny claims:

  • Taking statements from claimants while they are suffering the physical and emotional effects of their injuries
  • Taking statements from claimants while they are under the influence of pain and other medication due to their injuries
  • Requesting claimants to sign authorization forms disclosing private personal information
  • Advising or suggesting to claimants that they do not need legal representation
  • Attempting to settle a claim before the nature and extent of injury or damage is determined
  • Misrepresenting insurance policy provisions
  • Failing to advise of insurance policy provisions
  • Portraying itself as the claimant’s friend, counsel, or advisor
  • Making inaccurate statements about the law
  • Making inaccurate statements about the facts
  • Requesting duplicative information
  • Taking advantage of a claimant’s compromised physical and financial condition to secure an unfair settlement
  • Requiring a lawsuit to be filed for a claimant to recover
  • Using computer programs to determine the “value” of personal injuries
  • Failing to fully investigate a claim by, for example, not interviewing witnesses, and
  • Any tactics that unfairly use an insurance company’s power and knowledge to exploit the insured’s position of physical and financial vulnerability, weakness, or naiveté.

Insurance Company Tactics

Anything an insurer does to wrongfully deny a claim, delay a claim, take advantage of a claimant, frustrate the claimant, wear the claimant down, or exhaust the claimant’s resources is a game. In short, any insurance company claims tactic​ that is not designed to evaluate and resolve a claim honestly and fairly is a game.

I represent individual claimants. I have seen the tactics. However, I believe it is possible to objectively determine what legitimate claims evaluation is and what pure game-playing is. What is going on in much of the insurance claims handling area is gamesmanship.

A prime example of claims games insurance adjusters play is demonstrated in articles that appeared in Bloomberg and the Chicago Tribune. The stories discussed the tactics of a major insurance company that seeks to put people in its “Good Hands.” The articles revealed that a major overhaul of the insurer’s claims process involved putting on “Boxing Gloves” to deal with claimants. The company denied much of the story, but those who toil in the field know the Boxing Glove approach. Delay and Denial are the marching orders.

If an insurance claim is delayed or denied, contact the Blumenshine Law Group today at (312)766-1000 or email [email protected] for a free no-obligation consultation.

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