A Day in the Life of a Claimant

It was a daily chore, during my tenure as a subrogation specialist, to call the opposing insurer and do my best to work past the ‘them versus me’ tone on the line.  Until the day one of them said something that sent shock waves through the telephone line.

My insured was in an accident and was found to be 49% at fault.  In most states, that meansinsurance34 they are not at fault.  Therefore, my client had not placed a claim with my company initially and had instead filed with the carrier that was 51% at fault.  As the agent repeated to me, it made more logical sense to the insured.  If I was on the outside looking into the insurance world, I might agree.

When it finally hit my desk, my insured had spent five months trying to work with the other carrier. I had a police report, photos taken by the insured, the insured’s notes, and the various form letters sent to my insured.

Their offer to the insured and to me had been half of the cost of the claim.  After a month of back and forth phone messages, emails, and letters, the whole mess went to arbitration.  A week before, I actually got to speak with the other representative.  He then disclosed that it was their company’s practice to either deny the claim (even though they knew they were at fault) or offer to pay half.

His professional voice did little to shroud his ‘holier-than-thou’ tone as he explained that my insured should have been happy with just that.  It wasn’t the first time I had heard this of this practice.  It is not just a Property/Casualty practice, but also in Health insurance as well.

What it comes down to is the claimant is not the insured.  In Health insurance the employer is the insured.  No one wants to make waves at work, right? What is the government going to do for one person?  With so many bumping around and changing insurance yearly or every six months due to cost, not coverage, the carriers feel it’s just business.

After all, there are Health Insurance companies who will first deny an expensive claim just to see if the claimant notices.  Of course, if they hire a lawyer and make a big fuss, there will be an apology and then payment.

For instance, the current Health insurance case in Omaha, Nebraska.  An insured, Amy Bowell McClean, was receiving a monthly injection of Gamma Gard.  Monthly the payments range up to $10000.  But the doctor increased the dosage by 50%, so the local Blue Cross/Blue Shield suddenly denied coverage.  The reason it’s not necessary.

You can read about it here:  http://www.wowt.com/content/news/Insurance-Claim-Called-Life–Death-414420063.html

What follows are lawsuits, court dates, depositions, and arbitration.  Insured’s become mistrusting.  When you build an entire business on expectation and confidence – it makes all of the rest of us look bad.

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