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22 Settlement-Maximizing Tips from an Insurance Insider
Negotiating with Insurance Companies brings you an insider’s perspective on how to establish coverage, influence the carrier’s reserves, and gain a tactical advantage in negotiations and litigation. The latest revision adds more than 25 new sections on such timely topics as texting while driving, cyber bullying, and internet insurance sales, as well as advice and sample letters for dealing with outrageous low ball offers.
Author Joseph Vaccaro has more than 40 years of claims handling experience, with 11 years in the claims department of one of the nation’s largest insurance companies. There, he supervised adjusters and handled casualty claims in all lines of both personal and commercial insurance.
In Negotiating With Insurance Companies. Mr. Vaccaro brings you an insider’s perspective on how to establish coverage, how to influence the carrier’s reserves on your claim, and how to gain a tactical advantage in negotiations, mediation and litigation.
Negotiating With Insurance Companies puts decades of insurance claims experience at your fingertips and provides practice-proven advice and strategies for handling issues related to:
- Personal auto claims;
- Commercial auto/truck claims;
- General liability claims;
- Big damages, bad liability cases;
- Own occupation disability income claims;
- Non-ERISA health insurance claims;
- Homeowners and commercial property losses; and
- Bad faith.
- Overcome defenses
- Protect attorney’s fees
Here, in 22 tips, is a small sample of the many ways Negotiating with Insurance Companies will help you maximize the value of your clients’ claims:
- Get an expert opinion on causation early in the case. In complicated medical causation cases (e.g. cases in which your client has a long history of pre-existing conditions), have your client’s medical records reviewed by a medical expert who can then draft a letter that clearly explains and documents the cause of the plaintiff’s medical problems as related to the accident. By sending such a letter to the adjuster early in the case, you often can eliminate many common causation arguments before they are made and prevent the carrier from entrenching itself into a position that becomes difficult for you to undo. [§6:25]
- Never paraphrase policy language. When presenting a coverage argument to an insurance carrier, never paraphrase the policy language. Use and interpret the exact words and phrases written in the policy, and relate the facts of your case to that specific language. [§2:13]
- Use the adjuster’s own words. Adjusters often make outrageous statements that do not comport with the reality of the case. When you hear something like that, resist the urge to argue. If you listen carefully, you will pick up on what I like to call “leakage” – words or phrases that poke holes or reveal defects in the adjuster’s arguments. Write them down. Later, you can use those very words against
the carrier in a letter to the adjuster or a complaint to the Department of Insurance, if warranted. [§3:34]
- Update your settlement demand in advance of mediation. You file a lawsuit and tell the carrier that all your pre-suit settlement proposals are “off the table.” If you do not reinforce that position by presenting the carrier with a new demand in advance of the mediation, you are setting yourself up for failure. Regardless of what you may have said previously, the carrier will come to the mediation. [§7:02]
- File a detailed consumer complaint with your state’s Department of Insurance. If the claim is not one you want to litigate, but the offer is simply unreasonable, send the adjuster a letter, asking him to explain why he believes the carrier’s offer is reasonable and why your client should accept it. If the adjuster cannot or will not explain the carrier’s position, send a detailed letter to your state’s Department of Insurance, along with a request for assistance. This kind of complaint, especially when a copy is sent to the carrier, will trigger. [§3:53]
Personal auto claims
- Your client is entitled to “loss of use” of his vehicle; don’t fall for bogus arguments to the contrary. Claimants with auto damage claims generally are entitled to recover for “loss of use,” whether they rent a vehicle or not. Therefore, you should always assert the loss of use claim because it will put several hundred extra dollars in your client’s pocket. The carrier may try to avoid the loss of use claim if your client has a second vehicle in the household that is available for him to drive, by arguing that there really is no loss of use. Don’t fall for this argument; it’s bogus. Likewise, your client is entitled to rent a vehicle of like kind and quality. The carrier may argue that it is only responsible to provide basic transportation (especially if your client is not renting a vehicle). Don’t fall for that bogus argument. [§8:21]
- “Total loss” value includes special equipment. Whatever you do, do not allow the insurance company to declare a vehicle a total loss, but refuse to pay for non-standard equipment, without either (1) getting compensated for that part of the loss from the third party or (2). [§8:45]
- Maximize the value of no fault coverage to your client. If your client has been incapacitated from working and has medical payments coverage under an auto policy or has a health insurance policy or both, you may want to instruct the insurance company to reserve your client’s no fault coverage to pay for wage loss only. Unless there is a disability income policy, your client will not be able to collect wage loss under the medical payments coverage or health insurance coverage. Thus, reserving the no fault benefit to pay for wage loss maximizes your client’s benefits and provides a steady income while he is recovering from his injuries. [§8:111]
Commercial auto/truck claims