Unscrupulous Insurers and Unpaid Claims

Seems we get a lot of letters here regarding insurers that won't pay legitimate claims. Given that you are paying for a service -- the payment of a claim in the future when you've suffered damages of one kind or another -- it is doubly frustrating when you finally encounter this situation and discover your insurer is denying you that service.

What can you do? Do you always have to get a lawyer?

Well, I can't say in every instance, but you'll have to remember that your insurer has a lot of money -- you might even say, a "war chest" -- in order to fight against the very people who fund them, their clients. That means you. They also can have claims payment processes that encourage the claim administrator to decide against you if anything, even the tiniest detail, is not quite right. This keeps the insurance company's money in their pocket longer -- and the longer they can keep from paying you, the longer that money stays invested and working for them.

Sad, but true. So a lawyer can be a good investment.

Now, this is not to say that most insurers are not good corporate citizens that live up to their obligations. But notice that some insurers actually market themselves based on their claims payment process -- which obviously means that they believe that a speedy claims settlement process is a selling point and that you, the consumer, will recognize that.

If you've encountered an unscrupulous insurer (for one reason or another), be sure to contact your state department of insurance to lodge a complaint and consider a letter to your state governor. If your state has an ombudsman, this could be another person in your corner. Contact that person and see if they will take your case on without charge.

If you are from outside the US, you'll have to search a bit to find your local equivalent. Canadians can check out Insurance-Canada.ca for consumer resources, and can complain to their MP. Again, there may be a provincial ombudsman function and you can apply for help there.

If your case is particularly spectacular, think about approaching your local news station. Local television stations can often have consumer advocate reporters. These folks will take on a case if it is "news worthy", and because publicity is great pressure, you might just get good results.

Better yet -- check out complaints against an insurer before you sign up with them. After all, who wants to pay premiums for a service that a particular insurer may be already planning not to provide?

MLA

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