Top 10 Things Insurance Companies Don't Want You to Know
Denver Injury Lawyer
Policyholders are at a disadvantage. Their insurance company:
- Wrote their policy;
- Tells them what it means;
- Makes the decision on their claim; and
- Has all the money.
Dealing with an insurance company is an information game. To be paid the full compensation amount that you're entitled to after an injury accident, you need all the right facts. Here are the top ten pieces of information that these companies don't want you to have.
-
Insurance companies make profits from investing
They invest in stocks, bonds, real estate, etc. So their annual profits are proportional to how much money they invest. This explains why insurance companies love delay. If they can retain the money they owe you, they can earn profits or interest on it. When the company brings in more money than was anticipated for that year, their stock price rises. When the stock price rises, executives receive bonuses.
-
Insurance adjusters don't work for you
They may be very polite and pleasant people, and may seem to have your best interests at heart. But they work for the company and their job is to save money for their employer. What sort of bonus or promotion would the adjuster earn if he offered you the full amount you're entitled to? If he hasn't been consistently conserving the company's money, they'd have moved him on by now.
So the offer he makes you to settle you injury accident claim is certainly not going to be the maximum you're entitled to. He may present it as fair and reasonable or even generous, and say you're a lucky person to have such a good insurance company and such a quick amicable settlement. But are you informed enough to see the real facts?
-
If you sign the medical release form given you by the adjuster, you're giving the company an advantage over you
The adjuster will ask you to sign this release form so that the insurance company can subpoena a copy of your medical records. They'll want to see them in order to decide what to pay you.
But these records will include doctor's notes and many details that you may be unaware of. So if you, let's say, didn't follow your doctor's orders in some respect, and he noted it down, now the insurance company has something to use against you. If you're claiming injury, how severe can it be, if you don't follow the doctor's orders? So don't sign that form until you consult an attorney who's familiar with personal injury law.
-
There's a time limit on your ability to make a claim
If you're injured, perhaps quite severely, then for a good while you may be entirely focused on medical matters. You may even be incapacitated for a while. Your adjuster may urge you to obtain "the best medical care available", and not to rush the important process of healing yourself. He may assure you that the bills will be covered.
But there's always a statute of limitations. If you aren't aware of how long it is, and you take too long receiving medical care before you file a claim, it may expire and you may then be legally unable to make the claim.
-
If you bought your policy from an agent, and that agent misrepresented the coverage, the company will be obliged to honor the coverage as the agent described it.
Many insurance agents, although they receive training from the company they work for, know little of the policies they sell. And can you wonder at that, if you've ever tried to read a policy yourself and understand it? They'll know enough to describe it in glowing terms, but not enough to tell you which things are not covered, or under what circumstances. Typically you won't receive the actual policy from the agent, but later in the mail. So what you've bought is what the agent described, not what comes in the mail.
-
If there's something ambiguous in your policy, it must legally be interpreted as being in your favor, not the company's
Legal language is famously unclear to a layperson. The term "ambiguous" means "having two meanings" (think of "ambidextrous" - can use right and left hands equally; and "ambivalent" - can't decide between two possibilities). In other words, that particular sentence or passage in the policy can have meaning A or meaning B.
If it's held to have meaning A, the company will benefit. If it's held to have meaning B, the policyholder will benefit.
This would not be deliberate on the part of the company. But some policies are so complex and rambling and have so many exceptions and conditions, that the lawyer who wrote them might have slipped up and left something that could be interpreted in either of 2 ways.
-
It's the company, and not you, who must prove that an exception in the policy (or a limitation or exclusion) is applicable to your claim
As you know if you've glanced at your policy, the part which describes what's covered is short, and then follow many pages of exceptions.
When you make a claim, the company may come back saying that they can't honor your claim because of such-and-such exception on p. 14 of your policy. For most of us, that seems pretty definitive and we don't think to argue back.
However, just quoting that exception isn't enough. The company must also prove that it's clear and applicable. It's not your job to prove that it isn't.
So an attorney is needed to challenge the company's statement and prove the exception doesn't apply to your case.
-
Punitive damages can be assessed against insurance companies who engage in fraudulent or malicious behavior
Looking back at item #1, we know that insurance companies profit by investing their money, which means that if they delay paying pieces of it out to policyholders, they can make that much more profit. Delay is a handy thing. Life happens during delay. People become incapacitated from their injuries; they may die; or they may lose their house, their spouse, and their will to insist on a maximum compensation from the insurance company.
Moreover, these companies have platoons of lawyers, and many policyholders are intimidated by lawyer letters and official documents. So if the company wrongfully denies a claim, many people will roll over and do nothing about it.
Appropriately high punitive damages are seldom awarded by juries. Such an award would have to be in the millions to be relative to the giant company's wealth. Even if the damages are awarded, the judge can reduce them, and the insurance company can appeal. More delay.
But if you have a lawyer who specializes in personal injury claims, the threat of punitive damages can influence the company to be honest with you.
-
Health insurance companies can reimburse themselves from your auto accident settlement money
Let's say there's an accident and you're injured, and you use your health insurance to get the medical care you need.
Then the wheels finally turn and you receive compensation from the insurance company of whoever caused the accident, for your injuries, pain and suffering, and whatever else you were entitled to.
Your health insurance company can put a lien on it. They can take whatever the amount was that they paid out for your medical care. It's called "subrogation" and is legal. But there's disagreement about details and there have been many court cases over it.
At Hull & Zimmerman we can fight subrogation for you, if the circumstances look right.
-
Forty-six states have Prompt-Pay laws for insurance companies, but the companies can wriggle around them
Those Prompt-Pay laws apply only to claim forms that are completely and accurately filled out when first submitted. But insurance companies have created dozens of rules and regulations about how to file claims. So seldom can anyone get it right the first time.
This creates delay again, allowing the company to retain money it owes for longer, making more profit on it.
So in summary, if you're injured in some type of injury accident, do go ahead and get immediate medical attention. If you delay, and an injury makes a late appearance, as many spinal and neck injuries do, the insurance company can say, Why did you delay, if it's a bad injury?
But also consult a lawyer as soon as possible, before time slips away, evidence gets lost, people forget things, and perhaps your strength to stand up to the insurance company starts to ebb.
If you can, take photos and make videos of injury or damage. Be sure you keep all receipts, such as for housecleaning services or lawn mowing, while you're too ill to do it yourself. Such receipts help create the picture of your injuries and strengthen your case.
At Hull & Zimmerman, our Denver injury lawyers give you a free consultation and will answer all your questions to help you understand your situation.
Greater Denver metro area and Colorado Personal Injury Lawyers.
Hull and Zimmerman, P.C.
2921 W. 120th Ave., Ste 220
Westminster, Colorado 80234
Phone: 303-423-1770
Fax: 303-423-2102
Toll Free: 1-866-385-3505
Email Us
