Posted: Fri Mar 14, 2008 6:20 am Post subject: Who do I reach out for a claims problem?
If I ever face a claims related problem & is on the verge of complaining against my insurance carrier, who do I go at first? Do I go to the state body of insurance? Or do I seek the help of an attorney? _________________ Register Now to have your Insurance queries solved.
Posted: Fri Mar 14, 2008 6:27 am Post subject: make sure
Hi there...ofcrs the State department of Insurance is the one you ought to look for such helps..but make sure that you've tried out all the easier options to achieve what you need at last. Try out the adjuster for any negotiations pending....don't forget to consult the broker (if it is something he might help with)...at the end of it...don't stop yourself from visiting the state DOI.
Balkansterritoryagent _________________ Register Now to have your Insurance queries solved.
Agreed...but then again it often takes a longer time than expected to solve your case if it is a distinct one.
Yeah, I'd agree to most of who are of the opinion that hiring an attorney may increase your expenses without any assurance. But you shouldn't ever forget that the attorney is the only person who is aware of the laws in your state & is equipped to guide in accordance with those laws.
Also, would like you to make a note that the insurance claims are guided by the state laws & not the federal laws.
Fedcox _________________ Register Now to have your Insurance queries solved.
Posted: Fri Mar 14, 2008 7:35 am Post subject: You need to make a real choice..
My friend...let me tell you a truth :
If you hire an attorney, he would be the right person to do it for you. He'd be the professional who'd act faster than the DOI. Since he is a single person acting on your behalf, his only job would be to analyze your case in particular & draw the different possibilities. He'd be the one who'd keep a tag of your aims right from the very beginning & thus would be in a better position to derive a strategy for your case.
Remember that your DOI would be processing such claims in bulk & hence in their eyes you're just another case, while in the eyes of your attorney you're the client. So he is gonna give you the best in term of his knowledge & the best of his service & guidance. Now, the choice is yours my friend! _________________ Register Now to have your Insurance queries solved.
Good morning Dr.Jonesvolga, and welcome to the community...
It really depends on what the problem is....if you have one pending and would care to share the details we'd be better equiped to answer your question...
An attorney is a good choice 'sometimes' but also if it's an adjuster you are having trouble with many times, by going to their supervisor is all that needs done...
It's really difficult to answer your question without knowing the source of the the disagreement....
In most cases I would recommend the DOI, (it's free!)...an attorney never is...and of course it's possible that this is a black and white issue that can be easily put to rest. _________________ Have you been helped by a poster? Do you want to show your appreciation? YOU CAN !! Just simply click on the donate button and send them some coin!
My personal experience with the DOI is that they forward your complaint to the Insurer. The Insurer offers an opinion back to the DOI. The DOI rubber stamps this opinion and sends it back to the person that filed the complaint.
The End.
At this point, the consumer can give up, hire an attorney, or try the adjuster/supervisor approach again.
My personal experience with the DOI is that they forward your complaint to the Insurer. The Insurer offers an opinion back to the DOI. The DOI rubber stamps this opinion and sends it back to the person that filed the complaint.
I've seen that happen in the past as well... but it's not always the case. Trust me... it's up to the state DOI as to how aggressive they want to get. It's up to the people of that state to make sure that they have the right people in office to affect the DOI. But some states have very aggressive DOI's. No carrier wants to mess with CA's DOI! CA has some of the strictest Fair Claims Practice laws in the US and the DOI routinely enforces them with a vengeance. Other states can be almost as aggressive.
But there is another reason for filing a DOI complaint and it has little to do with what the DOI does. 1) most carriers will require that a high management person "answer" the complaint. This means someone with more experience is going to review the claim. 2) Many carriers have guidelines as to how many complaints an adjuster should get over a period of time (some consider the difference between "founded" and "unfounded" complaints).
I worked for a scummy carrier that was audited by the FL DOI and was fined a boat load of money (because their practice was not to pay claims). So they made up a rule that adjusters could be fired if they received a DOI complaint (rather then address the companies problems of not paying claims that were owed, they transferred the problem onto the adjusters who had nothing to do with the problem).
As mentioned by Lori, calling or email the state DOI is free and it can't hurt. In many cases I _have_ seen it solve the problem.
No carrier wants to mess with CA's DOI! CA has some of the strictest Fair Claims Practice laws in the US and the DOI routinely enforces them with a vengeance.
I do somewhat agree, but, I'm not so sure insurer's are afraid to *mess* with the Cali- DOI. (See story below)
New Evidence That Poizner Aide Destroyed Key Document In Attempt to Help Industry;
Industry's Strength In Department of Insurance At Issue As Commissioner Announces New General Counsel Hired From State Farm's Law Firm
Santa Monica, CA -- Insurance Commissioner Steve Poizner's special counsel William Gausewitz destroyed a fax sent to him by an insurance lobbyist that appears to have served as the basis for a declaration he claimed to have prepared independently for submission to a Sacramento Superior Court this summer, according to new documents consumer advocates have obtained from the Department of Insurance through a Public Records Act request. Last month, the Foundation for Taxpayer and Consumer Rights (FTCR) obtained a series of e-mails between Mr. Gausewitz and insurance company lawyers and lobbyists indicating that Mr. Gausewitz privately tried to assist companies' effort in court to have the Department of Insurance pay legal fees associated with a failed lawsuit the insurance companies brought against the Department of Insurance, rather than the insurers themselves.
Insurance industry lawyers later filed a document signed by Gausewitz in the court case -- but made it appear that the California Attorney General had filed it.
In a November 5, 2007 written response to FTCR, which requested a copy of the draft declaration that the insurance industry first sent to Mr. Gausewitz, the Department of Insurance stated:
"[Insurance industry lobbyist Jeff] Fuller faxed a proposed declaration to Mr. Gausewitz. Because Mr. Gausewitz was unwilling to sign the draft declaration prepared by the insurers, he prepared text for an alternative version of the declaration and provided that text to Fuller... Mr. Gausewitz then discarded the fax."
Consumer advocates said the destruction of a key public document added another layer of concern to the incident, which caused the group to call on Commissioner Poizner to fire Mr. Gausewitz. FTCR noted that without the original document, the public cannot know whether or not Gausewitz actually made even a single word change to the industry's requested declaration.
"By destroying documents, Bill Gausewitz tried to cover his tracks in order to avoid the appearance that he was abusing his authority and serving as an insurance company toady at the Department of Insurance," said FTCR's Executive Director Douglas Heller.
Commissioner Poizner Names Lawyer from State Farm's Law Firm As General Counsel of the Insurance Department
The latest revelation concerning the Department's upper level management, comes as Insurance Commissioner Steve Poizner announced today his appointment as General Counsel a lawyer from a law firm that has frequently gone to court to block enforcement of insurance reform Proposition 103.
Poizner's new General Counsel, Adam Cole, is a partner in the San Francisco office of Heller Ehrman, a national corporate law firm. Heller Ehrman has played a leading role in attacking Proposition 103 in court on behalf of its client State Farm, California's largest insurance company. Heller Ehrman has gone to court on behalf of State Farm to:
- strike down regulations requiring insurance companies to pay over $1.2 billion in premium refunds;
- evade State Farm's responsibility to pay millions in rate rollbacks;
- prevent the Department from publishing data about insurance service in low-income communities that 103 require to be disclosed to the public;
- prevent consumers from going to court to stop insurance companies from violating Proposition 103;
- block rules that would require insurers to base auto insurance premiums on motorists' driving records rather than their ZIP Codes.
"Like their colleagues at several other big law firms who represent the industry, Heller Ehrman's lawyers have prospered by representing State Farm in its continuous assault on the voter-approved initiative. But the mission of the California Department of Insurance is to enforce the laws passed by the voters and protect consumers from unfair practices by insurance companies; and the office of General Counsel is one the most important positions in the Department in pursuit of that mission," said Harvey Rosenfield, the founder of FTCR and author of Proposition 103. "The 'Gausewitz Affair' highlights how easily the Department's 'fierce independence' from the insurance industry, embraced by Mr. Poizner, can be quietly yet deeply subverted. Mr. Cole must now demonstrate that he has transferred his loyalty from the firm he represents and its clients to the consumers and taxpayers of California whom he serves, and we intend to hold the Commissioner accountable for the actions of all of his appointees."
The Commissioner's new General Counsel was hired after a taxpayer-funded search by a private firm, which apparently focused only on corporate law firms.
A list of Proposition 103 suits Mr. Cole's former firm Heller Ehrman has been involved in on behalf of State Farm is available upon request.
FTCR is California's leading public interest watchdog. For more information, visit us on the web at: www.ConsumerWatchdog.org.
================================
Story number (2)
Insurers Liking the Coverage of Schwarzenegger's Policies
By Peter Nicholas, Times Staff Writer : 9/24/06
SACRAMENTO
With a onetime State Farm official and a former insurance lobbyist in top staff jobs, Gov. Arnold Schwarzenegger is repeatedly siding with insurers in legislative battles as they maneuver to fend off fees, fines and concessions to policyholders.
A veteran insurance lobbyist, Dan Dunmoyer, is now the governor's deputy chief of staff, helping to craft his entire policy portfolio. Former State Farm official Kathleen Webb is Schwarzenegger's insurance advisor, vetting insurance-related bills that reach his desk and recommending which he should sign into law.
Both have given the insurance industry special access to Schwarzenegger's government and taken positions that protect insurers' financial interests. Webb, in particular, has met continually with industry trade groups and attended private meetings where insurance lobbyists plot strategy and discuss ways to push their agenda, her calendar shows. She has not recorded a single meeting with a consumer representative.
When insurance-related bills have crossed Schwarzenegger's desk, he has sided with or at least not opposed the industry nearly nine times in 10, a review of 56 bills tracked by insurance groups shows. At other times, he has sought to kill or blunt legislation before it reached him.
Administration officials have sent letters to lawmakers, for example, warning of their opposition to bills that the industry wants defeated letters that in some cases coincide with industry lobbying campaigns to beat back the legislation.
"I don't know that I can point to one pro-consumer bill that has made it through and been signed by the governor in recent history," said Sen. Deborah Ortiz (D-Sacramento).
The governor vetoed one bill that would have extended for nine years insurance industry fees that pay for seismic research. He rejected another that would have barred insurers from raising auto rates for home healthcare workers who use their cars to assist low-income patients. He also vetoed a measure that might have required insurance companies, rather than the state, to pay the medical expenses of certain accident victims.
"People expected of Arnold Schwarzenegger independent advisors who would bring a fresh perspective," said Doug Heller, executive director of the Foundation for Taxpayer and Consumer Rights. "Instead, the governor has brought in State Farm and its cronies."
Meanwhile, insurance money has poured into Schwarzenegger's campaign accounts. Since he jumped into the recall campaign in 2003, he has collected about $4.4 million in donations from insurance interests, state records show.
Schwarzenegger promised as a candidate in 2003 that he would purge the capital of powerful "special interests." But he pleased environmental activists in 2003 by hiring one of their own, Terry Tamminen, who was among the governor's most influential aides before resigning last month. And Richard Costigan, a former lobbyist for the California Chamber of Commerce, the state's chief business advocate, is the administration's top liaison to the Legislature.
Now Schwarzenegger has elevated insurance interests to senior levels of his government, giving them too much influence, in the view of consumer groups.
The governor's aides insist that the industry receives no special treatment. If consumer groups don't see the governor's staff, it is because they haven't asked, they said.
Consumer activists said they've seen no point in contacting insurance advisor Webb.
"It's pretty much assumed that under this administration, we were not going to get anything meaningful signed," said Amy Bach, executive director of United Policyholders, a nonprofit group that offers information to the public on insurance matters.
Bach added: "As an advisor, it's incumbent on her to seek us out."
For Dunmoyer's part, his involvement in insurance issues is limited to offering "expertise" to colleagues inside government who are responsible for insurance matters, said Adam Mendelsohn, Schwarzenegger's communications director.
"No industry or organization gets a more sympathetic ear from this administration to the exclusion of another industry or organization," Mendelsohn said.
But insurers see in the governor a reliable ally. Stephen Lilienthal, chief executive officer of CNA insurance companies, wrote in a June letter soliciting money for Schwarzenegger's reelection that the governor "has been a critical first line of defense" for the industry.
CNA, a commercial insurer, has spent $275,000 lobbying in Sacramento since Schwarzenegger took office.
Insurance interests have long been a formidable player in Sacramento, adept at derailing or neutralizing unfriendly legislation. The Schwarzenegger administration is helping.
I recomend going to your agent first. That is what your agent is supposed to be there for. The agent should be your representative and should be the one to step up in these situations.
If your agent does not step up to bat for his customers, you need to shop for a new agent once the claim is resolved.
Also, as mentioned above, you can also go above the adjuster and speak with their manager. DOI is also your best option if the manager does not seem to be helpful.
I had a friend who was an adjuster and he had one complaint. When the complaint was made, TDI came in and scrutinized everything from making sure his license was properly displayed, how his files were kept up and his discussion logs he had with this customer. They looked for anything to hold against him.
I feel an attorney would be your last resort. What I've seen too many times is an attorney getting involved in a property damage only claim and his fees are paid out of the settlement, leaving even less money topay for your damages.
I've also seen claims really get dragged out when an attorney gets involved because the claims handler starts handling it by every letter of the law and the timeline the state requires.
Posted: Sat Mar 15, 2008 9:18 am Post subject: Thanks to all of you!
Thanks to all of you for sharing your experiences with me!
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It really depends on what the problem is....if you have one pending and would care to share the details we'd be better equiped to answer your question...
Thanks a lot Lori!
I'm not into it as yet...but since I'm a very process-oriented person by nature..I needed to get your feedbacks before I leap into it. I'm from Florida ...though right now I'm in Vienna (looking after my ancestral property), I'd need to get a cover for my new car upon my return next month (ie. after 3 long years).
Regards,
Dr.Jonesvolga _________________ Register Now to have your Insurance queries solved.
But there is another reason for filing a DOI complaint
I'm going to add one more reason, these complaints (DOI, is all states I know of) are very time sensative...meaning the carrier has a limited time to respond to the complaint....and (in my state) the DOI does enforce these and let me tell you all carriers I know set up and take notice and promptly respond...all compliants are not justified...and no big deal to respond to...the ones though that have some 'funny' business...big trouble...
FK, not agreeing with the storys (meaning there was no wrong doing, sounds certainly like there was)....but was there anything in there about complaints filed by consumers against carriers and there outcomes, or such? I'm not saying they may not have some scum buckets at the top, but (as we saw in a recent pres.admin.) there can be some scummy behavior at the top, (morally) but still can get the 'job' done (on the comsumer compliant level is all I'm talking about--I AM NOT DISAGREEING with you re: the information you provided...
Most DOI websites also (and I find this very interesting) will actually go into detail (no names of course) re: complaints what they were and how they were resolved (per ins carrier name)...you might check the company you are dealing with to see if similar complaints exsist...(not all sites but most do)...
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I recomend going to your agent first. That is what your agent is supposed to be there for. The agent should be your representative and should be the one to step up in these situations.
Awesome MB, and something I forget to mention all the time! You are absolutely correct....(unless it's an online purchase ! then perhaps you can try policy services but not sure how far you willl get...another argument for maintaining an agent)...
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I've also seen claims really get dragged out when an attorney gets involved because the claims handler starts handling it by every letter of the law and the timeline the state requires.
Also once an attorney rep letter is received the adjuster can have zero contact directly with the person ALL communication goes thru the attorney, ONLY....
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though right now I'm in Vienna (looking after my ancestral property),
Well I significantly depressed now! (kiddin' sounds wonderful)... _________________ Have you been helped by a poster? Do you want to show your appreciation? YOU CAN !! Just simply click on the donate button and send them some coin!
I had a friend who was an adjuster and he had one complaint. When the complaint was made, TDI came in and scrutinized everything from making sure his license was properly displayed, how his files were kept up and his discussion logs he had with this customer. They looked for anything to hold against him.
I feel an attorney would be your last resort. What I've seen too many times is an attorney getting involved in a property damage only claim and his fees are paid out of the settlement, leaving even less money topay for your damages.
I've also seen claims really get dragged out when an attorney gets involved because the claims handler starts handling it by every letter of the law and the timeline the state requires.
Based on my personal experiences and not to be read as criticism.
By what you state in the first paragraph it would appear the DOI was more interested in collecting some "Random Taxes" (aka - fines & penalties) than in resolving a customer complaint.
By what you state in the second paragraph that might not be true. Getting 70 to 80 percent of *something* is better than getting 100 percent of nothing from an *denial* of the claim.
By what you state in the third paragraph it would appear your blaming the Lawyer for the unfair claims practices of an insurer?? (also I think delayed *timelines* are allowed not required) Have you read or heard of McKinsey and Co. ? If not I can post a few articles for you to read.
By what you state in the first paragraph it would appear the DOI was more interested in collecting some "Random Taxes" (aka - fines & penalties) than in resolving a customer complaint.
What I meant by this scenario is, they do follow up all complaints AND make sure the adjuster is following all the rules imposed on them by the state. They take complaints seriously.
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By what you state in the second paragraph that might not be true. Getting 70 to 80 percent of *something* is better than getting 100 percent of nothing from an *denial* of the claim.
True, that is why I did include consulting an attorney as a step I would take. But, I feel before I give up 30% of the cost to repair my car, I'm going to exhaust all the free opportunities I'm entitled to.
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By what you state in the third paragraph it would appear your blaming the Lawyer for the unfair claims practices of an insurer?? (also I think delayed *timelines* are allowed not required) Have you read or heard of McKinsey and Co. ? If not I can post a few articles for you to read.
By no means do I blame the attorney for the way the claims adjuster handles the claim. As Lori mentioned previously, when an attorney enters the claims process, everything stops and takes a different course of action. This delay is created by the claims department of the insurance company, not the attorney. But, the claim process is handled differently when an attorney gets involved.
I understand my remarks, if viewed from an attorney's point of view, would look as though I would recommend not using an attorney, but that's far from the truth. I've had experiences where someone had already hired an attorney before even filing the claim, then get mad when noone from the insurance company will talk to them. There is a process in which a claim can be resolved in a fair and prompt fashion. I feel an attorney should only be brought into the picture if all the customary means of resolving a claim have been exhausted.
I'll openly say that atty rep'd claims take longer to settle.......When an attorney is involved the rep can no longer have ANY direct contact with the party they represent....it all has to go thru the attorney...so I have to call the attorney and ask him/her to call me back to ask a question request something...don't know that in all my years I've ever got a return call the same day, and more times than not I have to call them again...Or send a medical authorization (to the attorney) then wait six weeks to get it back...how is that the adjusters fault? You'd be surprised the number of atty rep'd people that will call me in an attempt to get information on the progress of their claim because they can't get ahold of their own attorney...All I can tell them is 'well, i sent them some forms I need signed before I can move on that issue and that was six weeks ago, you should talk to your attorney about that'...I know attorneys are busy....and I further know that all attorneys do not operate in this manner, but I also know from my experience this has been the rule rather than the exception. So to my way of thinking, in all but a very very very rare case, atty rep'd claims take much much longer to settle...sometimes though there is nothing wrong with that, and it is a very good thing (for their client)...there is also the occurance with a claimant, that I am thrilled to death to hear they are attorney rep'd... _________________ Have you been helped by a poster? Do you want to show your appreciation? YOU CAN !! Just simply click on the donate button and send them some coin!
then perhaps you can try policy services but not sure how far you willl get...another argument for maintaining an agent)...
(kiddin' sounds wonderful)...
