Insurance companies are lovely. Just like the IRS and the DMV are.
I had a client that had his house burn down. The insurance company refused to pay off on the fire insurance, saying that the house wasn’t a total loss because there was one brick wall still standing. Brick doesn’t burn, you know. I had to have the fire chief condemn the one-walled building before the insurance company was convinced that the residence was a total loss and that they had to pay the claim in full.
I can’t prove it, but I’ll bet that insurance companies rate their adjusters based on how much they don’t pay out.
I’m not touching most of this with a barge pole but, for the record, between about 1995 and 2001 insurance companies did indeed make ever larger losses culminating in 150% to 300%+ loss ratios (i.e. $1.50 to $3.00 + paid out in claims for every $1.00 taken in premium). The industry was ready for a HUGE smack in the mouth anyway… and then WTC came along.
Lots of companies got out of the industry altogether and the ones that were left had additional excuses for jacking up rates. As a consequence, 2002 and 2003 have been profitable. There are plenty of signs of it taking a nosedive, however…
The worst losses have been in liability cover, particularly Professional Indemnity/ Errors and Omissions and Directors & Officer’s insurance (the so-called “Casualty” classes). I’ve seen plenty of loss ratios in excess of 1000% for the late nineties in these classes. Things like Enron, WorldCom and the IPO Laddering cases hit them hard but the fact was that they were simply undercharging anyway. Since 2001 I’ve heard many businesses squealing about sevenfold rates in their E&O cover but, as you can see, even that may not be enough to bring about profit in some cases…
I’d hazard a guess that the reason “people hate insurance companies” is that “people who express an opinion on it hate insurance companies.” We’ve seen this before. The only people speaking up are pissed off, and whatever the percentage of satisfied customers is, it’s a really quiet percentage.
I applaud you, Ruby for having that attitude toward your job. But I think you’re being naive about some of the other people in your line of work.
A friend of mine lost her fiancee a couple years back. He was crossing the street and got hit by a truck. The insurance company that handled his life policy claimed it was suicide and refused to pay, despite a host of witnesses who said it was clearly no such thing, and despite his having no history of depression or suicidal tendencies. The families had to sue to get their money, and the company contributed no small amount of additional emotional anguish to an already traumantic event.
Now, I realize that the plural of anecdote is not data, but everyone I know has stories about claims that were unreasonably refused. Or about companies who drop long-term customers after a single claim. I believe you that the majority of adjusters have a responsible attitude toward their jobs. But there is a sizeable minority that exhibits unethical behavior.
Maybe. Fact is, there are a lot of bad insurance companies out there, especially in the health care field. There are also a lot of great insurance companies out there who actually provide the services they are obligated. Some even go beyond that.
My only large claim was a total loss house fire. An adjuster was on-site at 8am the next day with a $5,000 expense check to take care of immediate needs. We gave them an inventory of everything we lost, and the company paid the full amount (six figures) in about 90 days. One of the adjusters called us several times a week to give status updates and to check on our expense needs and helped us replace items. To my great surprise, my rates were not affected.
I hate 'em because they won’t give me insurance. I have a seizure disorder, but haven’t had a seizure for three years. Every time I’ve applied for insurance, the mealy-mouthed insurance agent tells me that the statute of limitations for coverage on that is two, so I am eligible. Then invariably, I get a notice stating that the insurance company cannot cover me because of my seizures. I guess I should be mad at the insurance agent & not the company. I can understand that I’m a risk, and I actually save more money not having insurance, no matter how expensive my medication (meds cost me about $250 per month, where insurance would be about $350); however, it never fails to burn me up anyway.
Where did Hello Again mention that two different companies were involved? S/he spoke about the insurance company–period. The insurance company was asked what services the insurance would provide, the insurance company made clear that it would cover Occupational Therapy, and then the insurance company declined to cover that same Occupational Therapy.
It’s fairly straightforward.
Furthermore, HelloAgain made no mention whatsoever of where this health insurance comes from. You assume that it comes through the employer, but this might not be the case. Hello Again might be self-employed, or might be in some other situation that requires dealing directly with the insurance company rather than going through an employer. And even if the insurance does come through an employer, the fact remains that the insurance company was asked what it covered, and then failed to provide coverage. The employer is not even an issue.
Maybe you should study reading comprehension before you go pissing all over someone.
I must speak out in support of my home and auto insurance company, Farmer’s, who covers both my vehicle and home. I have been with them for almost 20 years, in two states, and they have always come through for me. Maybe I have been lucky, but I have had weather related claims, (hail, wind), theft (auto and home burglary) as well as auto accident (my fault). When I got a ticket for speeding it did not change my premium. Sometime the adjustor writes the check on the spot or sometimes it takes a week, but they have always been generous and prompt and never penalized me for submitting a claim.
I wish I could say the same nice things about my health insurance (not Farmers), which I get through work, so I have no control over the selection of the company. My health insurer sucks.
I was lucky. My insurance company covered my - medically necessary - breast reduction. (Well, I could tell you about the horror that was trying to get a revision done, but… nah.)
But I hate the ones that tell a woman that she’s fat. *That’s * why her breasts are causing numbing in the fingers, migraines, permanent nerve damage, etc. That’s why she’s in pain that comparable to N-stage cancer. And they’ll cover her surgery (according to what was all “spelled out” in her policy) but only if she loses weight. Even if she’s a 32 bandsize. Then they add further insult to injury by only approving a set amount to be removed, regardless of what her surgeon deems necessary.
Do this: Google “complaint ratio”, “insurance”, “[your state]” From the resulting hits, look for a link to a state government site that will give you a listing of insurers in your home state and their corresponding “complaints/1,000” ratio. You’ll see who the problem children really are.
Auto adjuster here. I won’t speak for corporate policies in general, but since I am where the rubber meets the road as far as you all are concerned, take this or leave it: If you are dissatisfied with how your claim is being handled you have 3 options: 1) let it go and get on with your life (do NOT do this!), 2) make the claim person explain why they are doing whatever it is they are doing that you disagree with (some of us just assume you are versed in the applicable legal codes & know what we’re talking about) 3) If you try #2 and the claim handler blows you off or fails to make an attempt to communicate with you, inform the person that you will file a complaint with your state’s Insurance Commissioner (and DO IT!).
The money I pay out is not mine. If I feel you are owed $X, I really have no problem paying you $X as quickly as possible. If you think $X is not sufficient, I am all ears as long as you can give me a reason other than, “I just think you should.” It is NOT in my best interest to piss you off or upset you in any way because then you are likely to yell at me. And then I go home and kick the dog. I know 47 other coffee-swilling coworkers that feel the same way (there are 3 others here who should be taken out and maimed)–and together we handle the majority of ALL total losses in Colorado. In fact, if I piss off too many of you, I won’t be handling claims for too much longer (no promotion jokes, please!).
Like Ruby says, it is unrealistic for a company to train its claim people to find ways of declining payment. My experience has been that we are directed to find a way to pay; and decline or limit payment only if doing so is fair to the customer (I’ll never pay you less than the market value of your car if it’s totaled, but I’ll also not pay you more). That said, some companies are more pleasant to deal with than others.
I do work for an insurance company and sometimes do not like my job for various reasons (such as telling someone no, that is not covered) but I also am also a policy holder with insurance companies for medical, dental, auto, renters, etc. I do understand both sides and everyones opinions.
But as to the above quote…most states are not no-fault states which mean that in addition to physical damage coverage (which is not required unless you have a lien on the vehicle) drivers are required to also carry liablity insurance on their vehicles. This means that if the driver is at fault for an accident (liable) they have the liability coverage that will pay physical damage and/or bodily injury to the not-at-fault party up to the policy limits. So the premium that a person can pay is not just related to that persons vehicle and its worth but also the amount of damage it can to (to property or persons). The premuim paid is also related to the drivers risk (traffic violations, prior accidents, age, etc…but lets not go there).
So that being said…I will give an example. Let’s pretend that “Jane” was having a really bad day and the worst of it was that she was distracted and ran red light. Jane ended up broadsiding a brand-spanking new (add your dream car here) worth (add your price here) which was in turn pushed into a telephone pole at the corner of the intersection. Did I mention that Jane was having a really bad day? And that she was also driving a bit too fast? Jane was driving a mid-level sedan and suffered just minor injuries but the other car, while a safe vehicle, was hit at such an impact on the side that it caused all occupants of the vehicle to be taken by ambulance to the hospital and totaled the vehicle. Total bummer for all involved which includes the company that owns that telephone pole because it was also damaged and needs to be replaced. Now if Jane did not carry liability insurance she would be screwed. But luckily she is insured and not only is she being taken care of (she does carry collision coverage and personal injury protection) but also the owner and occupants of the other vehicle and the owner of that telephone pole are being taken care of as well. We only hope that Jane has the property damage and bodily injury liability limits to cover everyone involved…but that story is for another day…and lets not even get into the attorneys involved…or the injured person in the other vehicle that was only injured mildly but decided to milk the situation for all its worth and get as much money possible…
And while I hate seeing my checking account drained for $130 per month for auto insurance I keep doing it because one never knows when they could have a day like Jane’s. :eek:
And don’t even get me started on the uninsured drivers out there! :mad:
Except that Jane is not going to get what she is entitled to unless she pitches a great fit, files a grievance with the insurance commissioner, and tells the company that she is calling a lawyer.
Her car should be replaced but they will offer way less than what it will cost to replace her car with a “like kind” car.
Insurance might make lots of money, but they work hard to do it.
Nearly all of them pay out in claims more than they take in from premiums. They make money from investing, cashflow, reinsurance, ect.
If they are raking you over the coals, just get the minimum liability as required by law and put the additional premium amount in the bank each month. Then, when something happens…see just how far it goes
The perception of “evil” in association with Insurance companies only ends up hurting the public that believes it. Insurance companies get sued and payout big settlements in a climate like this. Or, they pay out higher damages to settle things OUT of court. As a result, they have no choice but to raise rates.
The legal climate is driving insurance up and up and up. Perscription drugs, for example, become much more expensive if they happen to be covered by insurance. The result? Rates go up as another segement sucks money out of the insurance industry…who, by the way, is funded by customers.
I worked for an insurance company that was in the top 100 in the country. However, our executives at the time were making 1-2 million each in bonuses and salaries each year (reinsurance). I perfectly understand the bad apples and selfish bastards in the industry…but the industry itself isn’t evil. They are trying to provide a service…but they keep getting hammered and they cannot function without our money.
Willa was having a good day. She’d just gotten back from a trip to see her son, she’d just picked up her two-year-old granddaughter, Hannah, to take home with her for the weekend, and she was heading home. Life was good.
Halfway home, her PT Cruiser’s t-boned by a Dodge Caravan driven by Randy, who’s fallen asleep at the wheel at 4:30 in the afternoon and has run his stop sign. Willa’s car is pushed into the guard rail, flips over it, and rolls several times down an embankment and 50 yards into the field below.
All three are taken to the nearest hospital. Willa and Hannah are airlifted to the Trauma 1 center in the largest nearby city. Randy is eventually transferred there as well. Hannah dies because of severe head trauma, but only after several hours with a neurosurgeon. Willa remains in the hospital for five days while they perform surgery on her index finger and right wrist, which is badly broken. She ends up with lots of interesting hardware and pins sticking out from her wrist. What was a good day has turned into a nightmare.
Although Hannah’s bills have ended, her parents’ health insurance doesn’t want to pay because it was a car accident - the car insurance should pay. Sadly, Randy has insufficient insurance - he’s one of those underinsured drivers. Willa’s car insurance doesn’t want to pay - it’s Randy who caused the accident, but he doesn’t have enough insurance to cover it. Willa’s health insurance doesn’t want to pay - her car insurance should do it. Her car insurance doesn’t want to pay, because it’s a health thing. It’s going to take well over a year to get this mess sorted out. Meanwhile, Hannah’s still dead, Willa’s still having surgeries to counteract muscle breaks caused by the accident, and Randy’s got to deal with the fact that his negligence caused the death of a two-year-old, not counting the pain of both families. It’s to the point where Willa (and her insurance agent) are thinking of advising Willa’s daughter and son-in-law (Hannah’s parents) to sue Willa, just so that they can get money from the insurance company!
Willa’s my mom, and Hannah is my niece. Why do I hate insurance companies? You figure it out.
Bitterly,
Snicks
Forgot to add - both Willa and Randy have liability insurance. Willa’s doesn’t want to pay because it’s Randy’s fault, but Randy, while having liability insurance, doesn’t have enough.
I wonder why Randy’s insurance didn’t just issue a Bodily Injury settlement of $25,000 (or whatever his limit was) as soon as fault was finalized? They should have if they didn’t.
Willa’s car insurance coverages would be very specific. If she does not have PIP/Medical coverage, it is a slam dunk there is no coverage there. She ought to be able to file a claim against her own "Un(der)insured Motorist coverage if she carries that. Given that there has been a fatality, that should be a pretty quick settle as well.
The balance of medical bills would then have to come from the health insurer as all other sources have been exhausted. An attorney in this case would be a wise decision if only to clarify who has what obligations and to orchestrate the payments. It’s entirely possible, for instance, that Randy’s liability coverage and Willa’s Underinsured liability coverage could be reserved entirely for non-economic losses (pain & suffering) which would then force the health insurer to begin covering medical expenses immediately as they are incurred.
Inigo, thanks for your questions. I’ll answer them as best I can, but I don’t know all the specifics, nor do I know anything about the wrangling’s they’re going through as I’m not directly involved. I know that there’s been quite a struggle, and several meetings between my parents, my brother-in-law and sister, and insurance agents. Whether a lawyer has been consulted I don’t know, tho’ I can’t imagine that one wouldn’t have been. If it matters, my brother-in-law has a law degree, although he doesn’t practice law, so you can take from that what you will.
I’ve cooled down a little, so now I’ll try to give you the answers I know.
I don’t know what Randy’s insurance has issued, if anything. I do know that there have been discussions about how to get money from Randy/his insurance, involving going after property and assets and such, but apparently Randy doesn’t have much to go after.
Another wrinkle is that I’m not certain if fault has been finalized or not, legally. The police have obviously taken my mother’s and Randy’s statements long ago, but my brother-in-law told me last week that the researcher hasn’t finished his reconstruction yet (the accident happened in January). This reconstruction might be required for fault, and apparently it’s to be finished either this week or next. In any case, it seems to be that Randy’s coverage will still be insufficient for the medical bills incurred.
I do not know what type of insurance my parents have, other than that it’s probably the basic package you get when you get insurance for a new car, which I would assume would included PIP/Medical (I believe mine does, but I’m also in Minnesota, not Wisconsin, where my parents live and where the accident occured). (And I’m woefully undereducated about even my own insurance, which I need to rectify soon). The car was not yet paid for, so my parents would have had full coverage on it (they generally drop something [collision? You see my ignorance here] when the car is paid off). And this I do know - just because she files a claim is no guarantee that she’ll see any money.
Due to the struggles I’ve heard about, I’m fairly certain that my parents would have consulted a lawyer by now, but I cannot attest to whether they actually have done so. And my brother-in-law does have a law degree, but he does not work as a lawyer (and I believe his interest was in property law anyway, so I don’t know how exensive his knowlege in this situation might be).
Another wrinkle is the health coverage. My father is a doctor, and so, has a very high deductible on his health insurance - I know I’ve been told that my parents have it really only for catastrophic situations (of which I believe this would qualify). I doubt his deductible would be this high, however.
I only know that from what I’ve been told, it’s been next to impossible to get this resolved. This is probably due to the fact that the investigation is not yet complete, coupled with the wrangling between the insurance companies. And while it seems like it’s been forever, perhaps four months isn’t that long of a time in these dealings at all.
Thanks for your comments, Inigo, really. I’ve taken them to heart, and I mean to discuss the specifics with my mother to get more information and to review my own policies to be sure I understand my own coverage. Boy, they’re dry reading, tho’.
Snicks
I love a cup of warm java, agood property policy & a big fir log on the fire on a cold spring night. Does that make me a freak? Or has that nothing to do with my being a freak?
If you have an insurance agent make him go over your policies with you–ask the questions that have come up in this thread as they pertain to your situation. If you do not have an agent or if your agent will not provide this service for you–leave this agent/company and get an insurance agent. They are worth any extra expenses you might see in premiums…if they are willing to do their jobs.
I’m sorry about the accident. That there is a reconstruction going on makes things a bit less incriminating for the insurers–because nobody is yet 100% certain just what happened. It would be nice if health insurers could step up in thse cases to handle the medicals as they come up, but there is a definite heirarchy of coverage in auto claims, and Major Medical (health insurance) is the last in line. This is the main reason I suggested an attorney. If it can be demonstrated to the health insurer that any automobile liability Insurance will be flagged for non-economic losses, they may understand that they WILL be drawn into the claim to handle all of the medical expenses. Nobody needs nastygrams from the hospital in a time like this, especially since liability has not even been determined yet.
To add insult to sodomy, a “hospital lien” may be filed against any liability settlements to cover Hannah’s bills. An attorney will be useful in getting you the last laugh on these–the bills were incurred by someone who is now deceased, and so the debts belong to nobody–certainly not Willa. I’m not sure how these bills apply to minors, however. They may indeed belong to the parents–who also have a right to some non-economic recovery as they lost a kid.
