STRATEGIES FOR SUCCESSFUL CLAIMS RESOLUTION

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There is more to claims handling and successful claims resolution than only knowing the rules, obtaining the policies and declarations page, etc. There are strategies for successful claims resolution, and for optimizing the overall value of the allegation, as well as resolving the matter before trial. Many lawyers know the rules; though less know strategies of how to optimize the case in every respect. Even fewer still are truly successful negotiators. They simply DO NOT teach “negotiation” in law school. Negotiation is often a skill learned from experience alone. There is no substitute. Many successful negotiators liken the process of dealing with insurance companies to playing poker. Much of the process is knowing when to hold or fold your hand, as well as when to press your bet. These are critical skills that are difficult to learn, and somewhat must be experienced first hand.

Regardless of this, there is still information to be learned from studying claims handling strategy and negotiation. The important point is that insurance companies can be beaten in a couple of ways: they can be beaten by the “cards” you possess (the “cards” that are truly in your hands), or by the “cards,Either way” the insurance company THINKS you have in yEither way,will allow you to prevail over them. Helping them beat themselves mentally, is just as good as prevailing over them any other way. As many successful sports teams will attest, “winning is winning, regardless of how it is accomplished.” The more pragmatic and practical negotiators and attorneys heartily agree with this. As such, one need not lie. However, often as much in a claim is achieved with what IS said, as with what is NOT said.

Thus, be savvy and play your cards close to the vest. Do not volunteer information (you can never retract information once its out there; you cannot “un-ring the bell”). Some things may be insinuated or hinted at, if innuendo may be of help to you. Again without being dishonest, you can simply allow things to unfold (in your dealings with the insurance company) in a way that is to your benefit as opposed to theirs. Often times an insurance adjuster may make an assumption or consider things to be a certain way, and many do not feel it their “duty” to go out of their way to help their opponents and to correct improper assumptions or mistaken facts. Try not to “shoot yourself in the foot.”

Some of the initial strategies have already been outlined to you. The initial phases of a claim should be about YOU gathering data and information to help you later. Demand everything (or as much as you can get) in writing. Some insurance carriers are ethical; but many more simply are not. Do not believe everything (or really, anything) you hear. These are basic strategies that should be followed, but there are certainly more. Sometimes, letting insurance companies know information that you have (or you know about) can be of benefit to you. For instance, simple things like information or knowledge you might possess; such as the information that you as the insured (the 1st party) happen to know about insurance “bad faith.” Perhaps also that this “breach of the covenant of good faith and fair dealing” (or “bad faith” as it is known) is contained expressly in the Uniform Commercial Code (UCC), state laws, insurance codes, and in all contracts as well, and can give rise to large punitive damage awards. Things such as this, to let them know that YOU KNOW certain strategic information which could be used against them.

Another strategy that can be used with an insurance company, is to let them know nonchalantly that you have spoken with an attorney (or two) regarding your case, but that you don’t really like lawyers and do not really want to hire one if it can be avoided. This subtly lets them know that YOU know that you have a good case; that lawyers are out there who want this case and that they are kind of “on deck,” and waiting to sign on but you have not brought them aboard yet. This can sometimes help you as well, but NOT if done as a threat; be very nonchalant. Insurance companies hate lawyers and lawyer involvement. Generally, they make the average value of claims go up several times the normal amount, and the insurance companies also know that if an attorney is involved this will likely end any access to you, including them taking statements from you [and possibly catch you admitting something or making a mistake]. The insurance company knows if they treat you poorly or make you a bad offer, they could soon be facing a lawyer.

If your insurer is unfair with you, lies to you, misleads you, or otherwise does improper things; then you can sue them not only under a contract claim for breach of contract, but also for “bad faith.” Very few plaintiffs are aware of this. You might also let slip that you know that while you may be capped at trial for the damages only of the insurance contract amount itself; the attendant bad faith claim has no such limitation. You could sue under this cause of action for punitive damages, and this can be any amount the jury deems appropriate (thousands, or if egregious enough, millions of dollars). Further, such awards are not covered by normal policies and would have to be paid from their insurance company profits, revenues and/or general operating funds. Basically, much like an “excess verdict” is paid. This is powerful knowledge; and knowledge not generally known by most plaintiffs [or even some lawyers]. This can definitely be of benefit to you, as the insurance company would have to view you as a distinct and real threat to them, if you know your rights like this.

Insurance companies hate paying “excess verdict” amounts, amounts above and beyond their policy limits. Excess verdicts are amounts that are awarded at trial, which are beyond policy limit amounts. This often occurs because insurance companies refuse to settle claims, which then proceed to trial and a large verdict is awarded. At that point, because the insurance company failed to settle the claim when they could have and let it proceed to trial; there really ARE no “policy limits” any more. Failing to pay this “excess verdict” and exposing their own insured to this judgment amount, would THEN expose the insurance company to a bad faith lawsuit and a punitive damage claim from their own insured. Just as insurance companies hate paying excess verdicts, they likewise hate bad faith verdicts — for similar reasons. Paying either must come from general operating revenue or profits from the insurance company, not from insurance policy “reserves.” Generally managers get demoted or fired for such decisions and refusals to settle. These verdicts are definitely a sore spot for insurance companies. As such, in a subtle way, letting them know at the appropriate time that YOU know about these things and how to utilize these causes of action if the need arises.

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