Good Faith Claims Handling

Seek Now (fka Ladder Now) is a third-party vendor to insurance companies. It has non-licensed inspectors do work that historically was accomplished by company or independent adjusters. Here is a memo from a Seek Now manager to his field inspection team:Continue Reading The Outcome Oriented Claims Culture Is Pervasive and Killing Any Good Will Towards the Insurance Industry

Are you a policyholder, insurance restoration contractor, or public adjuster dealing with a roofing claim adjustment involving roofing shingles with State Farm? Have you asked the State Farm adjuster for the process explaining how the adjuster is handling the claim? Why wouldn’t State Farm provide and publish the honest methods it uses to adjust these claims with its customers if you asked for them? Continue Reading Are Your Roof Claims Being Properly Handled by State Farm in Good Faith? The State Farm Shingle Locator Service (aka RLS)

Do you remember the post, Church Mutual Found To Be Systematically Underpaying Claims By a Federal Judge and Engle Martin Grossly Underestimated the Loss? Guess who was found guilty of engaging in unfair insurance claims practices last week? Church Mutual.1 Why would any church subject its parishioners to such unholy claim delays, denial, and underpayment?Continue Reading Church Mutual Is Not So Holy When It Comes to Good Faith Claims Practices

Do insurance companies support training for their claims adjusters and managers to promote good faith and ethical claims handling? Barry Zalma recently stated in his September 1st insurance industry newsletter, Zalma’s Insurance Fraud Letter, the following:Continue Reading Insurance Fraud By Insurers—Do Insurance Companies Live, Teach, and Promote a Culture of Ethical Good Faith?

The American Policyholders Association Board of Advisors meeting resulted in me writing two blogs today. While Doug Quinn was explaining a program providing whistleblowers an avenue to report illegal claims activity, which I noted in Are You an Employee in the Insurance Industry Who Is Upset About Unethical and Illegal Claims Activity?, the information about Citizens Property Insurance claims adjusters systemically backdating letters for about two months caught my attention.Continue Reading Citizens Property Insurance Employees and Vendors Should Read this Blog Because of Systemic Wrongful Claims Handling

The property insurance claims industry is increasingly turning to independent adjusters rather than company adjusters. The number of independent adjusters calling, texting, and literally confessing to me about unethical conduct has exploded over the last few years. My thought is that insurance companies are hiring independent adjustment firms and then placing financial pressure on those entities to reduce claims severity. Insurers trying to make their financial claims goals will simply hire a competitor of the independent adjusting firm if those numbers are not met. Those independent adjustment companies, in turn, have their claims managers place more emphasis upon closing claims for less than what is owed—damn regulatory ethics requirements and good faith treatment.
Continue Reading Do Independent Property Claims Adjusters Need More Legal Protection From Unethical Managers

How often do insurance companies shop for a new opinion looking for a way to deny coverage of a large loss? This was the situation in a recent trial which resulted in the insurer being liable for $44 million. The facts summarizing the “shopping” for a new expert opinion regarding a boiler and machinery loss were outlined by the court:
Continue Reading A $44 Million Verdict After Wrongful Denial of a Boiler and Machinery Claim—Yet No Bad Faith?

Merlin Law Group attorney Drew Houghton brought an article, Discovery of Insurer Employee Incentive Plans: Rewarding Employees For Paying Insurance Claimants Less, to my attention. It was written by longtime colleagues Mike Abourezk and Marialee Neighbours. Their article is important and raises one of the fundamental ethical questions of claims management: The role of the claims professional regarding company profit. While insurance companies need to be profitable in the long run, I have yet to see a claims goal that rewards claims managers for making certain that the customer has not had benefits missed and not paid after a loss.
Continue Reading Thoughts On Claims Incentive Goals—Where Is the Goal To Not Overlook All Damages?