Most insurance carriers, believe it or not, do not like complaints. They take the claims person away from the everyday task of working on claims or management tasks.
The following might help with general complaints
The first thing you must understand is the organization itself. Claim departments by in large are structured as follows:
3. Unit Manager, over several supervisors by line of business
4. Assistant Manager, over Unit Managers, but not in all offices
5. Claims Manager or Claims Vice President, in charge of local office
6. Regional Claims Vice President- In charge of several offices in a region
7. Home Office Claims. At the home office you have several levels:
Field Management - Senior VP in charge of regional managers
Technical Management - Vice Presidents in charge of lines of business, such as auto, general liability, property
Major Claims - Such as asbestos, lead paint, or those claims with long occurrence type exposures. They may also handle large and complex claims. (Large being over $750,000).
Excess Claims - Some Home Offices do not have an excess unit.
The contact order is upward starting at the adjuster.What moves a carrier to resolution of an issue is a focused complaint that causes people above the adjuster to get upset that they are being troubled with such a minor issue. But, keep in mind, that the higher you go the greater your chances of success in resolving your complaints.
One thing you rarely see is an effective, documented complaint
For example, very few people confirm conversations with the adjuster or who they talk to. Also, very few people cc (carbon copy) the next level. When you raise the voice of concern over claims handling, documentation is everything in dealing with an insurer. If you write to an adjuster, cc his or her next in line, and request a written response in a set time frame. Do not make the letters threatening, make them to the point and polite. Be the good guy and put the ball in their court. If you are nasty, your next contact might be from counsel, and thus, no more communication with the insurer.
Always ask them what their policy is on the issue you have raised. Make sure you ask for them to reply in writing and once again set a deadline. Ask them if they need information from you and when they need it.
Be Polite, Be Prompt, Be Persistent
Your complaints should be followed up by a phone call and ask if they received your letter. Do they need anything from you to respond, if so what? Be sure you note your time deadline. Ask them who is handling the problem and who will respond to your request? Continue to be the good guy. Provide an extension if they ask for one and as always, confirm in writing what was agreed to and ask when they will respond.
I can't stress enough how important it is to document all contact with your insurance company. They will try to handle your complaint by phone with no records, but you must make sure that everything gets documented. Keep precise phone records and note everything that was said, when, and by whom.
Suggestions for medical matters:
1. Send the adjuster a letter, attach to the letter a narrative report from the Doctor, Radiologist, etc... If the injury was missed, have the doctor point out how an injury can go for a few days without pain and notice.
2. Ask the adjuster to support in writing his or her position from a medical perspective, noting they are not a doctor. The medical basis for their reason; not their opinion, but the medical opinion and/or medical basis they rely upon to support the conclusion they have reached and ask for a copy of that opinion. Put a time limit on the request; use the Unfair Claims Practices Act as a reference, also.
3. Next step is to go right to the claims manager with a copy of your letter; you can call the office for the managerís name. But demand a response in writing.
4. Also, find out what region this office reports to. The switchboard will usually tell you. Carriers have a pecking order as pointed out above. Work your way right up the chain and ask for a response in writing at each step.
5. Ask them what their practice and policy is to resolve an issue such as you raise, who is the decision maker you must speak with, and always ask in writing.
6. Complain to the State Insurance Commissioner if you do not resolve the case in a method you find fair.
Do not allow them to respond in any format that does not address the medical issues they rely upon, be specific, what medical opinion and/or literature can they point to that with a medical certainty rules out the injury occurred as you have set out. Point to your doctorís opinion and ask them where your doctor is incorrect.
Truth and Justice will prevail! Promote it for all you are worth, or your worth will be nothing!
Please don't believe "You're in Good Hands", or that "A Good Neighbor" will deliver "A Piece Of The Rock", if you buy their Insurance!
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