02/14/2000
I have read recently and in the past comments on dealing
with hard line self insured companies such as Wall Mart.
As I think back on managing such accounts as a claims manager, keeping mind many carriers
do this, i.e.. act as third party claims administrators. I have also had recent
involvement in a bad faith case as the plaintiff expert in a suit against a self insured
company
My musing starts with one my opinion as an expert witness and I stated this in the case I
was the expert for the plaintiff : A self insured company must be treated the same as an
insurance company with respect to their duties and obligations
In the case that I worked on there was a verdict over and above the offer of the self
insured company. The law in that state (Montana) was clear a self insured company is an
insurance company or treated by one under the Unfair Claims Practices Act of Montana. Now
I may be off on the law to a degree , since I did not dig the case out of storage.
My opinion in this case was that the company failed to comply with accepted claims
practices in the administration, investigation, evaluation and offers on the claim, much
like the comments on Wall Mart they simply would not make a reasonable and fair offer on
the case. In my job as an expert, it was clear to me that this company tried to hide behind
the shield, that they were just a company, but they were not, they had their own claims
department, claims manager and claims adjusters, one problem is that they were largely
controlled by the legal department.
The cases that I see comment on should be treated just like you were dealing with a
carrier, take them to task, file a bad faith suit against them, get to know the insurance
codes the unfair claims practices act, most acts define them as subject to that act,
complain to the insurance commissioner.
Tell them in your correspondence that they must comply with the unfair claims practices
act and point out what their duty is in regards to the act as well as general legal issues
that have been found to be bad faith in your state.
Bottom line do not let them hide behind the shield they are not an insurance company, they
are and should have the same duties and obligations
Mike Cerf
Expert Witness Insurance Claims
Sherwood, Oregon
503-925-1937
mcerf@teleport.com
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