(This information came from Mike Cerf (prairielaw forum))

The Inside Game is Not Fair & Not Just,

Chapter 6, 12/30/99

I have read with some interest the many postings regarding low speed impacts and feedback on my last musing on the Inside Game and Low Speed/Low Velocity Impacts

I wanted to take a moment to once again comment or muse, on the issue that the "Claims Game" is not about fairness, it is not about justice for you or your client, it is not about equity and it is certainly not about restoring you or your client to what he or she was prior to a loss.

Mike's Rule: It is all about one thing and one thing only
*** It's about money ***

As I reflect on many years as part of the inside game, I can recall so many tragic cases and those cases where plaintiff's left hundreds of thousands of dollars on the table, I have seen cases that were worth millions settle for pennies on the dollar and I have seen cases worth little settle for millions.

I recall as I start this musing many years ago I spent a year speaking to third year law students at the request of the dean of the law school who I got to know after settling a rather tragic burn case involving his daughter. When I looked out at all of those young faces, ready to change the world I wondered if they knew that in the injury game, they in the long run could only do one thing for their clients get them some money.  So many thought if they just presented the facts they would get paid, this is not what happens

The claims game is not a zero sum game, your gains do not equal your losses, the carriers gains exceed your clients losses in most cases greatly. It is not the function of the claims department to pay what your claim is worth or what your clients claim is worth, rather it is their function to ensure a profit for the carrier when the can.

Now I must also state, that in my opinion it is the job of the carrier to pay what a claim is worth within a range and in certain cases to just simply pay what it is worth, but in practical terms that is not the reality you will work in if you become a player in the claims game. Rather you will have to learn the game and be prepared to fight each step of the way for the dollars you seek.

Mike's Rule: You want dollars not truth, justice or equity from the claims adjuster

Rules of the Game (or at Least What Mike Thinks They Should be)

- You are entitled to be treated in a fair and ethical manner
- You are entitled to prompt payment when payment is due and to be paid in fully and fairly
- You are entitled to know why they do not want to pay you
- You are entitled to just compensation when it is due
- You are entitled not to be part of the litigation game if they owe your claim
- You are entitled to have your interests treated at least equal to that of insurance company if you are an insured
- You did not buy adversity if you are an insured
- You are entitled to prompt and courteous responses to correspondence
- You are entitled to a prompt. fair, objective and thorough investigation of your claim
- You are entitled to treatment that ensures the carrier will seek and find coverage, not to seek and find ways to avoid the coverage obligation

The bottom line is that the claims department has the power and they have the money. But inherent in this in my opinion the fact that the power must be put to use in a manner that ensures fundamental fairness to all parties. This power must be used in a manner that is consistent with what is expected by society at large, that is when a claim is owed, the insurance carrier steps forward to solve problems, not create them.

Mike's Last Rule for Today: The greatest power in the hands of the carriers is:
1. Delay: The carrier can afford to wait.
2. Compromise:  Delay leads to compromise

In summary what has occurred in the claims game is that we now see before us a financial game ruled by the law of large numbers and the book. What has occurred is the abuse of the power of the carrier, that being delay and compromise, the carrier can afford to wait, this provides power to the claims adjuster, yet as we are aware this power is greatly abused. This abuse has in our industry lead to the attitudes that prevail between the plaintiff bar and the insurance industry, one of fundamental distrust.

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Mike Cerf
Expert Witness Insurance Claims
Sherwood, Oregon
503-925-1937
mcerf@teleport.com

Truth and Justice will prevail! Promote it for all you are worth, or your worth will be nothing!

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