It is no secret that in every major city across this country the biggest buildings are invariably owned by an insurance company.
Nor is it any secret why they can afford these buildings. They operate what are essentially huge, sophisticated betting pools, taking your wager (which is essentially what a “premium” is) and hoping you’ll never be involved in a claim that they’ll be have to pay.
If they file a claim, they have an elaborate system for trying to welch on the bet, if they can get away with it, or paying as little as possible. Sometimes their conduct is illegal. “Adjusters” who work for insurers operate like detectives.
First, they will determine if the incident is covered under the policy. This is not always clear. Sit down and read a business insurance policy sometime. I’ve always been proud of the “A+” I received in contract law, but some insurance policies will almost require a code-breaking machine. That is, of course, a deliberate strategy of creating ambiguity in the event of a dispute.
Occasionally, coverage responsibility gets litigated in court.
In any event, the adjusters are usually extremely thorough when they decide to deny a claim. They keep an elaborate database, shared among all insurers, of the claims histories of tens of millions of Americans and often discriminate against people based on their claims history. They expect that juries don’t like people who make a lot of claims.
Insurance companies also unquestionably discriminate against immigrants. Our office successfully recovered a settlement on behalf of a Nigerian man whose policy was cancelled after an accident simply because he had other Nigerian friends who the company claimed were likely to commit a fraud.
If you speak with any personal injury lawyer, he or she will tell you that adjusters simply give a hard time to foreign-born accident victims.
Very often, some insurance companies assign claims made by immigrants to a special investigative team where it is made clear that the claimant is suspected of fraud, asked to give a statement under oath before a stenographer and inappropriately treated as a criminal suspect.
Insurance adjusters have numerous other methods they utilize to wear down a claimant.
They will delay settlement of a case if they know the claimant is financially strapped, hoping they will “starve out” the victim into accepting a lower settlement than is deserved.
They will pretend they believe the stories of biased witnesses who will take a hostile position against you. They will hire an “expert” witness whose opinion is bought and paid for, i.e. a “liar for hire” to say your case is weak or contrived.
They will demand receipts for goods damaged in a flood or fire, knowing full well that nobody holds on to receipts for furniture or clothing for years.
They will hire detectives to place you under surveillance if they have the slightest suspicion you may be faking disability.
They will hire physicians to examine the medical records of your entire life and minimize the impact of your claim, saying the damages resulted from an injury you received 20 years ago or had at birth.
If you are claiming against somebody else’s insurance policy, their first line of defense is to blame you. Of course, it was “all your fault.” Thankfully, the Massachusetts state legislature and the courts are fully aware that the insurance companies cannot always be counted on to do the right thing.
Massachusetts General Law Chapter 176D was enacted to require insurance companies to effectuate fair and prompt resolution of claims, and making it unlawful to force claimants to litigate unnecessarily.
Violation of this law is actionable under the Consumer Protection Act, G. L. Ch. 93A; triple damages and attorney’s fees are possible. So you can sue the insurance company for “unfair claims settlement practices.” Naturally, I have found this increases offers pretty quickly.
In the course of a claim against an insurance company, the insurance company can be required to produce documents for inspection by a claimant’s lawyer.
All of the notes and documents in the possession of the claims adjusters, the training manual used to train the adjuster, internal memorandum about your claim, supervisor’s notes, and similar documents can be requested.
Nobody on either side enjoys court cases. Unfortunately, the insurance companies often leave us no choice.
The author is a nationally prominent writer and civil litigator. He is the author of How to Win a Lawsuit Without Hiring a Lawyer and recipient of the Lawyer of the Year award from Massachusetts Lawyers Weekly. He serves as General Counsel for the National Writers Syndicate. Attorney Grossack consults with clients in Hull and Newton, Massachusetts. He can be reached by phone at 617-965-9300 or email at firstname.lastname@example.org.