Sunday, March 28, 2010

What If My Insurance Company Doesn't Want To Pay My Claim?

You've had the same insurance company for years and you've never had a problem. Fortunately, you've also never had a claim. Now, you need help with a car accident or a hail storm or something else that should be covered under your insurance policy but you're being told you don't have any coverage and you're on your own for the damages. "What, no coverage!?! After paying for insurance all these years?!?" It can (and does) happen, but there might be some things you can do to get things paid for anyway. Here are a few tips in case your insurance company does not want to pay your claim:

1. Contact Your Local Agent. You personal agent represents the insurance company, but they work for you! The insurance company may write the paycheck, but the clients are where the pay comes from. No income, so call your local agent and get some personal help. Although an agent cannot change the company's rules, they often know the best way to get claims paid with the company they represent. They also have a relationship with the claims representatives that you don't have, and they can go to bat for you on why your claim should be paid.

2. Ask To See Your Policy. All insurance policies list what is - and what is not - covered under the policy. Sometimes a claims representative may read the policy one way, which you may be able to interpret differently. At the very least, if you look at the specific portion of your policy that the insurance company is using to deny your claim you may be able to find another way to present things to help get them paid for.

3. Talk To The Claims Manager. No one likes it when you ask to speak to their manager; claims representatives are no different. Sometimes just asking to speak to a claims manager will get an uncooperative claims representative to be more fair about things. If it does not, be ready to plead your case in a calm and professional way to the claims manager. The manager can often make adjustments or exceptions on a claim that allows you to get your damages taken care of.

4. Have Your Claim Taken To Claims Committee. If all else fails, ask that your claim be taken to the claims committee. Although this typically takes a week or two, it can often lead to claims being paid that have previously denied. A claims committee is typically made up of 4-5 people in different positions that may see a claim differently than the original claims representative. The committee will vote on your specific claim, similar to the way a jury votes in a trial. If the commitee finds in your favor then your claim will be paid regardless of what has previously happened.

What You Should NOT Do When Trying To Get Your Claim Paid. Although it can be difficult after hearing that your claim is not going to be paid, it is important to try and remain calm. Yelling or swearing at your claims rep usually does not get you anything but hung up on. Claims reps are people too, and they don't want to be screamed at any more than you do. Threatening to leave the company will usually do little to help your cause either. While the insurance company wants to keep you as a client, it is typically not factored into the decision on whether your claim is going to be covered. Threatening to sue is also not effective. Insurance companies have attorneys on staff that get paid to review claims for possible lawsuits, and handle any issues that may come up.

Your best bet when dealing with an insurance company that does not want to pay your claim is to get help from your local agent and have all of your facts and figures straight in case you need to dispute an insurance company's decision. Although it does not always feel like it, your insurance company really is on your side and wants to resolve things for you as quickly as possible. Remember, the company you're dealing with may be a corporate giant, but the claims rep you are talking to is just another person like you. Being nice can go a long way.


Anonymous said...


Robert Edgin said...

Unfortunately, most personal auto policies only consider vehicles with a GVW of under 10,000 to be "personal" and therefore covered as an extension of the coverage on your policy. The rental company probably did a good job of having you sign the waiver of coverage, but a poor job of explaining the lack of coverage under your personal policy. They may not know that coverage does not extend based on the weight, although it seems like they should since truck rental is their full time job. However, I do not believe they are required to tell you anything more than what the releases you signed entail.