LARGE LOSS INVESTIGATIONS
Make No Mistake About It
All Claims Are Investigated For Fraud And You Are A Suspect Until Proven Otherwise
The opinions in this article are based on large loss claims, where most bad faith settlement practices occur. Losses under $50,000.00 are not usually subjected to carrier bad faith, although with recent severe storm damages payouts that may change.
Click the link below to read insurance industry publications that instruct carrier adjusters how to deal with insurance claimants. Although there is some merit to their instructions, many insurance adjusters take advantage of policyholders when trying to soften them up for a quick low ball settlement. Overwhelmed policyholders usually ask the same question, “What Did I Do Wrong?” The answer is nothing; it’s just a clam handling tactic.
Insurance adjusters are instructed to question policyholders when investigating a claim. Inconsistencies with the initial transcript taken by the insurance call center operator could cause a carrier to be suspicious. Inconsistent statements made by family members, friends, or neighbors can also cause major issues. Insurance adjusters have the right to interview anyone with information about your loss, but they cannot compel non-policyholders to cooperate.
Investigators Casting Doubt On Insurance Claims
You may face a hard line of questions if the cause of your loss cannot be determined by local officials or the carriers’ forensic investigators. Artificial Intelligence (AI) Software Programs are now analyzing policyholder’s claims for acts of fraud, concealment and or material misrepresentations, including but not limited to statements, applications of insurance, public and private data, which can be problematic if a controlling, overzealous and or egotistical insurance adjuster wants to minimize your claims.
Recorded Statements vs. Written Statements
Never be bullied into an audio or video recorded statement. Your carrier can request multiple interviews. Insurance adjusters and or their forensic investigators are also entitled interviews. Your interviews will likely be recorded whether you know it or not, and in the State of New York as long as one party to the conversation is aware of the recording, (in this case the adjuster) it is perfectly legal, however, if your policy doesn’t specify that your interviews must be recorded, you may insist on making a written statement. Unfortunately, many adjusters threaten to deny claims by invoking the policy’s “failure to cooperate clause”. Don’t be fooled by this ploy. Insurance policies do not usually exclude written statements and your claim cannot be legally denied if you refuse to comply with non-existent policy language.
Ask To See The Controlling Policy Language
If your carrier’s adjuster is unable to supply you with specific verbiage in the policy’s “Property” section (NOT the “Liability” / “Casualty” section) of your insurance policy then you are entitled to give a written statement, which should include the adjusters written questions.
Written questions and answers will afford a policyholder the opportunity to challenge ambiguous questions.
Written statements also give you ample time to;
- Review the adjuster’s questions
- Challenge, clarify and correct ambiguous questions
- Take the necessary time to review and edit your answers, so that you can sign with confidence
You should also photocopy or photograph (cell phone) your statement before handing it over to anyone, because once you relinquish physical control of your document/statement your carrier can tell you that you are no longer entitled to have or hold what they now deem to be their protected work product. Also see, When A Lawyer Is Not A Lawyer.
False Promises Of Receiving A Copy Of Your Recorded Or Written Statements
If you agree to a voice or video-recorded interview, regardless of the adjusters promise a carrier will likely refuse to give you a copy. Once given, your statements are deemed the carriers’ work product. You can however obtain your statements through the discovery phase of litigation.
The same goes for written statements especially when a carrier is challenging the legitimacy of your claim.
You have the right to have a public adjuster report your claims and be present during interviews and or examinations under oath. Although a public adjuster cannot interfere with a carrier’s investigation or advise you on matters of law, they can recommend you stop an inappropriate interview and file an official complaint with the New York State Department of Financial Services for carrier violations. Placing a carrier and or its adjusters on written notice of specific violative acts usually resolves carrier bad faith acts because it creates an official business record that can be filed in a complaint with state investigators.