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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 seems to be changing. 

When finished reading this article, 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.

 

Interrogation

Insurance adjusters are instructed to question policyholders when investigating a claim. An inconsistency with the initial report taken by the insurance call center operator could cause the in-house or field adjusters to be come suspicious. Inconsistent statements made by family members, friends or neighbors can also cause major issues.  Insurance adjusters have the right to interview anyone with knowledge of how your loss occurred, however, the adjuster 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, to include their statements, which can be a problem if the policyholder is subjected to a controlling, overzealous and or egotistical insurance adjuster attempting to stem the flow of your insurance payout using a tactic of flagging your claim for any reason at all.   

Recorded Statements vs. Written Statements

Never be bullied into an audio or video recorded statement.  Your carrier can request multiple interviews besides the one you elect to make to a carriers’ claim center operator.  Insurance adjusters and or their forensic investigator are also entitled interviews. Your interviews will likely be recorded whether you know it or not, and in the State of New York a 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 dosn’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 extant policy language.

“Supply Me With” The Applicable Policy Language In The Property Section Of My Insurance Policy

If your carrier’s adjuster is unable to supply you with specific verbiage in  the “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 an adjuster’s ambiguous language in favor of the more specific subject matter “being sought” by your carrier. 

Written statements also give you ample time to;

  1. Review the adjuster’s questions
  2. Challenge, clarify and make them correct their ambiguous questions
  3. 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 will tell you that you are no longer entitled to have or hold what they 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, your carrier will ultimately inform you that you are not entitled to a copy of it regardless their adjuster promised you.  Once given, your statements are deemed to be a carrier’s work product. Usually, the only recourse to obtain your statements is through the discovery phase of litigation. 

The same goes for written statements you hand over to your carrier. Very few adjusters if any, would jeopardize their employment once they have the document in their control, especially if the legitimacy of your claims are being challenged by your carrier.

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. Usually, placing a carrier and or its adjusters on written notice of specific violative acts resolves most problems because it creates an official business record that can be filed with state investigators pursuant to a consumer service bureau complaint. 

 

 

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