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Health & Fitness

Insurance: Are You Really Getting What You Paid For?

Is your insurance company honoring its part of your contract?

As an insurance professional for the last 30 years, I have seen some things that are completely unbelievable, both good and bad.

You have carried your car and home insurance with XYZ Insurance Company for the last 20 years. You suffer a hail loss to your home, which damages the home and also the other structures on your property.  You call your insurance agent to report it, who then either makes the claim for you with the company, or gives you the number you need to call so you can make the claim yourself (which is preferred, since you suffered the loss and have all the details).

An adjuster comes out and appraises (assesses) the damages.  You
receive a letter stating if you make the repairs immediately, the company will
pay the entire amount, subject to your deductible, but if you wait, after a
certain period of time they will only pay a portion. Does this seem wrong to you? 

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It is! 

It’s a way for the insurance company to force you into doing something you might not be comfortable with.  Another tactic is to “steer” you to a repair company, offering to pay 100% if you use that company, but again, only a portion if you use your own.  This is illegal, and a violation of the guidelines set forth by the Insurance Commissioner.

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Now granted, insurance fraud is rampant, and most insurance companies are aggressively fighting fraud, which costs us, as consumers, billions in added premiums to make up the difference.  However, the legitimate
claim for the legitimate insured should be handled with good faith, within a
reasonable amount of time, and in the insured’s favor.  Anything less can be perceived as poor business practice and possibly bad faith.

Be sure to read your policy when you first receive it and then again if you have a claim.  If you don’t understand it, have your agent or other insurance professional (such as myself) explain it to you.  Ultimately, during a claim, your adjuster should be explaining things to you so you understand them.  More often, the
adjuster is so overwhelmed with caseload and management, you get the Cliff
Notes version.  Additionally, the adjuster may not be well-acclimated with the policy, and adjusters speak “insurance-eze” so what makes sense to them might not make sense to you, the layman.  This is why it’s important to ask as many
questions as needed to make sure you thoroughly understand what they’re telling
you.  Indeed, it is your duty and obligation to read your policy, but if you don’t understand it, then the insurance company should by all means explain what you do not understand, since you signed your part of the agreement (policy contract).

Finally, and most importantly, an insurance policy does not (repeat…does not) supersede state laws governing insurance transactions. That’s a very important tidbit of information to remember.  Under no circumstances should you be
railroaded by your agent or your insurance company.  If you are reading a policy, and it says one thing, the company should be complying with your policy language.  Also keep in mind that if you work with a local agent, they are licensed to sell insurance, not adjust it.  Those are two totally separate licenses.  If you have a claim, your agent should be directing you to the claims office.

Some key words to remember:

Company:  The Company that actually wrote the policy (such as State Farm, Allstate) and insures you.

Agent:  The local person who actually sold you the policy (Joe Smith, etc) on behalf of the Company.

Adjuster: The person who handles your claim in the event of a loss, on behalf of the Company.

Appraiser: The person the Company assigns to come out and assess or estimate your damages.

All of the above are licensed and governed by the Insurance Commissioner to conduct their business professionally, and with the proper education and licensing.

For further information regarding laws governing insurance transactions, contact the Georgia Office of the Insurance Commissioner at 404-656-2070, or visit their website at www.gainsurance.org.

Marguerite Girard is a 30-year veteran in the insurance industry.  She
wrote regulation for claims handling procedures for self-insurers.  She was awarded the Georgia Governor’s Commendation Medal for her work and was also awarded Investigator of the Year in 2006 and again in 2009. For more information about Ms. Girard, click on her name, and then “see more”.

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