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Unfair Claims Practices – What You Must Know to Prevail

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Insurance Claim

Insurance Claim

While insurance companies are responsible for paying all legitimate insurance claims, unfortunately, some unscrupulous insurance companies will use unfair claims practices in an effort to lowball your claim settlement or to provoke an outright claim denial.

When unfair claims practices overtake the duties of an insurance company, consumers must become vigilant right from the beginning of the claim. Use the following insurance claim help tips to your advantage.

Providing a recorded statement



When dealing with your own insurance company, your insurance claim is known as a first-party claim. The “duties” clause of your insurance policy compels you to cooperate and to provide a recorded statement if asked. If you refuse to cooperate, it will almost always result in justified claim denial.

A third-party claim occurs when you have filed an insurance claim with an adverse, liability carrier. In this case, you are not bound to cooperate, as you have no contractual relationship with this company. Nonetheless, it should be to your advantage to cooperate fully and to comply with reasonable information requests. Unless you sense biased, unfair claims practices.

In an environment of unfair claims practices, recorded statements can be used as a means used by unscrupulous insurance companies to place faulty “red flags” in your claim, subjecting it to unfair delays, to a lower claim settlement, or as a means to enable a claim denial.

Let’s assume that you provided a statement immediately following your report of the loss. This is common practice with insurance companies requiring their adjusters to make contact within 24 hours. And this is a good thing. But in the case of an unscrupulous insurance company while this perceived customer service may seem impressive at first glance, consider how the timing could be used to your disadvantage.

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An insurance claim is the result of a loss. It is stressful and difficult. Is it not possible, that in the immediate aftermath of your loss that the details might be sketchy, or even unknown. Is it fair to pin you down, to commit you to details that you might not even know about? Is it reasonable that you might not fully understand the extent of your injuries or the precise degree of your damages?

Most states have adopted good faith insurance standards that prohibit insurance companies from demanding statements when an insured is under duress. And, in the case of reasonable insurance investigations, “conflicts” are not regarded as “red flags”, but rather as a reflection of the dynamic nature of insurance claims.

In the case of a first-party claim, while you have the obligation to fully cooperate, there could be certain situations where you could legitimately delay a recorded statement. Complications from injuries would be one example. A second example – you are in the process of seeking an attorney to represent you. In the end, however, you must comply with the request for a recorded statement or face a near-certain claim denial.

Clearly, unfair claims practices that include intentional misrepresentation of your recorded statement represent the worst of bad faith claims handling. Nonetheless, these tactics persist. Only through knowledge of the events themselves and the proper response to the event, can consumers hope to prevail in an unfair insurance dispute.

Consider these basic insurance claim help tips if you sense you might be the victim of unfair insurance practices.

  • Become an active player in the settlement of your insurance claim
  • You must maintain courteous and persistent contact with your adjuster.
  • Beware of the unexplained, “ongoing investigation”. Your adjuster is responsible for informing you of the general nature of your claim delay. Always seek to determine the exact reason for the delay. This should give you a good insight into whether the delay is reasonable or not. Even if you are unable to secure the specific reasons for the delay, always inquire what you might accomplish to expedite your claim settlement.
  • Always document all contacts with the adjuster, focusing on your willingness to cooperate and to provide any further information that could resolve the delay.
  • Recognize that in order to triumph, to achieve a fair claim settlement, you must be proactive, and you must refuse to transfer your power to the insurance company. Those who do are far more likely to suffer the negative effects of unfair claims practices.

© 2020 Sid mark

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