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Insurance Law Blog

Monday, October 16, 2017

RULE NUMBER THREE: When You File a Claim, You Initiate an ADVERSARIAL Process

In my first two posts, I explained that the two most important things I could ever tell any lawyer (or client) are Rule Number One and Rule Number Two.  And those first two rules remain paramount.  But the third most important thing I could communicate, is Rule Number Three: When You File a Claim, You Initiate an Adversarial Process. 

You will say, “Everybody knows that.”  Maybe, but few people understand just how adversarial the process may be.  Over the past 25 years, many of my clients failed to see that behind the friendly smiles lurked Rule Number One and Rule Number Two.  They learned too late that the insurance company was not their friend.  They were surprised how their policy language could be used to deny, diminish, or delay coverage.  They had been duped by the sympathetic smiles and warm assurances.

Does this mean that insurance companies don’t always play fair?  Will they sometimes try to trick their Insureds?  What about the fact the Insured had been with the company for 30 years?  The answers in order are: yes, yes, and so what?  Let me illustrate. 

My own home was damaged in the 2003 Cedar Fire.  Upon arrival the adjuster literally put his arm around my shoulders and assured me they would take good care of me.  A few weeks later the same adjuster brought a “contractor” to meet with my contractor about the scope of repairs.  The gentleman arrived in full contractor regalia, driving a contractor pickup, wearing contractor jeans and boots, and sporting a contractor-size measuring tape. His demeanor was of the rugged career contractor. Yet during the inspection he seemed ignorant of certain basic repair procedures.  The following  day I called the adjuster to get the contractor’s license information.  Faltering considerably at first, the adjuster finally admitted that the gentleman was not a contractor at all, but rather just a fellow claims adjuster--from Idaho--with whom he “sometimes consults on cases like this.” Had I not known to inquire about this guy's credentials, I'd never have known that he was not a real contractor.  I'd have been duped by the adjuster into believing he was a contractor on whose authority the adjuster could reasonably have relied to oppose my contractor's scope of repairs. 

Such landmines are more commonplace than you might think.  Claims adjusters pretend they don’t see the Insured’s risk of liability. Investigators falsify inspection reports. Coverage lawyers dismiss inconvenient legal precedents and somehow miss evidence of covered injury, loss, or liability. 

The remainder of this series will reveal dozens of these landmines and tips on how to detect and counter them.  Meanwhile, always remember, no matter what the issue may be, no matter how complicated or fraught with doubt the decision may be, see Rule Number One.





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