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What to Know About Insurance Complaints

Posted on: November 11, 2022

LEGALLY REVIEWED BY:
Chi Hung Nguyen
November 11, 2022

Rarely do people understand the inner workings of large corporations and insurance companies. This means that it can be easy to lose your complaint to an insurance company in the shuffle. Here are some simple tips to help understand the basics about making an insurance complaints.

How are insurance companies structured?

Like many large businesses, insurance companies have many layers to their internal structure. Understanding how they work can help you stay informed about how to get copies of important documents like claims agreements. From the lowest level to the highest, insurance companies are typically made up of the following:

  • Insurance adjuster
  • Supervisor
  • Unit manager who is above multiple supervisors
  • Claims manager or claims vice president that typically is in charge of a local office
  • Regional Claims Vice President that is in charge of several local offices in a region
  • Home office claims
  • Senior Vice President, or field manager, that is in charge of several regional claims vice presidents

There are also other internal and external groups or departments that some insurance companies hire to help manage the large amount of claims. Some examples include:

  • Technical Managers who are skilled with insurance claims but chose not to have a role that involves supervising or managerial tasks
  • Large Value Claims employees that only handle high dollar cases
  • Excess Claims employees that only handle policy matters that involve an excess insurance policy
  • Outsourced help with underwriting and other third party servicing issues

Some outside companies that insurance providers use include managing general agents that are able to bind the insurer to the insurance policy contract provisions and obligations, and third-party administrators handles claims.

If your insurance claims adjuster is not responding to you, then you may be able to seek greater success with those that are higher up. The insurance company and president may take a look at a particular claim, evaluate it and then send it back down to their employees. After, those that are assigned to carry out the president or general counsel’s instructions will treat your case seriously and resolve it quickly. On the other hand, claims that start at the lower level may stay there for quite some time since this is one of several strategies that insurance companies use to save money and win cases, and escalating a claim implies that they cannot do their job even if the adjuster did do his or her job correctly or at least thinks so. Another option is consulting policyholder counsel organizations and insurance expert witnesses.

Does it matter who makes insurance complaints with the insurance company?

Yes, the insurance provider is more likely to take the claims and complaints of the policyholder, the person who bought the insurance, than an outside person like an injured claimant that is just a third party seeking some remedy for the damages he or she suffered. Duties, like the duty to investigate and pay claims promptly, are owed by the insurance provider to the insured person. Failure to carry out these duties in good faith can be grounds for an expensive bad faith lawsuit. Insurance companies may be held more responsible for failing the customer that bought their insurance than for failing an outside person who makes a claim or insurance complaints.

Create a paper trail

You may have heard the phrase: create a paper trail. This means that you document everything, so that you have proof showing your journey, process and story from start to finish. This documentation is something you should also prepare and turn over to your attorney. Documentation is important because it acts as evidence to back up what you say, and can help resolve your issues with the insurance company quicker. Examples of everything you should document include:

  • Conversations: how do you document on paper a verbal conversation? Confirm the conversations in writing after. For example, if you call your insurance adjuster and they verbally make a commitment to you or tell you that they will resolve the case by a specific time, then you can follow up with a letter or e-mail that confirms everything you discussed and agreed to during the call so that if the insurance company later tries to deny that the conversation ever happened, you have a copy of the letter and/or e-mail that confirmed everything you talked about.
  • Ask for a written response by a certain deadline: after you provide any documents or information the insurance provider needs, you should ask what the insurance provider’s policy is about the issue you are having and set a specific deadline to respond.
  • Make it clear: it is better to make your point in a couple paragraphs rather than go on and on for several pages. If you are dealing with a different professional than the first insurance company employee you spoke to, then you may want to outline a brief history of everything you had already established with the previous insurance employee so that the new point of contact can understand everything that is happened and what it is you want to happen to fix the problem.
  • Follow up: After you make a phone call or verbal complaint, follow up in writing, you should think about following up again after the agreed deadline has passed. Some laws require tracking and responding to specific deadlines, and this can help paint the picture of how the insurance company is treating you.

It is also worth noting that you should do your best to put aside negative emotions when writing or speaking with the insurance company employees – don’t come in with a threatening voice or tone. While injured claimants and policyholders that are being run around by insurance companies often feel frustrated, emotional letters and comments are more easily dismissed by insurance companies. Being professional and polite can be difficult under these circumstances.

Hire an attorney that is an experienced negotiator and able to help guide you to the resolution you are seeking.

Contact an experienced personal injury lawyer for insurance complaints

Navigating complex personal injury cases and handling insurance companies can make the recovery process even more difficult. Experienced attorneys strategically weigh the cost and benefits of each case to minimize the time and expense involved while maximizing their clients’ compensation.

Are you trying to secure your financial recovery with the help of experienced attorneys? If so, we can help.

The Pusch & Nguyen Law Firm has helped countless Texans handle their insurance disputes. Our experienced trial lawyers have gone up against some of the biggest names in the insurance industry while successfully bringing home payouts for clients. Our successful reputation speaks for itself, and with offices in both Houston and San Antonio, we are well equipped to assist Texans who are in dire need of our services. Register online for a free case evaluation or call us today at 713-528-8108 (Houston) or 210-702-3000 to schedule an appointment with a member of our team.

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