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Insurance Manuals: Getting Their Playbook

Posted on: January 5, 2023

LEGALLY REVIEWED BY:
Chi Hung Nguyen
January 5, 2023

insurance manuals

Auto insurance is one of those products a person only needs to buy for the times when something goes wrong, but it quickly becomes a necessary part of life to help recover after a serious car accident or truck accident. Getting back on the road to recovery should be easy, but many times insurance companies use tactics to delay, or even wrongfully deny, an insurance claim.

Insurance companies may try to convince an injured claimant to accept less money than the total amount the injured claimant could recover. Insurance companies try to persuade claimants that they should accept only a few cents on the dollar to save time, stress and any money that would be spent in going to court. Litigation at the trial court level can be time-consuming enough. Sometimes, there is also the possibility of an appeal, which takes the case to a higher-level court for reconsideration of the case after the current judge already decided the case. Settling for less than a case is worth is exactly what the insurance company wants.

After a car accident or truck accident, injured claimants often wonder where to begin. Once everyone at the scene of an accident is safe and time-sensitive evidence is collected, some may wonder what to do next when facing off against a big insurance company with more time and resources than the average person.

A big part of getting the answers you need is learning to ask the right questions, and understanding how insurance companies work.

These manuals, insurance claims procedures and other relevant materials can provide insight to the insurer’s ideas on how claims should be handled. It can be used to company what should have happened as opposed to what actually happened.

Ask for The Insurance Claims Manuals

Many insurance companies have their own, internal job training programs and instruction manuals to ensure that the industry standards are being upheld. In some cases, this takes the form of insurance claims manuals that provide guidance on procedures and matters ranging from giving notice of a claim to the insurance investigation. The idea behind having a standard procedure is that everyone within the company follows the same standards across the board.

Having and maintaining standards helps the insurance company uphold its duties and obligations under the law. The insurance company must try to effectuate timely and fair settlements in good faith and deal fairly with injured claimants when liability has become reasonably clear. In other words, once it is clear who is at fault, the insurance company should handle a claim quickly and fairly.

Whether the insurance company carried out its duties in good faith and dealt fairly is an objective test, meaning that it is analyzed from an impartial, outside point of view regardless of what an individual personally thinks is fair.

In State Farm Mut. Auto. Ins. Co. v. Engelke, an appellate court in Texas agreed with the decision of the lower court, finding that the insurance company needed disclose everything from other lawsuits, complaints, independent medical reports, advertisements, the claims file as well as insurance claims manuals. The court in this case agreed that this information would show how the insurance company’s employees are instructed to handle claims, how much the insurance company is required to investigate as well as the guidelines given to doctors using independent medical examiners.

The Right Time

Insurance claims need to be handled and processed carefully. An insurance claims representative cannot mislead a claimant or an insured client about the statute of limitations. The statute of limitations is a deadline created by the law to file a lawsuit for the specific basis of a lawsuit, or cause of action. The law makes rules like the statute of limitations because the law does not allow a person or company to be held liable for certain cases like car accidents and breaches of contract forever. It is for this reason that insurance company should let a policyholder know when a statute of limitations deadline is going to pass.

The insurance claims manual includes the steps its employees should take in handling a claim when they first get it. For example, because some statute of limitations deadlines are affected by the date of the insurance claim, the policyholder should be notified about a claim as soon as possible. Some manuals require notification within 24 hours.

Procedural Manual

This manual outlines the steps an insurance claim is processed step by step, from start to finish. Whether insurance companies actually follow through with each of these steps is another matter.

Insurance Policy Manual

An insurance company may also have a policy manual that shows how the insurance company interprets their own policies’ wording and meaning.

Orientation Manual, Training Manuals and Code of Professionalism

Like any other business trying to manage its employees, insurance companies have internal rules that its employees should follow. Usually, these rules discuss being fair and handling claims as professionals.

This can also include educational or training materials that the insurance company uses to teach their employees how to handle claims. These materials can cover a wide range of subjects, including:

  • property damage losses,
  • bodily injury claims,
  • arson investigations,
  • fire claims,
  • handling insurance claims coverage questions,
  • handling ambiguities,
  • waiver and estoppel,
  • interpretation of insurance coverage,
  • pollution claims,
  • wrongful termination claims, and
  • insurance fraud.

Some local offices have different materials than the corporate offices. Regardless, the relevant offices may have documents that can be used to show the insurance company acted in bad faith.

Index of Manuals and Code Cards

It may be possible to get a copy of an index of all the different manuals used at the insurance company. This is list of all of the manuals used. Code cards help understand abbreviations and the meaning of certain codes used in insurance documents.

Manager’s Manual

The manual used by the manager and others who hire new insurance claims employees can also show how the insurance company operates and its priorities.

For example, the manager’s manual may have the characteristics and qualities that the insurance company looks for in promoting insurance adjusters to supervisors or other higher positions. If the qualifications the insurance company is looking for when giving promotions are given are based on low-dollar payments, rushed closures of claims files without proper investigations, or any other negative case handling, these will provide a clear picture of the insurance company’s values and how a particular insurance company promotes inside the company.

Not every insurance claims employee has the authority to enter into a settlement agreement with an injured claimant. Instead, insurance company manuals and the insurance industry at large usually requires the insurance adjuster to seek the approval of a manger or higher-up before they can authorize a settlement agreement.

Even if an insurance company says that it has no claim manuals, it is required under insurance industry custom and practice and most state insurance laws to create and use certain standards that result in timely and fair adjustment of claims.

In Glenfed Dev. Corp. v. Superior Court, the insurance company refused to provide a copy of the claims manual, arguing that it would not provide evidence that can be used in court. The court stated “Our courts have, for years, recognized that claims manuals are admissible in coverage dispute litigation.” The court said that insurance companies are required by law to maintain guidelines. The guidelines outline how to process and report insurance claims. In conclusion, it would not make sense that a manual like this would not include relevant information about insurance policy terms that are at issue.

Some also recommend providing a copy of the insurance claims manual to any experts brought in to evaluate the case.

It is always also a good idea to ask if the claims manual, whether it be the claims representative’s manual, a procedures manual, supervisor’s manual, claims manager’s manual is current. Laws change and are updated regularly. If a particular manual used by an insurance company has not been updated in many years, it can be used to show the insurance company was not doing its job.

There are many official and unofficial documents that the insurance companies use to manage their business. If the insurance company makes a mistake, its documents will show as much. It is important to ask for everything and anything that can help support an injured claimant’s case against an insurance company.

Ensuring you have all of the information needed in your case is one of many steps experienced personal injury lawyers take in order to help their clients receive the maximum amount of compensation.

Contact an experienced personal injury lawyer 

Without experience in the insurance industry or legal experience, understanding which factors or evidence can help or hurt your case can be difficult to understand.

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 713-524-8139 (Houston) or 210-702-3000 to schedule an appointment with a member of our team.

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