How do Insurance Companies Evaluate Claims?

Since 1995, there has been a major shift in the insurance landscape which we have all seen in the industry's uniform response to every kind of claim from car accident claims to earthquakes in California to hurricanes in New Orleans. To understand the implications of the casualty insurance industry's common denial of claims one must first know and understand the fiduciary duty of each insurance company to place its policyholder's interests FIRST and FOREMOST.

The Fiduciary-Indemnity Principle is the Ultimate Standard of Bad Faith

Campbell v. State Farm Mutual Insurance Company, 98 P.3d 409 (Utah 2004):
"Insureds buy financial protection and peace of mind against fortuitous losses. They pay the requisite premiums and put their faith and trust in their insurers to pay policy benefits promptly and fairly when the insured event occurs. Good faith and fair dealing is their expectation. It is the very essence of the insurer-insured relationship."

"In some instances, however, insurance companies refuse to pay the promised benefits when the underwritten harm occurs. When an insurer decides to delay or deny paying benefits, the policyholder can suffer injury not only to his economic well-being but to his emotional and physical health as well. Moreover, the holder of a policy with low monetary limits may see his whole claim virtually wiped out by expenses if the insurance company compels him to resort to court action."

Bad faith occurs when the insurer fails to promptly and fairly pay

• Promptly pay less than full/fair compensation, or
• Fairly pay only after unnecessary delay or forced litigation

The Benefits of the Bargain

Farris v. United States Fidelity & Guarantee Company, 587 P.2d 1015 (1978):
"That insurers sell their products as being not only an agreement to indemnify the insured for certain kinds of loss but also to relieve the purchaser from anxiety concerning all aspects of claims is readily apparent in our society. One cannot watch television for very long without being exposed to commercials for the sale of insurance, which, for example, indicate that the purchaser will be in 'good hands' that he will have the assistance of a troop of mounted cavalry, that he will have 'a piece of the rock,' or that 'like a good neighbor' the insurer will be there. As such advertisements reflect, the relationship between insured and insured does not merely concern indemnity for monetary loss."

"If an insurer were free of such special duties and could deny or delay payment of clearly owed debts with impunity, the insured would be deprived of the precise benefit the contract was designed to secure (i.e., piece of mind) and would suffer the precise harm the contract was designed to prevent."

The "Colossus" Software Program

Simply put, Colossus is a mortal enemy of the injury victim. Colossus is a claim evaluation software program currently used by at least 12 of the largest automobile insurance companies writing policies in the United States. The program itself is designed to evaluate bodily injury claims and place a value on one's life. Whistle-blower claims adjusters from several of the insurers that utilize Colossus testify that the software program is designed to lower claim payouts and increase company profits. It sounds rather jaded, as these insurance companies have essentially placed Colossus in a claim evaluation position traditionally left to seasoned claims adjusters.

Insurance companies that utilize the Colossus software program are notorious for the 'low-ball' offer. While the program may control costs and please insurance company shareholders, it does so at the expense of those actually injured and in need of real financial help. Use of Colossus is currently the basis of a class-action lawsuit filed against Allstate Insurance. Other insurance companies that allegedly use Colossus are Farmers, CNA, American Family Mutual Insurance, The Hartford, Met Auto and Life, USAA, and Travelers Property & Casualty.

Our injury lawyers are skilled at beating Colossus, so don't allow yourself to be victimized twice!

Common Unfair Tactics Used by the Insurance Claims Adjuster

Tactic: "You have until next Thursday to accept this offer or else it is withdrawn forever"
Response: Nonsense.  The only thing that would forever bar or extinguish a personal injury claim in Missouri is the applicable statute of limitation. An adjuster will use this strategy to pigeonhole the claimant into accepting the 'initial lowball' offer before he or she has time to even think about its fairness or consult with an attorney. Unfortunately, many claimants fall victim to this ploy and sign a Release with the insurance company which actually extinguishes any future right to compensation in exchange for a minimal settlement. 

Tactic: "If you retain an injury attorney we are not going to increase our offer, and in fact we may deny the claim all together"
Response: Can you imagine if the police threatened a person charged with a crime when he/she asked to speak to a lawyer? It would be unconstitutional, plain and simple. This tactic is misleading and is the exact opposite of what ends up happening. Attorneys at my firm are skilled at dealing with insurance companies and typically obtain triple, quadruple, or more, than the adjuster initially offered the injury victim. The reasons for this are numerous. My motto is 'don't be victimized twice' and call our firm for a free consultation.

Tactic: "The car was barely damaged, there is no way you could have been hurt"
Response: This is another unfair strategy used by the insurance industry to undervalue claims. How would an adjuster really know how bad you are hurting? Moreover, is the adjuster a doctor? I can tell you first-hand from taking countless doctor depositions that the trauma caused to the human body can be just as severe when there is minimal property damage. We have represented clients that were involved in 10-mph 'fender-benders' and thereafter ended up requiring back surgery several months later as a direct result of the crash. Don't let the adjuster convince you he's a doctor.  Call my local attorney hotline at (314) 448-0934 for a free consultation.

Contact a St. Louis personal injury lawyer at our firm 24 hours a day for a FREE CONSULTATION at (866) 840-3636 or complete our online case contact form.