“They Can’t Do Anything But Say No”

We’ve al been in situations where we have to ask for something but at the same time, doubting whether we’ll get what we want. And the only way to justify asking is to rationalize the request by thinking that we’ll never get what we want without asking. So, we inevitably conclude that “they can’t do anything but say no”. The same thing happens when people submit claims to their insurance carrier. You have to put your claim in someone else’s hands and wait for them to decide whether you have a valid claim. Usually, it boils down to a settlement between the carrier and insured. However, there are those instances that arise when damage occurs and the insured feels that it should be covered but, it likely is not. A case in point recently arose when an insured driver hit a plastic five gallon container with his car and filed a claim alleging damage to the transmission oil cooler. Upon investigation, it was also learned that the drainage of transmission fluid, which the driver claimed never to have noticed, resulted in the complete destruction of the transmission. For those that are not aware of the location of a transmission oil cooler, it is usually located in the radiator/condenser area, in the front of the vehicle, where air can come in contact. Knowing that the plastic container would have had to enter the air opening in order to contact the cooler, the bumper and grille areas were examined for damage and none was found. In addition, the air opening was much too small to allow even a part of the container to enter and make contact with the cooler. Furthermore, none of the cooling fins or tubes that were part of the cooler were damaged by anything external to the vehicle. Needless to say, the claim was denied much to the disappointment of the insured.

The message here is if you, as the insured, know that there is element of uncertainty in your explanation, then don’t be surprised if your claim is denied. That is not to say that all claims have to have a reasonable explanation. There are times when only an expert can explain the circumstances that are not obvious to a layman. But, when the explanation is bordering on the absurd, it’s time to reconsider your claim. Remember, you can submit your claim because they can’t do anything but say no.

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I’m Not the Enemy!

Earlier this year, I was asked to investigate the cause of failure of a hot water line fitting in a commercial establishment.  As most of you know, I am an engineer who performs forensic analysis on failed products.  It so happens that the guy that installed the failed part was insured by the company that hired me.  As soon as I called him to find out what work he had done, he got very defensive saying that I was hired by the insurance company to deny the claim.  This isn’t the first time that this has happened to me.  In fact, this is more like “par for the course”.  I understand that when people submit a claim to their insurance company, they are worried about whether the claim will be covered.  And when a technical expert shows up, that scares them even more.  I have learned over the course of my forensic career to be patient with people.  Sometimes, all it takes is a little give-and-take for the insured to feel more at ease.  By that, I mean as the insured expresses their thoughts, I listen and then explain why I am involved and what I will be doing.  At other times, the insured isn’t willing to listen or just won’t cooperate.  It is in these instances that I am viewed as the “enemy” and I’m the one “out to get them”.  In reality, I am usually tasked to provide an explanation of what happened to cause the damage or injury that occurred.  Remember, insurance adjusters are not experts in everything and as a result, have to hire people with expertise in areas other than their own.  But, there are those that just don’t or refuse to understand.  I know that it can be scary to have a stranger come to your door and ask a lot of questions but, there really is a purpose to the method.  Unfortunately, there are those that will attempt to commit fraud and as a result, make it harder on everyone else who is trying to do things honestly.  As it turned out, the insured that I was dealing with appeared to have been doing work outside of the scope of his insurance policy.

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