“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.

Would you Hire an Expert to Help you Deal With an Insurance Company?

In my last post, I talked about how people sometimes get angry when they find out that their claim is about to be denied because some engineer doesn’t see things their way.  All of a sudden, the engineer becomes a target for some nasty comments.  I also mentioned that insurance companies aren’t the only ones that could hire an engineer or any other expert for that matter.  Individual policyholders can do the same thing.  However, the reason that most don’t is because of the expense, preferring instead, to allow the insurance company to hire the expert.  I’ve thought about this quite a bit and am wondering if this is really true.  How many policyholders would actually hire an engineer (or adjuster, appraiser, etc) to determine if they have a claim and then pursue it if there is merit?  After practicing forensic engineering for over 20 years, I’ve lost count of the number of times that people have told me how cheated they have felt when their claims were denied.  Some believe that paying premiums faithfully for years entitles them to an unquestionable settlement.  Others believe that an investigation by an engineer, private investigator, or other expert amounts to an invasion of privacy and is insulting at the very least.  Regardless of a consumer’s attitude, it is in their best interest to engage the appropriate expert (if affordable).  Imagine having somebody on your side when you enter into negotiations with your insurer. Or, imagine when, there is a disagreement between you and your insurer about how your property was damaged and, you have someone to speak on your behalf.  Remember that your expert is not your “mouthpiece”. In other words, you are not hiring someone to speak for you regardless of the facts.  If you hire an engineer, the evidence must support your contentions if that person is to be able to present your case and DEFEND it.  If the facts don’t support your position, your engineer (or any other expert) is obligated to advise you.  In other words, the engineer has to make an unbiased call based on the evidence.  If the claim goes to court, the last thing you need is to have your expert’s testimony disqualified because of bias. 

So, having said all of the above, would you hire an expert to review your claim and help you deal with your insurance company?

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