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10 Reasons Why Your Insurance Claim Might Be Mishandled or Denied

There are a whole host of potential reasons why a policyholder’s insurance claim could be dealt with in an unjust, irresponsible way. Some reasons are straightforward and warranted, like attempted fraud or insufficient documentation. Others are more complicated and relate to the insurance claims process and adjusters more than the merits of the case itself.

In this article, we will discuss some of the less obvious reasons why you could run into resistance, delays, and outright denials when filing your insurance claim.

Man pointing both thumbs down

1. High Claim Volume: Southern California experiences very high claim volume due to its high population density and the number of homes with property insurance. Such high claim volume places a pressure on insurance carriers to service their customers without much attention to good customer service. In turn, insurance carriers hire inexperienced employees and rush them through claims training, after which they are then overloaded with claims of their own. One of these claims could be yours.

This process creates the perfect environment for poor customer service and improper claim handling. You may have even experienced this rushed mismanagement yourself or know someone who has encountered this problem. As an insurance provider which is withholden to its responsibilities to its shareholders, this behavior is unacceptable to say the least.

2. Insufficient Adjuster Training: On average, a property claims adjuster receives one month of training before independently handling claims. This includes training on policy, construction basics and estimate writing. Senior company adjusters, having worked for the insurance industry for many years, attest that this is not enough time to become proficient in the intricacies of claims handling. This is why you, the insured, do not want an inexperienced adjuster-in-training handling your claim.

3. Pressure to Deny Claims: Overwhelmed and overworked adjusters will look to deny claims rather than pay them. A denial is faster and clears time and resources for the adjuster to handle more incoming claims. Unfortunately, this leads to many improperly denied claims throughout the insurance industry.

4. Unwillingness to Pay: Many adjusters treat the insurance carriers’ money as if it’s their own and are looking to pay as little as possible. They enjoy being the gatekeepers to the insurance carriers’ checkbook and are even incentivized to do so. Many adjusters resist making a case for increasing the value of the claim even when the claim deserves it.

In short: They are not advocates for the insured, they are advocates for the insurance carrier.

5. Bias: Believe it or not, insurance adjusters hold a significant bias. In our personal experience, we have encountered claims where the insurance carrier’s adjusters appeared to have used socioeconomic bias to justify limiting the investigative process, thus minimizing the overall value of a claim.

6. Ego: There are adjusters and managers who resist or outright refuse to acknowledge any information that’s not presented by one of the company experts. Managers sometimes develop a “my way or the highway” type of approach. In turn, their adjusters adopt the same stance. This mindset creates a situation where adjusters are not receptive to explanations as to why certain parts of a claim that they are denying should indeed be paid.

7. High Stress: Most claims adjusters handle over 50 claims at a time. A healthy claim load is 25-30 claims. Overworked adjusters are impatient and ineffective employees who just want to shut claims down as quickly as possible. This attitude results in improper and unfair claims practices.

8. Work-At-Home Environments: Working from home is fine for experienced adjusters. Unfortunately, due to the recent change in working conditions, new trainees are not required to work in the office. They no longer have the benefit of working closely with their managers and co-workers, from whom they can learn valuable skills and wisdom that comes with experience. New employees quickly develop bad habits which involve not returning calls or following up on claims in a timely fashion. Once an adjuster falls behind, it is extremely difficult for them to catch up again.

9. Low Morale: Senior insurance adjusters that come from an insurance provider background and are uniquely qualified to speak on this issue often claim that the work environments within these companies are very demanding. The employees are heavily audited and graded. In addition, there are guidelines and expectations which take a heavy toll on employees morale over time. These issues ultimately affect the way they handle claims in a negative way.

10. High Employee Turnover: Currently, there is a mass exodus of insurance staff adjusters. Many leave just months after being hired. In their wake, they leave a number of mishandled and forgotten claims. The insurance companies are forced to either transfer the extra claims to their already overworked staff or outsource the extra claim load to other independent adjuster companies. This just further complicates your claim and places undue stress on the policyholder, who is left to suffer most from poor communication and disorganization.

Final Thoughts

Now that we have pulled back the curtain a bit on the inner workings of the insurance industry and practices of insurance providers, you may be feeling a bit defeated. After all, we have painted a picture of a system designed to resist paying your claim and an industry full of those who lack the training, time and resources to handle it fairly. If the cards are stacked against you, how is the average citizen supposed to secure what is justly owed to them?

This dilemma is at the core of why public adjusters exist. Public adjusters are well-versed in insurance policies as well as all the methods insurance providers try to use in order to prevent having to pay claims. We advocate on behalf of the policyholder to make sure insurance providers pay every cent they are obligated to pay.

Avner Gat, Inc. has 17+ years of experience as a public adjuster covering Southern California. We protect homeowners from the games and fine print that insurance companies are known for.

Call us at (818) 917-5256 to find out how we can help you.

Article Written By Avner Gat and Robair Sherrod

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