Nowadays, more and more people who go to sleep at night believing they are protected by their home or business insurance policies are waking up to reality. Insurance companies have become experts at the ridiculous. Denial letters are issued by the truckload based upon any and every conceivable loophole which they perceive exists and quite often based upon nothing more than a misunderstanding of their own policy. The most disheartening are those denials based upon the paranoia of the claim representative, and the most disturbing are those based upon the spite of a power hungry rep.
Lets start with those involving the claim rep actually not understanding the policy. When approaching an insurance claim, it is important to keep in mind that the mid-level claim representative is not an expert in insurance. They train in finding ways to deny claims but fail to understand the actual text of the policies. It is that failure which can provide the most valuable ammunition.
One example is a case where a protective safeguard provision set forth that a certain type of fire suppression system. Lets call it "Brand X Hood and Duct System". There was a fire at the restaurant and the insurance company denied, stating that the insured's fire suppression system was not functioning properly. At the deposition of the insurance rep following the filing of the lawsuit, the rep was asked what that provision of the policy meant...In reality, Brand X did not make a product called a Hood and Duct System. The insurance company meant to require a fire suppression system but didn't and just assumed no one would notice. The attorney for the claim rep couldn't say what it meant...and their attorney objected stating that the claim rep, who denied the claim, was not a lawyer or expert and couldn't answer the question.
Interesting. Especially considering the average person is supposed to understand the policy itself. So from the outset of your claim, think three steps ahead of them and prepare for a battle of wits.
Scott E. Agulnick