There are two different scenarios where you might be involved with an insurance company (or one of its adjusters.). One is where you are the policyholder making a claim under your own policy and the other is where you are making a claim against the carrier’s policyholder. If you are dealing with your own insurance company, you are owed some level of good faith. Many states recognize a fiduciary duty between the insurance company and it’s policyholder. If you are making a claim against an insurance company’s policyholder, all bets are off. You are pretty much swimming among the sharks.
Insurance companies like to market themselves as friendly and caring. From Allstate’s “you’re in good hands”; to Nationwide’s “we’re on your side”; to StateFarm’s “like a good neighbor,” they want your trust and confidence… and, most importantly, your premium dollar! This is somewhat strange as their business model is to take as much money from you, the policyholder, and pay out as little as possible on a claim. So even if you’re dealing with your own carrier, it’s necessarily an adversarial relationship.
Insurance adjusters will tell you they want to adequately compensate you but that translates to paying you the least they can get away with. They will tell you there is no need to retain a lawyer as they will fairly and quickly settle your claim. It is now clear from court decisions in many jurisdictions, insurance adjusters, unlike attorneys, owe injury claimants no duty to handle a claim in a reasonable manner. In fact, 13 jurisdictions have developed case law where courts have found that insurance adjusters do not owe independent duties to policyholders. These include Alabama, California, Florida, Mississippi, Missouri, Nevada, New York, North Carolina, Pennsylvanian, South Carolina, Texas and Vermont.
While you and your insurance carrier are in an adversarial relationship, that does not necessarily mean the insurance company is going to be mean and nasty to you in the claims process. It just simply means you have to recognize and understand that your objectives and those of the carrier are not the same when it comes to a claim. You would prefer they pay the claim and they would prefer not to pay the claim. Because of the adversarial nature, in many states, insurance companies are granted a certain amount of latitude in how they handle and adjust an insurance claim… even if it works to the detriment of the claimant. Specifically: (1) there is no obligation for the adjuster to “assist” you in better presenting your claim, (2) the adjuster does not have any obligation to tell you about critical time deadlines or limitations related to your claim, (3) the adjuster does not have to tell you about other possible coverages you may be entitled to for your loss, and (4) the adjuster often can not give you advice or suggestions on how to best coordinate multiple coverages related to the loss. In short, because of the adversarial nature, you cannot expect the insurance company to tell you how to effectively and timely present your claim or provide you with any help along those lines.
What does this all mean? Do not try to handle your claim on your own because insurance companies have little to no obligation to act in your best interests. Always have an attorney on your side whenever possible. This applies whether you are dealing with your own insurance company or making a claim against an insurance company’s policyholder… especially if you are making a claim against an insurance company’s policyholder!
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