Why Is It So Hard To Get Insurance To Pay My Claim?

This is a question that I hear all the time. Many clients have a simple claim, often with clear liability, but they can’t get the insurance adjustor to pay the claim. Other times, the adjustor will refuse to pay the full damages, and will only offer a portion instead.

The reason for this is actually really simple. It is money. Insurance companies have two sides to them.

The first side is the sales side, which includes their advertising, their agents, and their sales staff. This side of the company tries to make you feel safe, secure, and buy their insurance. Vague slogans about taking care of you and your family are everywhere. But the fine print in your policy may make quite a difference. The reason that it is there is to protect the second side of the company.

The second side of the insurance company is the claims department. The job of the claim’s department is simple: pay out the least amount of money required under the terms of the policy. Note that the job is NOT to pay claims fairly, pay claims on time, or protect your family. The claims department protects the insurance’s company’s profits. They will use any and every policy exclusion they can find, they will try to low-ball many claims, and will often try to get you to sign a release and accept a small payment before you know what your full damages are.

If you have a claim of any substantial value, it is important to talk to an attorney before you begin dealing with the insurance company. While attorneys cannot fix everything (such as valid exclusions that you simply didn’t know were in your policy) an attorney can make sure that your rights are enforced to the greatest extent possible and hold the insurance company to fulfillment of its contractual promises.

This is another reason to also read all of the irritating fine print in your policy. In the end, the smallest words can make the biggest difference.