Insurance companies are fundamentally for-profit entities. Their primary goal is to generate revenue and maximize profits for their shareholders. This profit-driven approach can sometimes lead to practices that prioritize the company’s financial interests over the needs of claimants seeking injury payments. When a policyholder files a claim, especially for significant injury payments, the insurance adjuster and company may scrutinize the claim intensely. This scrutiny often aims to minimize the payout, shift the blame or deny the claim altogether, thereby protecting the company’s bottom line.
Insurance companies employ a range of strategies to achieve this. They may interpret policy language narrowly, dispute the extent of injuries, or question the necessity of ongoing medical treatments. These tactics can delay the claims process and create additional stress for claimants already dealing with an injury’s aftermath.
Typical stalling tactics and warning signs
Insurance companies tactics can include:
- Requesting excessive documentation: Insurers may repeatedly ask for additional documents or information, even after the claimant has provided substantial evidence.
- Delaying communication: Slow responses to inquiries or prolonged periods of silence can frustrate claimants and delay the resolution of their claims.
- Disputing medical evidence: Insurers might challenge the validity of medical reports or request “independent medical examinations” by medical staff they hire to question the severity of injuries.
- Offering low-ball settlements: Initial settlement offers may be significantly lower than the claim’s actual value, pressuring claimants to accept less than they deserve for a quick settlement.
- Misinterpreting policy terms: Insurers may interpret policy language to favor denial or reduction of claims.
Claimants should be vigilant and seek legal advice if they encounter these issues.
Legal obligations under federal and Florida law
Insurance companies are legally obligated to honor their commitments to policyholders and injury victims despite their profit motives. Federal and Florida state laws impose strict regulations on insurance carriers to ensure they act in good faith and deal fairly with claimants. These regulations require insurance companies to:
- Process claims promptly and efficiently.
- Provide clear and accurate information about policy coverage.
- Avoid unfair claim settlement practices.
- Honor the terms of the insurance policy.
Failure to comply with these regulations can result in legal penalties and sanctions against the insurance company.
Insurance law lawyers can help
Insurance law attorneys play a crucial role in helping claimants navigate the complexities of the claims process. They can negotiate with insurance companies to ensure claimants receive fair compensation. If a claim is denied or delayed, attorneys can represent claimants in legal proceedings to challenge the insurer’s actions, collecting and presenting evidence to support the claim. They also help claimants understand their policy’s terms and protect their rights. These and other actions can provide peace of mind to clients, allowing them to focus on recovery.