Avoiding Self-Inflicted Claim Wounds:

Fun as it is to blame and focus on others for our insurance claim problems, policyholders cause self made claim problems which inhibit, or even prevent, recovery on a valid claim. Here is a list of examples I see in my litigation practice, the "shouda, coulda, woulda's" which I call, "self inflicted claim wounds." This article is written to help you recognize and avoid wounding your own claim:

1. Make the Claim: This seems obvious, but there are many people out there who believe the event + coverage = the claim. This is not true, every policy I know of requires the insured to present their claim to the insurance carrier. Do it in writing.
      
2. Set up a File: I think most people lead a double organizational life. Very meticulous records at work, a mess of record keeping at home. This is a self inflicted insurance wound. Starting now, set up and keep a file for your policies, mailers, and so forth. After reviewing what you receive, place it in the file with the postmarked envelope. Make notes of any conversation with the agent or whomever on the file. If you make a claim, start another file for the claim which includes things like receipts, telephone records (make your calls from a cellular so you have a record of even local calls).
       
3. Personality Conflicts & Threats: Claims are always wounded when there are threats and personality conflicts. Adjusters know much more about claims than you, and they are in a position of control. Treat your initial contact with the adjuster as a job interview - professional and polite. Note how long they are with you; ask about "all coverages" which might apply to your claim. Gather information, give information, document it in a non-threatening manner. When you disagree or are not getting your way, send letters which start out, "please reconsider your . . ." Communicate your difficulty without threats, "We are living under difficult circumstances due to lack of . . ." If you obtain legal advice, do not threaten with it. Just say, "we really need your help, please respond in writing ASAP."
      
4. Underwork/overworking: Two extremist approaches, underworking and overworking wound claims. Underworking is the "too busy" sort who fail to respond to calls, requests for documents, and make scheduling meetings an ordeal. These often delay in presenting the claim, "Because I was too busy." Underworking creates a record of someone who doesn't give a damn, and creates opportunities for delay and even denial. Similarly, the policyholders who approach a claim as the defining moment in their life wound their claim. Overdocumentation (multiple faxes in a short time), Threats, "If you don't . . .", Videotaping interviews with contractors, etc. These actions invite obstruction from the claim adjusters (who have discretion to help) and paint a portrait of an unreasonable insured. Also, like the perfectionist we encounter in life, the overdocumenter is so focused on others' performance, that their own work, even simple responses, are not done. Overworkers have claim problems and lose cases when they go to court due to being unsympathetic.
       
5. Accident vs. Wear & Tear: Insurance covers accidents, not wear and tear. Proof of the inception of loss is often where claims go bad before the homeowner even realizes it. In the common example of a pinhole in a pipe, do not adopt the adjuster's characterization that the pipe has a "wore out, rusty pipe." Call it a pipe failure; point out that it was not a drip, drip leak over time, rather a "burst." Roof leaks are generally not covered if the roof "wears out." Get on the roof (safely) and see what happened. Did kids get up there and tear it up? Was the roof hit by a falling tree limb? Did an antenna fall over and pierce it? Was the damage caused by driving rain, wind or hail? Know how the accident happened, gather proof (pictures, piece of the pipe, etc) and put it in your file.
      
6. Inventory: Have some record of the costly personal property and make sure it is covered. Room by room video is OK if you want to revise it as things are bought, but not necessary; I recommend costly heirlooms, paintings, the Rolex, and similar items be noted in your File by description and value. If you are giving an inventory for a loss; take time, room by room. If you have camping gear never used, or no longer used, you are still entitled to the value of it, or to gift it. This right is wounded when you erupt, "I was going to throw it out, anyway."
      
7. Dumb Bird on my Shoulder: Insurance companies ideally pay money for covered claims, they do not hire and manage restoration/construction activities. This is confusing because they "suggest" contractors who offer to "work for you." Clearly, a contractor sent by the insurance carrier will not stand by you should a dispute occur between you and the insurance carrier. Also, if you are not happy with the contractor, expect to be told, (with the Karaoke echo machine on), "why did you, you, you, hire him?" The management of contracting firms is often the most problematic, beyond the scope of this paper. Be careful, check licenses & references and control the money. POA has resources in this regard, as does your state contractor board.
      
8. Seek Proper Advice: Depending on the size of the claim, the behavior of the adjuster, and the progress of your claim, you might seek legal advice. Avoid the temptation to take your Tax Accountant, co-worker, or bartender's advice as you want information from an attorney doing insurance coverage work, not a general practitioner or family lawyer, for example. POA has resources in this regard, as does your state bar association.

Good luck with your claims and avoiding self inflicted claim wounds!

Dale Washington is a POA member-attorney practicing in Southern California.

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