If it does not already appear there, add to your collection of words to live by: “Never, ever, not under any circumstances, attempt to negotiate with an insurance company on your own. Working with an insurance company, always retain a lawyer.”
According to insurance law attorneys, although the insurance business typically falls into the “financial services” category, an insurance policy actually establishes a contract between you and the insurance company. Your insurance policy is not a financial instrument so much as it is a legal document. Attorneys and civil courts manage disputes over contracts, assessing justice and equity according to how much money changes hands.
Everyday experience easily confirms the fundamentally legal nature of the insurance business: read your insurance policy, noting the language it employs, and especially noting its specification of terms and conditions. When you buy or invest in an insurance policy, you establish a simple agreement with your insurer. You will leave your money with the insurer in exchange for the insurer’s agreement to pay the costs of accidents, illnesses, and “torts”-the assorted nasty things people can do to you. As long as you continue to deliver your money in good faith, the insurer must continue to protect you according to the terms of the agreement.
Two kinds of disputes may arise between you and an insurance company: In one instance, your own insurance company denies a claim on your policy, in effect saying that your particular accident, illness, or tort was not really part of your agreement. In the other instance, another person’s insurance company wants to settle your claim in order to prevent your filing suit against the person and the company.
In the first instance, you are most likely to become embroiled in a dispute with your own health insurance provider. You request or already have received medical treatment for a serious illness or accident, and your insurance company refuses to pay for your procedure, leaving you obligated to pay a large bill. You very likely will hear “previously existing condition” or “unauthorized treatment.” A few major health insurance providers have become notorious for denying clients’ claims with these two apparently magical phrases. In this kind of dispute, the language of your insurance policy frequently becomes the core of the conflict. You need an attorney, who in turn may need to depose some expert witnesses and file suit against the insurance company. With the assistance of an experienced insurance law attorney, you have a very good chance of prevailing in the dispute.
In the second instance, the other party and his or her insurance company have calculated how much the other person’s negligence or malfeasance has cost you, and they are prepared to pay you according to their calculations. According to veteran insurance law attorneys, settlement offers usually pay strictly for medical costs and lost income; they seldom compensate you for “loss of the enjoyment of life,” nor do they provide for lingering consequences of the other person’s irresponsibility. Because your insurance law attorney probably will take your case “on a contingency,” meaning that you pay legal fees only if you win your case, you have nothing to lose and everything to gain by retaining professional counsel and letting your advocate do the calculating and talking.
