Article
What
If The Company Won’t Pay?
Some Lower-premium Insurance Companies Don’t Pay
Claims
Kiplingers Personal Finance Magazine,
June 1999
by Kimberly Lankford
Saving a few dollars in premiums can backfire if your insurance company
stonewalls you on claims.
When the firetrucks arrived, Howard Green of Valparaiso, Ind., was standing
atop his house with a garden hose, trying to keep the roof from igniting. He had
accidentally set the chimney on fire while trying to remove a beehive, and the
flames had already spread into a bedroom and throughout the second floor.
The next day, Green says, his State Farm agent delivered a $5,000 check.
Green and his wife, Rosemary, bought respirator masks and began to inventory the
debris, which amounted to 40 bags of "smelly, smoke-laden stuff that’s ruined"
and burnt mattresses.
Seven months after the September 1997 fire, the 40 bags were still in the
couple’s garage and Green was still sleeping in his dining room. Green says that
State Farm had paid $75,000 for structural damage but still hadn’t paid their
$70,000 claim to replace the destroyed possessions.
For the first six of those months, Green says State Farm didn’t even make
them an offer. Then a company adjuster, who disagreed with the way Green’s
adjuster had prepared the inventory, grilled them for more than two hours on the
value of their damaged clothing and possessions. Next, in a very unusual
development, a State Farm attorney required the Greens to defend (under oath)
their claims on the value of nearly every shirt, suit and pair of shoes during a
six-hour deposition. "They even asked me for a receipt for a $40 Buck knife and
a $5 jock strap," Green recalls. Fortunately, in many cases the Greens still had
the receipts (although not for the jock strap).
State Farm is entitled to request documentation to protect itself from fraud.
But Green says he found it strange that the company waited half a year to
examine the bags in his garage. "In my opinion, there’s an attempt to beat down
the insured," he says.
A few weeks after the deposition, State Farm still hadn’t paid the bulk of
the claim. The Greens’ attorney, Tim Kelly, wrote a letter to the company: "If
this claim is not completely resolved by August 31, you will leave me with no
option but to file suit." About a week before the deadline--11 months after the
fire--State Farm sent a $48,000 check. Another check arrived a few weeks later,
bringing the total reimbursement close to their $70,000 claim.
State Farm would not comment on the specifics of the Greens’ case. "State
Farm prides itself on personal service in accordance with policy contracts,"
says spokesman Edward Domansky. "We only regret that the contents portion of the
claim took longer than either State Farm or our policyholder would have
liked."
How do you avoid a prolonged battle with a foot-dragging insurer? By all
means, try to sidestep such companies in the first place. But that strategy is
not foolproof. State Farm, in fact, has one of the better records.
To measure how claims-friendly or claims-hostile policyholders find the
leading auto and homeowners insurers, we gathered consumer-complaint statistics
from 20 state insurance regulators and data from the insurance-rating firm A.M.
Best. We also grilled lawyers, independent adjusters, agents, regulators and
policyholders for tips on ensuring that you get the coverage you’ve paid
for.
THE SQUEEZE ON CLAIMS
"They owed me $70,000 on my contents for 11 months," says Green, who had been
a State Farm policyholder for 30 years. "Did they earn interest on the money?
How about the millions of other people they stall? They make a fortune."
There’s no denying that insurance companies make a lot of money. In 1997 the
State Farm Group of companies collected $30 billion in auto- and
homeowners-insurance premiums and earned net income of more than $3.8 billion.
Allstate Insurance Group collected $17 billion and netted more than $3
billion.
The industry as a whole is rewarding shareholders with higher returns, but in
many cases it’s because they’re paying out less on claims. "It’s been my
experience that when a company’s profits zoom up, usually the claims payments
zoom down," says Clinton Miller, who has testified in about 400 bad-faith cases
and is the author of How Insurance Companies Settle Cases, a textbook for
plaintiffs’ lawyers. "If you’re a stockholder of an insurance company that’s
making phenomenal profits, you may want to buy your insurance from another
company."
A 1998 Legg Mason report on Allstate, for example, shows how profitable it
can be to put the squeeze on claims, which typically account for three-fourths
of an insurance company’s expenses. If Allstate could cut its loss ratio (the
amount paid out in auto and homeowners claims as a percentage of premiums) by
just one percentage point, the report says, it would save $186 million and add
28 cents to its after-tax earnings per share. Between 1995 and 1997, Allstate
did in fact manage to cut its loss ratio from 78% to 72%. (Legg Mason’s ratios
differ from the ones in the table on page 74 because the company includes
amounts paid to adjusters and lawyers.)
The story is the same for most large insurers (see the table). Within the
same two years, according to A.M. Best figures, many of the companies cut their
homeowners loss ratios by ten percentage points or more, partly because 1997 saw
few catastrophes. But even When you discount catastrophic costs, loss ratios
still declined. The only exception is American Family Mutual, which saw its loss
ratio rise from 68% in 1995 to 74% in 1997.
The differences are smaller for auto insurers, but the trend is still down.
State Farm made the most progress, cutting its loss ratio by more than eight
percentage points over two years. Among large companies, only Nationwide and
USAA have seen their auto loss ratios rise modestly.
ARE CUSTOMERS HAPPY?
A low loss ratio doesn’t necessarily mean that a company is shortchanging its
policyholders--sometimes it’s low because a company’s premiums are high or
because it attracts policyholders who rarely submit claims. Mild weather, safer
cars and stricter drunk-driving laws have lowered the numbers industrywide. So
it’s also useful to look for more tangible evidence of customer
dissatisfaction.
To get a more complete picture of how satisfied policyholders are when they
have claims, we collected complaint statistics from 20 state insurance
departments. Because we included the most populous states, our sample represents
about 60% of the total premiums paid to the nine largest auto and homeowners
insurers in 1997. (Few states had 1998 figures available when we conducted the
survey.)
Though figures vary widely because states have different methods of
categorizing complaints, some 50% to 75% of the states’ auto- and
homeowners-insurance complaints were related to claims. The companies with the
highest number of complaints in proportion to the total dollar amount of
premiums collected tended to be small or regional companies.
Among the nation’s largest insurers, Prudential Property and Casualty had the
worst homeowners-insurance complaint ratio: Its rate of 115 complaints per $100
million in premiums was more than double the average complaint ratio. Farmers
Insurance Group had the second-worst complaint ratio, with 73 complaints per
$100 million in premiums.
USAA was clearly the least-complained-about insurer on the homeowners side,
with only 16 complaints per $100 million--reinforcing USAA’s long-standing
reputation for high-quality service. But with few exceptions, USAA sells
policies only to people in the military and their dependents.
Among auto insurers, American Family had the highest complaint ratio (54 per
$100 million) and Liberty Mutual fared best, with 20 complaints per $100
million.
BEYOND COMPLAINTS
Complaints lodged with state insurance regulators are the best measure
available of customer satisfaction, but they capture only a segment of those who
are unhappy. Some customers complain only to their agent or insurer, or quietly
change insurers if they’re dissatisfied. Others go straight to a lawyer with
disputes, without first contacting their state’s insurance department.
Some of the highest-profile lawsuits have been brought against State Farm and
Allstate--not surprising, given that together they own a third of the homeowners
and auto markets. Both, in fact, have better-than-average homeowners complaint
ratios with state insurance regulators. (State Farm’s auto complaint ratios are
also better than average.) But a good record is little consolation if you’re the
one who must do battle with an industry giant.
In one class-action case, Allstate settled with victims of the January 1994
Northridge, Cal., earthquake, who had charged that their claims were low-balled
by engineers the company hired to assess the damage. Allstate agreed to reopen
the claims of about 10,000 policyholders, reinspect many homes and pay 100% of
any additional repair costs.
Although he did not participate in that suit, Bilgai Diaz was one of many
Northridge earthquake victims who says he had difficulty getting Allstate to
settle claims. In the six months after the quake, Diaz says, Allstate assigned
four different adjusters to his case. The next-to-last adjuster said the house
needed to be razed and rebuilt.
The company "had been offering me no more than $530,000" to rebuild the
house, says Diaz, yet his contractor said it would cost $870,000 (on top of
$200,000 Allstate had already paid to cover salvaging the foundation and
emergency repairs). Diaz took his case to a neutral appraisal board, which
recommended an award of $805,000. Diaz thought he’d be paid in 60 days so he
could start rebuilding.
Allstate spokesman Peter Debreceny says the company hasn’t paid Diaz because
"the Diazes haven’t started to construct anything." Debreceny also says the
company has offered Diaz an additional $750,000 to rebuild; Diaz says he’s never
heard that figure.
Diaz sued Allstate for breach of contract and bad faith in 1996. Five years
after the earthquake, the suit still has not gone to trial and Diaz’s house
remains uninhabitable. "My whole neighborhood is brand-new except for my
eyesore," he says. To add salt to the wound, the city of Los Angeles recently
notified Diaz that he must board up the house because the city considers it
abandoned.
AVOIDING PROBLEM COMPANIES
"Companies can look at claims as either an area in which to save money or an
opportunity to provide superior service to gain loyalty in the future," says
Charles Brown, an independent agent in Kennett, Mo. "It might be worth an extra
$5 or $50 in premiums each year to go with a company that makes it its business
to pay the claim and make it as easy as possible."
That’s good advice, but how do you find such companies? Our table below is a
good place to start. It shows the companies that fared best and worst in our
20-state complaint survey as well as the latest available loss ratios. But
sometimes problems are local or regional, so it can pay to do a little scouting
on your own.
As you shop, ask independent agents--who can represent several
insurers--which companies are known for hassle-free claims. If they’re unhappy
with a company, independents can send their clients elsewhere. "We’ve pulled
whole books of business from companies because we didn’t like the way they
handled claims," says Ann Martin-Grimm, an independent agent in Lewiston, Idaho.
To find out which companies generate the most customer complaints in your
state, ask your state insurance department for a list of complaint ratios for
all the insurers licensed in the state. (To find the insurance regulator in your
state, check www.naic.org.) The ratio itself isn’t as meaningful as how it
compares with others, so look at the entire list to determine where your current
or prospective insurer ranks. You can also ask whether the department has taken
any enforcement actions against an insurer. And you can read up on recent
lawsuits in the Insurance News Network’s lawsuit library (www.insure.com).
Once you purchase a policy, you can take further steps to protect yourself if
you have a claim. First, read your policy to be sure you know what’s covered. If
anything is unclear, ask your agent for an answer in writing.
Second, inventory your possessions and keep receipts. "The easiest way to do
that is to go through the house with a video camera," recommends Charles Brown.
"Open closets, open cabinets, open drawers and describe the items, where you
bought them and how much they cost." Then store the video outside your house
(your office might be a good spot). In case you need to document an auto claim,
keep a disposable camera in your car, recommends Mike Smerkanich, an insurance
agent with Cima companies in Alexandria, Va.
WHEN YOU HAVE A CLAIM
Ivan Culbertson’s Jeep Cherokee was totaled when he was hit head-on in late
October 1998 not long after the start of his final year at Willamette University
College of Law. Rescuers pried him out of his car and rushed him to the
hospital, where he had surgery on his face and shattered knee. The medical bills
exceeded $16,000.
The police found the other car’s driver at fault, but that person’s insurer,
a small, high-risk company, denied Culbertson’s claim. "Their excuse was that
their insured said I was at fault," says Culbertson. He tracked down a copy of
the police report and sent a copy to the company. It still denied the claim.
Having gathered his own evidence and kept track of every conversation and
letter related to the case, Culbertson enlisted the help of the Oregon Insurance
Division. An investigator agreed Culbertson wasn’t at fault and sent a letter
asking the insurance company to pay his claim. That worked. In March he received
a check for the full amount of his claim, although the company still didn’t
admit its customer was at fault.
Even if you choose an insurer with a good record, you can’t guarantee
trouble-free claims. And as Culbertson’s case illustrates, you may even have to
deal with an insurer you’ve never heard of or would not have chosen yourself. So
whenever you have a significant claim, be prepared for the possibility that you
may have to battle for a fair settlement. Here are some tips:
* Report a claim quickly and try not to alter the scene until you contact
your company--each one has different rules for presenting evidence. Save
receipts for major items and living expenses, police reports, and anything else
that supports your claim.
* Ask about deadlines--yours and the company’s. And keep an eye on the
statute of limitations. In many states, you can’t sue an insurance company more
than one year after a claim is filed. Time can get away from you if you think
the company--or even the insurance department--is working with you.
* Document all phone calls and letters (certified receipts always help). "Get
in writing from the company why they’re denying a claim," says Robert Hunter of
the Consumer Federation of America. "Once they’ve told you the reason, they
can’t come up with a new reason."
* Do some research to build your case. If you and the company disagree on
your car’s value, for example, check a used-car pricing guide (visit Kelley Blue
Book on the Web, www.kbb.com), or call a couple of dealers and report your
findings to the adjuster.
* Pester the insurance company if the claims process stalls. Start with the
claims adjuster and work your way up the ladder to the president, if necessary.
"It seems like a lot of insurance companies intentionally drag their feet hoping
that the insured will say `give me anything and I’ll walk away,’" says Gregory
Geelan, a lawyer in San Diego.
* Hire your own contractor or adjuster if you think the company’s estimate is
too low (see the box below).
* Hire a lawyer to assist you if you’re asked to give a deposition. People go
it alone because "they know they’re not guilty and want to cooperate," says the
Greens’ lawyer Tim Kelly. But many unwittingly say something that ends up
hurting their case, he says.
* Try to avoid signing anything that releases the insurance company from
further obligation to pay you. For example, it might take months before you
realize that an earthquake has damaged your house’s foundation.
WHEN YOU HAVE A SERIOUS DISPUTE
Because you’re up against very deep pockets, suing an insurer should be your
last resort. When a company takes in $20 billion a year in auto and homeowners
premiums, even multimillion-dollar verdicts have little impact on the bottom
line, says Hugo Warns, an insurance analyst at Legg Mason.
Unless you have a bad-faith case against the insurer--in which you could get
your legal expenses paid and possibly receive punitive damages in addition to
the amount of your claim--your costs will probably leave you in the red even if
you win. "If the company pays you $100,000 but you have to pay your attorney
one-third, you have $67,000 left to rebuild your home," says Miller.
So before you open this Pandora’s box, contact your state’s insurance
department (or try small-claims court, if your dispute involves just a few
thousand dollars).
Some regulators are more effective than others in pressing consumer
complaints, and none can force a company to pay a claim. But regulators can
generally levy civil fines if the company isn’t complying with state
claims-handling laws. Often that’s a big enough stick to get results. The Oregon
Insurance Division, for example, helped residents recover $4 million in disputed
insurance claims on 2,187 auto- and 353 homeowners-insurance policies in 1997.
THE NUMBERS below show the claims-paying records of the largest homeowners
and auto insurers in the U.S., which as a group represent more than 50% of the
U.S. market. We gathered each company’s complaint ratio--the average number of
complaints per $100 million in premiums--from 20 state insurance departments.
The lower the ratio, the better.
(Because of variations in state insurance department records, the statistics
are not fully consistent from state to state. Where possible, we included only
complaints that regulators have investigated and deemed "justified." In states
that do not report justified complaints separately, we used total complaint
figures. We also adjusted the complaint ratios so that a company’s absence in a
"lenient" state or presence in a "strict" state would not skew the numbers
unfairly.)
The insurance-rating firm A.M. Best provided the loss ratios, which measure
how much companies paid out in claims as a percentage of the premiums they
collect. Low figures indicate that a company may be stingy with claims--or
careful to select policyholders that make few claims. A large drop in the loss
ratio from 1995 to 1997 indicates the company has cut back on its claims
expenses.
Pay close attention to the two left-hand columns. Companies that show both a
high complaint ratio and a low loss ratio are the companies least likely to be
keeping policyholders happy when they have claims.
HOMEOWNERS
COMPLAINTS PER CHANGE 1995-97
$100 MILLION (PERCENTAGE
IN PREMIUMS LOSS RATIO(*) POINTS)
USAA 16 51% -5
STATE FARM 22 55 -14
LIBERTY MUTUAL 29 57 -7
NATIONWIDE 32 59 -6
ALLSTATE 33 52 -15
AMERICAN FAMILY 44 74 +5
SAFECO 59 60 -11
FARMERS 73 60 -37
PRUDENTIAL 115 50 -13
AUTO
COMPLAINTS PER CHANGE 1995-97
$100 MILLION (PERCENTAGE
IN PREMIUMS LOSS RATIO(*) POINTS)
LIBERTY MUTUAL 20 68% -2
USAA 27 75 +4
STATE FARM 29 62 -8
GEICO 31 68 -5
ALLSTATE 40 60 -6
FARMERS 41 64 -6
PROGRESSIVE 47 59 -6
NATIONWIDE 49 64 +4
AMERICAN FAMILY 54 66 -2
RELATED ARTICLE: GETTING A SECOND OPINION
TREMORS LEFT cracks in the walls and foundation and leaks in the roof of Leon
Robbins’s home in south central Los Angeles, even though it was miles from the
epicenter of the Northridge earthquake in January 1994. The estimated cost to
repair the damage? Only $7,200 (just $400 short of the deductible), according to
Robbins’s insurer, Western Home Insurance Co. At least $22,300, according to a
contractor that Robbins consulted. Or $40,000, according to another contractor,
hired by Robbins’s attorney after Western Home rejected the previous estimate.
After hearing from 11 more Western Home policyholders with similar stories, a
jury in Los Angeles County Superior Court in 1997 found the insurance company
guilty of bad faith and awarded Robbins $7.7 million, including punitive
damages. "We disagreed with the findings," says Western Home president Don
Preusser. On appeal, the case was settled confidentially.
Western Home also settled with the other 11 policyholders for an undisclosed
amount. "Almost everyone had been told that the damage was just under the
deductible," says Brian Kabateck, a partner with Quisenberry & Barbanel, the law
firm that handled the case.
What should you do if you think your insurer is low-bailing your homeowners’
claim? The first line of defense is to call one or more contractors to estimate
the cost of repairs. The estimate may be free, or you may pay a fee if the
estimate is clearly for insurance purposes.
If you want more firepower on your side, consider hiring an independent
adjuster to estimate damages and to go to bat for you with your insurer. While a
contractor’s estimate can help when your dispute is over the cost of repairs, an
adjuster can be your advocate when you disagree with your insurer over what your
policy actually covers or about reimbursements for possessions. An adjuster can
also help you submit and document claims and can represent you in negotiations.
Expect to pay an adjuster 10% of the amount recovered, or 25% to 45% of the
difference between what your insurer offers and the amount you eventually
receive. Adjusters are usually licensed with your state’s insurance department;
referrals are available through the National Association of Public Insurance
Adjusters (www.napia.com). Certified or senior professional public adjusters
have met the group’s experience, continuing-education and ethics requirements.
Copyright 1999 The Kiplinger Washington Editors, Inc.
Copyright 2000 Gale Group
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