Managing Your Practice

Liability and casualty insurance claims


The current discussion of the transition to ICD-10 and other health insurance reforms has overshadowed the broader issue of dealing with other types of insurance claims. We buy casualty and liability insurance hoping we will never need it; but when we do, it’s important to get it right, and your extensive experience in coping with health insurance claims can be put to good use in such situations.

Prompt filing is just as important with a casualty or liability claim as it is with a health claim. All insurance policies have a filing deadline, which varies with different policies and states. But just because you file promptly does not mean you have to settle on a payment right away.

Most insurers want a quick resolution as much as you do, but if you allow yourself to be rushed, you could end up with a smaller settlement than you deserve.

If you’re a regular reader of this column, you’re familiar with my first rule of dealing with health insurers: Everything is negotiable. And it’s no different with casualty insurers. Regardless of what adjusters tell you, the initial amount offered is never engraved in stone.

Adjusters are evaluated on the basis of how much money they "save" on claims; so their initial number will usually be low – often too low.

Just as with health insurance claims, there are multiple "gray areas" in casualty policies that can be negotiated. In the case of a burglary or storm or fire damage in your office, for example, reasonable expenses will vary considerably for repair of damaged medical equipment and replacement of equipment that was destroyed, or for rental of alternate office space while a damaged office is being repaired.

Other negotiable costs are moving expenses, storage of damaged and undamaged equipment, and depreciation on specific items. And as we all know from our health insurance experience, injuries are particularly fertile areas for negotiation.

Another adjuster’s trick, which you may have already encountered with a damaged car, is to steer you to certain repair shops and contractors that give the insurer prenegotiated prices for their work, but may offer inferior parts and service. Most policies do not require that you accept the insurer’s choice of contractors. Insist on having work done by people you know and trust. Almost always, you are entitled to the same kind and quality of materials you had before the disaster.

Do your own research on the value of lost and damaged items; the more documentation you have, the less likely an adjuster is to question your claim. Just as with health insurance coding, preparation pays off.

Document your losses very specifically. Adjusters often attempt to group material losses nonselectively, just as health insurers sometimes attempt to "bundle" your services. For example, if a certain cabinet contained medical supplies, try to be very specific about the supplies it contained. That way, you can assign value to individual items, rather than allowing the insurance company to estimate a lump sum.

After the trauma of a burglary, fire, or flood, you may overlook some damage. As many victims of hurricanes and other natural disasters have learned, damage that is not immediately apparent can add up to a significant amount of money later. Another thing your insurer may not tell you is even after you arrive at a settlement, you can still file another claim if you discover additional losses.

It is usually not wise to rely solely on your insurance agent in such situations, because an agent’s loyalty resides primarily with the insurance company, not the claimant. Retaining a lawyer is often a good idea, if only to review paperwork and help you value your losses. It will cost comparatively little, and is usually money well spent. In addition, you will probably need a lawyer for representation if you have a large or complicated case, and certainly if you suspect that the insurance company is not dealing with you fairly.

A less expensive alternative to a lawyer may be a public insurance adjuster. Public adjusters are professionals who work for policyholders, not insurers. They inspect the loss site, analyze the damages, assemble claim support data, review your coverage, determine replacement costs, and strive to maximize your settlement in the same way the insurer’s adjuster will try to minimize it. You can find more information and a list of public adjusters in your area on the website of the National Association of Public Insurance Adjusters.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He holds teaching positions at several hospitals and has delivered more than 500 academic speaking presentations. He is the author of numerous articles and textbook chapters, and is a long-time monthly columnist for Skin & Allergy News.

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