United States: Reversing Insurance Claim Denials Part 3: Negotiating A Resolution

Last Updated: September 7 2016
Article by Mark Miller

To see this video, please click here.

In our final installment of this series addressing best practices that businesses can employ to reverse business insurance claims, Mark Miller addresses strategies that can be employed to negotiate a favorable settlement.  At every step, insurance carriers pass the ball back to the policyholder, hoping that the policyholder will go away.  Insurance claims adjusters, with a slew of insurance company lawyers behind the scenes, drive the process, and are often unwilling to change their position unless they see both corporate and professional risk.  A policyholder's prime objective, therefore, is to create risk for the insurance carrier and the individuals involved in the claims adjustment process.  If done in a highly professional manner, the insurance carrier will make it known that they want to settle.  If done improperly, a mess is about to ensue.

To learn more about the process, and how to successfully walk the line, watch the video.

To see a transcript of the video please see below

Reversing Insurance Claim Denials Part 3: Negotiating a Resolution

Once you've gotten them to the point of negotiating, talking, you know, picking up coverage, point number 3 is negotiate coverage. Now, what you want to do here, what you got to do here is, these are all negotiating tactics. You're looking for leverage, you're looking for ideas, and you're looking for concepts and you're looking for case law support that puts you in a position to recover as much as possible.

Step back. Look at it, and find out what you can do to present to them, to get them to change their mind if they've denied and pay the claim, and if they're paying the claim, find out what you can give them that will help them go to their boss and say, "We have to give them more."

A lot of times, you know, we look at this more like, "I don't want to write a letter. This is going to take time, it's going to cost money. I don't want to put this effort into this. I don't want to do this, and I don't want to do that. It's just too much. We got too much on our plates." That's all true, but here's the reason why you want to engage in this process, is because you have somebody sitting at his or her desk saying, "Hmm. I've got this lawsuit, we sent them a letter, it's not covered, I'm done. My boss is happy because I got rid of it, and I'm going to go out for a drink with my friends."

What you need to do, is you need to counter that. You need to give this person something back that they take, and they look at and say, "Oh, my God, we have a problem. I need to go to my boss and find out what to do." Or if they're senior enough, "Oh, my God, we got a problem, let's reevaluate." Likely it's going to go up a chain, and somebody's going to look at it, but what you have to sort of understand is it can't go up that chain. A phone call doesn't go up the chain. A poorly written letter that says nothing, that does not give them the evidence they need to back down on their position, does nothing. They need something that they can give to their boss, to their boss's boss, and they can sit back and say, "You know what, they got a point, I think we need to reevaluate and pay them some more money." But, without that paper trail, without that file, which is a physical file, more an electronic file, without that file being built, by you, as a policyholder, to them, they cannot reverse their decision and do the right thing.

Work with them, negotiate, see what you can get. Get the most you can get. If they're not playing ball, then develop a strategy to get them to play ball, but negotiate it. Nothing is set in stone. Nothing here is set in stone, and the things folks should sort of take out of this, if anything, is insurance companies when they say no, they don't necessarily mean no. They want you to believe no, but they don't necessarily think that you're going to take it. They're waiting to see what you do, and you need to play your hand and follow through. It's sort of a game. It's not a fun game. It's not a game that everybody's happy about, but it's a game they play, and it's a game you're going to have to play to get the money you deserve.

Miller Friel, PLLC is a specialized insurance coverage law firm whose sole purpose is to help corporate clients maximize their insurance coverage. Our Focus of exclusively representing policyholders, combined with our extensive Experience in the area of insurance law, leads to greater efficiency, lower costs and better Results. Further discussion and analysis of insurance coverage issues impacting policyholders can be found in our Miller Friel Insurance Coverage Blog and our 7 Tips for Maximizing Coverage series.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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