description
inside information from industry veterans
How Insurance Companies Resolve Cases covers the spectrum of settlement concerns, from estimating bodily injury damages and investigating coverage to claim denials and insurance schemes. action cards. speed up the processing of your claims and reduce your frustration with insurance companies. this book offers:
- insurance company liquidation techniques to consider
- aspects of claims frequently questioned by insurance companies
- insurance policy defenses and coverage issues
- how to contact insurance companies
- duties owed by insurance companies
- how to effectively deal with adjusters
- how insurance companies process claims
- Most Popular Adjuster Negotiation Techniques
- how indexing and booking systems work
- what insurance companies look for in their investigations
- how insurance companies seek to limit coverage
- “liquidators will often offer two-thirds or one-half of the claim received from the plaintiff’s attorney” section 240
- “A local claims administrator has about $50-100,000 of discretionary settlement authority. Typically, he will extend $20-30,000 of discretionary settlement authority to his claims supervisors, and $10-15,000 to office claims staff.” section 240
- A prudent plaintiff’s attorney will ask the insurance company directly, early in the relationship, “Is there a coverage issue? Is there a liability issue? Section 702.1
- “Avoid Monday mornings and Friday afternoons, as these are the busiest times for adjusters. These are the times when they will be less receptive to phone calls from attorneys or requested meetings.” article 780
- “99% of plaintiffs’ attorneys are unaware of supplemental coverages that expire and are paid in excess of policy limits.” section 240
- “A natural trap many attorneys fall into is negotiating the value of your case against the policy limits. If the plaintiff was 20% at fault in a comparative fault jurisdiction and the policy limits are $100,000, many attorneys will ask for $80,000. instead, they should value the case regardless of the policy limits.” article 740.1
- “Nurses in hospitals and clinics maintain the best documentation of pain observed in a given patient. use your notes to rule out false claims of soft tissue injury.” section 240
- “An undocumented lawsuit is not worth the paper it is written on. the insurance industry loves all the documented claims and loves the paperwork. why? because that’s how it’s always been done.” section 702.7
- “The general rule of thumb in the claims settlement industry is that 30 days is the usual and customary time frame for requesting an insurance company to respond to a settlement claim. This is because the claims industry is set up on a 30-day journal system.” section 702.7
- “Usually, when an attorney sets a ten to thirty day time limit in their demand letter, the paperwork requirements are set aside and settlement authority is granted over the phone. the idea is that the paperwork can be done on or after the date the case is resolved, rather than before.” section 240
- How do insurance companies rate cases?
- what do adjusters need to settle a case?
- Who makes the real decisions on insurance cases?
- How do insurance companies rate pre-existing injuries?
- How do I prove my client really has a soft tissue injury?
- what is the structure of most claims departments?
- How can I find out the policy limits and get a copy of the insurance policy?
- • cruise lines and airlines. • hotels, restaurants, bars and nightclubs. • nursing homes. • prisons. • commercial and residential owners and renters. • hvac manufacturers, installers and suppliers. • claims management and coverage issues by policy type— • commercial general liability policies. • coverage of directors and officers. • coverage of errors and omissions. • event cancellation policies. • cyber liability insurance. • Own material damage. • business interruption coverage. • coverage of military and civil authorities. • labor practices liability insurance.
Knowing how insurance companies operate can help you get fair settlements faster. By learning what the home office counts on and what it doesn’t, you can present your case in the best light with minimal wasted effort and make both you and your case stand out.
The book is packed with expert settlement information you can use today. Some tips include:
negotiate
valuation
documentation
response time
How Insurance Companies Settle Cases reveals how insurance companies evaluate and negotiate claims and answers the following questions:
Straight answers to each of these questions can be found in section 240 of How Insurance Companies Resolve Cases, and the book is packed with more insurance company secrets.
revision 29 highlights
Get a better understanding of how insurers work and how to get better deals for your customers. learn how to convey the true value of your case, sidestep delays, and how to resolve your case. This edition of how insurance companies resolve cases brings you the new chapter 19, impact of covid-19 on the insurance claims handling issues it covers:
• claims related to covid-19 and specific businesses
Other new topics include: • Physical loss or damage in first party property claims. • structured payments as a settlement tool. • the insurer’s improper use of a shadow adjuster. • withdrawal of the insurer from the defense without justification.
and more!
short index
chapter 1 introduction to the claims game chapter 2 the basics chapter 3 creating the claims file chapter 4 investigating coverage chapter 4a investigating the opposing insurance defense attorney chapter 5 researching the facts chapter 5a checking health Defendant’s Insurer Chapter 6 Using Insurance Experts and Consultants Chapter 7 Settlement Negotiations and Engagements Chapter 7a How to Succeed at Settlement Conferences Chapter 7b Common Negotiation Mistakes Chapter 8 Techniques Not Found in Claims Manuals Chapter 8a claim claims: the art of being a squeaky wheel chapter 9 claim denials chapter 9a claim evaluation software chapter 10 action letter overview chapter 11 releases and settlements chapter 12 how to estimate bodily injury settlements chapter 13 motorist coverage with underinsurance chapter 14 how to take a claims representative statement chapter 15 bad faith, bad news chapter 15a extraordinary bad faith cases chapter 15b common claim myths chapter 16 settling bodily injury claim from $5,000 to $75,000 chapter 17 personal injury claims uninsured motorists chapter 18 claims department and claims manual
about the author
mr. frangiamore is a director of 2nd insight, inc., a consulting firm that provides expert witness services and testimony in a wide variety of insurance-related cases. he is a former unit claims manager for wausau/national insurance. while across the country/wausau, mr. frangiamore was responsible for the oversight, litigation, and settlement of most major West Coast environmental claims and litigation. He also served as the manager of the California Construction Defects Unit, which handled insurance claims related to some of the largest residential and commercial construction projects throughout the state of California. Mr. frangiamore has been retained by many major law firms representing insurers, policy holders, and brokers. He has testified at depositions and trials in many insurance coverage disputes and claims handling in both state and federal courts. many judges, private mediators, special teachers and lawyers recognize mr. frangiamore as one of the most effective negotiators of complex insurance claims in the country.
mr. Frangiamore graduated from Union College in Schenectady N.Y in 1981 with a bachelor’s degree in political science; and from golden gate university with a juris doctorate in 1985. mr. frangiamore has been admitted to practice law in california (active) and the state of washington (inactive).
