Personal Services Insurance Company
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Unfair Insurance Company Tactics: Your Recorded Statement Used Against You
In the current environment where insurance companies look for ways to deny claims rather than pay claims, beware that your recorded statement may be used against you. In fact, “inconsistencies” in recorded statements are routinely used to unfairly delay, deny, or lowball your insurance settlement.
There are two situations where you can expect to be confronted with a requirement for a recorded statement.
In a third party claim, where you are seeking damages for injuries or damages you sustained as a result of another party’s negligence, that company now becomes responsible for your loss as a third party carrier. You are not required to cooperate with this insurance company because you have no contractual obligation to them. This, however, will not necessarily stop that insurance company from attempting to coerce you to submit to a statement.
The focus here is the first party insurance claim where you are seeking coverage from your own insurance company. In this situation, your insurance policy requires you to cooperate. If you fail to cooperate, you are at risk of an eventual claim denial. Therefore, you must provide the statement. Don’t think that by demanding a delay (unless you are legitimately obtaining a lawyer), or by demanding an in-person visit from an adjuster, that you are helping yourself. You have an obligation to cooperate.
Under the guise of customer service, the insurance company will contact you usually within 24 hours of your filing of your insurance claim. While you might be impressed by their prompt attention to your loss, consider how the timing can pose an inherent risk for you.
Inherent risk because within a day or two following your loss, are you fully in command of all of the facts? Is it reasonable that you may not know the full extent of your damage, or even the full extent of your injuries?
- For example, you might say in your recorded statement two days after an accident that you are not injured. Realistically the symptoms of a whiplash injury might not occur until after this. If you subsequently visit a doctor for those injuries, expect to have to defend your “conflicts” to the insurance company.
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Auto theft claims are frequently subject to further insurance investigation. You statement detailed that your car was stolen between 10 PM and 8 AM. But in subsequent investigation the investigator finds a neighbor who saw the car in your driveway at midnight. This information conflicts with your original statement. While you have made no attempt to misconstrue the facts, the “conflicts” in your statement might easily subject you to an unfair claim delay, or even a claim denial.
Recorded statement “inconsistencies” serve as fertile ground for insurance companies to reduce or deny claims. If you believe you have encountered an unfair claim delay, you need to attempt to identify the specific source of the delay.
Maintain an ongoing, persistent, courteous dialogue with your adjuster.
Only through dialogue can you hope to discover the root cause for the delay. If the adjuster asks you to clarify points in your previous recorded statement, do so. Cooperate.
Always take an active role in your claim.
If you can determine a cause for the delay, you might be able to work on your own to solve it. For example, in the auto theft claim, suppose the adjuster shared with you that the insurance company had “spoken” to your neighbors. Take action – speak to your neighbors!
“Yes I spoke to my neighbor. He works the night shift. He returns home at midnight. His observations narrowed the time line by at least two hours. I called the police and informed them of this development. Here is the name of the detective I spoke with.”
While insurance companies clearly have a right to investigate all claims, the unfortunate reality is that they use the “under investigation” tactic to give them more time to keep your money and to wear you down. Too frequently, this “investigative phase” is unfairly based on a biased interpretation of the recorded statement.
About the Author
Join those who have already utilized Jane Pytel’s expertise to effectively manage an insurance claim, how to identify what is going on behind the scenes, and how to overcome the patterned obstacles insurance companies will use to delay, devalue, or deny your insurance claim. Visit Jane at http://solutionsforyourinsuranceclaim.com/
Individual dental insurance for braces (re-post)?
Sorry, Yahoo Answers won’t let me extend this question anymore so I am going to repost this question and wait for more answers.
What is a good “individual” dental insurance if I were to get braces? I have done some research and nailed it down to DeltaCare and Pacificare. So which dental insurance is better, or any other suggestions? Pacificare cost slightly less than DeltaCare as far as co-payments go. Both are HMO plans, all the PPO plans covers little to nothing for braces, so HMO seems to be the only way to go for an individual plan. DeltaCare seems to be more reliable since it’s associated with Delta Dental, a little more costly also.
I’m more concerned about the “quality” of the services as far as making claims and such. So DeltaCare, Pacificare, or ay other dental insurance/plans? Any personal experience with either of these companies? I am in San Francisco, California.
Well, I called both companies today and asked them several detailed questions about braces and co-pays. You are right that Pacificare is a little bit cheaper but not by much. The cost for my 11 year old son to have braces is $4770. The co-pays as you probably discovered are broken down into start-up costs, coverage for 24 months, retainers, final records, final retainers and any additional items like an RPE in my son’s case (rapid palatal expander).
DentalCare coverage co-pays are as follows:
startup: 200
24 month coverage: 2500
(any additional amount after 24 months is $75 a month
and in my son’s case he needs an additional 6 months
or 450 more)
retainers: 250
RPE that he needs is an additional 400
Total is 3800 for co-pays
Total cost from the orthodontist is 4770
So, possible savings of 970
Keep in mind that additional dental services for the family plan
cover all kinds of dental services but co-pays are still required. A family plan is 225 a year and this includes the orthodontic treatment I mentioned above.
Now for Pacificare DHMO:
The co-pays for braces:
startup: 250
24 month coverage: 1895
(you will have to pay any additional monthly amount that your orthodontists requres—no coverage or co-pays after 24 months)
retainers: 250 past the 24 months
150 for final records
RPE that he needs is an additional 400
Total for copays—hard to get an exact amount as it depends on your dental office charge per office visit after 24 months but you can get a rough idea based on what I provided above. It is a little cheaper than DeltaCare but not by a whole lot.
Now some very important things to remember:
DeltaCare is 225 for a family plan and Pacificare is 400 for a family plan for a year. While Pacificare is more expensive—almost double—it is more benefit reach with regard to much lower co-pays on a lot of dental work. For example, a root canal molar is a 400 co-pay with DeltaCare but only 175 with Pacificare. For a filling with a resin-based composite–3 surfaces, anterior is 85 with DeltaCare and with Pacificare it is 25.
Now while it may seem to you that Pacificare is better with regard to being cheaper with braces and better overall co-pays for other dental services there is a catch—-and it is a big one! With Pacificare all work has to be done with your general dentist and not a specialist like an endodontics or periodontics dentist. If the general dentist cannot do the work and refers you to a specialist you have to pay everything out of pocket—no co-pays or anything. This is scary considering that many general dentists are either unable, unwilling or not skilled enough to do a root canal and usually more complicated root canals like a molar which is very expensive. Also, with Pacificare you cannot even refer your kids to a pediatric dentist. They also have to go to the general dentist. On top of that it is about a 175 more a year for the premium than DeltaCare.
DeltaCare on the other hand lets your primary dentist refer you to a specialist if they are unable to do the work. They also let you refer your kids to a pediatric dentist as well after their first visit to the general dentist.
So there are so many details to consider and after all this discussion I am still not sure which dental HMO is better here??
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