To Your Health: 13 Important Facts and Secrets Insurers Might Not Tell You


There are rules of engagement that often need to be observed when you try to make a claim with your insurance company and if you think they are going to pay out your money without any further questions or before putting a few obstacles in your way, you might be in for a shock.

Most insurance companies don’t like paying out on claims, despite what they might say, and although you need to be fair and say that they have every right to validate any claim submitted, you should expect to face a battle to get paid.

There are plenty of aspects about how insurance companies operate that they would rather that their customers didn’t know about, so here is an insight into some of those little secrets and some pointers on how to get what you deserve.


#1 You might need professional help

Insurers would probably prefer that you attempt to resolve a claim by yourself rather than hire a specialist like an attorney to give you the support and guidance that you might get the right payout.

Insurance companies don’t want you to hire someone like an attorney as they will have the know-how and experience to know what questions to ask and how to answer any challenges that might be forthcoming.


#2 Know who is on your side

It is common for the insurance company to send a loss adjuster to see you and go through the details of your claim.

They may come across as friendly and appear willing to help you get your claim sorted in a positive way, but it should always be remembered that they are working for the insurance company and not you.

This means that their goal is likely to reduce the amount you get paid by rejecting certain aspects of your claim or find reasons not to pay you at all.

You would be wise to bear in mind the role that the insurance adjuster plays in the claims process, and keep it professional and cordial, but guarded.


#3 Why your insurer wants to get a statement from you

It is always a good idea to find out more about what your insurance actually covers and what you can claim for before you are ready to put down in writing the exact details of why you are requesting a payout.

You should always give an honest account surrounding the circumstances of your claim, or the whole claim could be rejected if you are found to have provided incorrect details.

One of the main reasons why insurers are so keen to get a written statement from you as early as possible is because it gives them an opportunity to scrutinize what you have said and see if they can find any inaccuracies that they can seize upon.

If you have an attorney or professional adviser handling your claim, run through the details thoroughly and find out how you describe the events and circumstances in the right way.

Your insurer doesn’t want you to know that they are hoping you might trip yourself up inadvertently and that’s why they are so keen to get you to provide a statement as soon as possible.


#4 Your insurer might try to sow seeds of doubt

It is possible that the insurance adjuster might try to say that you are not entitled to make a claim because the circumstances that led to the claim are not covered by the terms of the policy.

A typical scenario with health insurance claims, for instance, would be to say that you already had related health problems before the accident. It might also be claimed that certain events, such as a minor vehicle collision, are unlikely to have caused the extent of the injury suffered and therefore your insurance doesn’t allow you to request compensation.

Don’t give up at the first hurdle if you are told that your claim is not valid, as this is a potential tactic used by insurers to deter some claimants from pursuing a payout.


#5 The first offer is rarely their best offer

Some insurers will probably try to convince you that their initial offer is the best you can expect.

Insurance adjusters are trained in negotiation techniques and if they can get you to take a lower offer than you might get if you stand firm, their tactics will have paid off.


#6 They might try to call your bluff

You should also be aware that it is feasible for an insurance company to appear to be unconcerned about threats of court action, although secretly, they are probably keen to get it over and done with without going in front of a judge.

You might need an attorney to help you force their hand and get the best payout if they pretend to be uninterested in resolving your claim.


#7 Independent medical assessment

Be wary of going to a doctor who comes recommended by the insurance company, as plenty of insurers use a panel of doctors who are good at finding reasons to deny your claim.


#8 Always remember there is a legal contract in place

It is always worth reminding yourself that your insurance company is there to provide you with the compensation you are entitled to and it doesn’t hurt to keep in mind this duty of responsibility to pay a valid claim.


#9 Consider hiring a public adjuster

It often pays to do what your insurer doesn’t want you to do, as there is normally a reason behind their desire to get you to see things their way.

A public adjuster is hired by you and represents your best interests, not the insurance company.


#10 Hold the insurance agent to account through your insurer

If you bought insurance through an agent and it turns out they have misrepresented the coverage details, the insurer still has to honor that coverage, despite what the insurance company might say at first.


#11 Getting the right payout

Another point about insurance agents is that if they have caused you to be underinsured your insurance company may still found responsible for paying a higher figure than the benefit amount.


#12 Ambiguity can work in your favor

Insurance jargon is commonplace, but if a term is found to be ambiguous in its meaning, your insurer may be forced to pay you out as it could be viewed that you couldn’t be expected to understand what was meant.


#13 Taking your cover away

Finally, another card that an insurer might play is to cancel your insurance after you claim on the grounds that you did not provide accurate information when you applied.

It is always worth remembering that policy applications can be very open to interpretation, so challenge this action if it seems that the insurer is just trying to find a way to avoid paying.

Knowing what tactics insurers might try should help you stand your ground and get what you deserve when you make a valid claim.

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