What do you do if an insurance adjuster or an insurance company isn’t being fair to you? Well, you need to stand up for your rights, and there are a lot of things you can do. You may not know it, but you have a lot of power. Both Illinois and Missouri have specific statutes and regulations that govern the conduct of insurance companies, and it’s up to you to stand up to them.
If you’re dealing with an insurance company or a claim representative, you hold a legal claim, whether it’s car crash, truck crash, slip and fall, a dangerous product, a workers compensation claim, or another type of personal injury, then you hold that claim, you’re dealing with that adjuster, you’re trying to get paid. Sometimes it’s smart to have a lawyer, sometimes you can resolve the case on your own, but if the insurance adjuster is not being fair to you, there are some things you can do. So, let me do two things: one is I’m going to tell you how they’re not fair to you, and two, I’m going to tell you what you can do about it.
Many times they’re not fair to you because they say that, “It was your fault. You should have been looking out for yourself.” They’ll say that, “We don’t have to pay medical expenses because you have health insurance. We don’t have to pay wage loss expenses because your employer covered you with sick pay or vacation pay or disability pay. Don’t get a lawyer because they’re only going to make it cost more money. We’re going to pay your medical providers directly. You waited too long to get treatment.” It’s your fault when it really isn’t. “We’re only going to pay for a certain amount of medical treatment. You only should have treated so long, and after that you shouldn’t recover.” Or, there’s a sense of urgency, “You have to settle this case now. I’m going to leave this open till tomorrow, and then we’re done. We better settle this case now.”
These are all lies. They’re all techniques that insurance adjusters are trained to do to try to settle the case cheap and to save the insurance company money, and then not pay you a 100% of your damages. They’re trying to pay you 10%, 20%, 30% of your damages, and you should insist on full compensation for your injuries because that’s what the law in the state of Missouri and the law in Illinois and federal law states. So, you make sure you insist on that.
Then, what are your rights? Well, I wrote a book called “Essential Questions to Ask Before You Pick a Lawyer or Settle Your Case.” You can get it on www.burgerlaw.com. It’s for free. It’s a free book. You get your PDF. You can read it. All those ways the insurance companies rip you off is set out on Pages 16, 17,18 of the book.
So, what are your rights? Well, we also set out on Pages 19 through 21 — I’ve done blogs on these and other things — about what your rights are, and so, both Missouri and Illinois have specific statutes and regulations that govern insurance adjusters and how they have to be fair to you.
So, for instance, they have to make a bona fide effort to communicate with claimants where liability is reasonably clear. Within 15 days of receipt, they have to acknowledge it. They have to provide the forms necessary to make a claim. They have to provide a proof of loss claim. Within a reasonable amount of time, they have to affirm or deny liability on a claim. They must promptly, in a case of denial of a claim, provide a reasonable and accurate explanation of the basis of the denial. If they accept and affirm liability, they have to offer payment on claims if the amount of the claim is not in dispute, if there’s not a bona fide dispute in a claim.
If the determination of liability is completed within 30 days, or whether it’s accepted or denied, they have to provide a reasonable written explanation of the basis of the lower offer or the denial. They have to do it in writing. They have to provide definition, limitations. If they’re going to exclude liability, they’re not providing coverage, they have to explain that to you.
They have to report vexatious delay findings by a court of law to the Illinois Department of Insurance or Missouri. In automobile collision claims, within 40 days, they have to make a final payment of property damage to the automobile, and there are a whole host of other claims.
In a fire claim, if a fire claim’s unresolved for more than 75 days from it’s reported or after receipt of proof of loss, they have to provide a reasonable written explanation to you of the cause of the delay. They have to provide a copy of written estimate on which their attempt to adjust the claim is provided. They have to review and respond in writing to you. It’s always write to your and email to your claim representative.
Missouri has fewer statutory protections, but they still have some good ones as well. Illinois’ is more robust and more detailed, but Missouri has them as well. Within 10 working days of receiving notification, they have to acknowledge within 10 days the receipt of the claim or acknowledge that there’s a claim. They have to provide within 15 days of a request, so do a written request or an email request. They have to provide the forms necessary to present claims. Within 10 days, they have to reply to communication from a claimant, which reasonably suggests that a response is expected. Within 15 days, they have to either accept or deny a written claim.
Within 45 days of the date of the initial notification and every 45 days thereafter, they have to give you a written notice of, the investigation is incomplete and what information’s outstanding, what’s still they don’t meet. They just can’t sit on their laurels. They have to move this claim, and adjust and pay this claim.
Within 30 days, they have to give written notice about a statute of limitations or what limitations there may be if a person is unrepresented. They have to give third party notices of statute of limitations as well. And, if there is a settlement entered into, they have to give the insured a copy of the present value calculation of future benefits.
So, these statutes are in Missouri Rights Statute, 375.1007, and there are many regulations in Missouri as well, and I’m reading these. These are from the book. Go to my website and you download this book for free, “Essential Questions to Ask Before You Pick a Lawyer or Settle Your Case.” And, in Illinois, it’s 215 Illinois Statute Section 5\154, and then there are different subparagraphs, 154.6 is one, and there are also Code Title 50, Section 919.80, also has a robust and full set of regulations.
So, remember that you have rights of communication, rights to be notified of things. That doesn’t mean the insurance company has to pay you, but know that you have rights to be treated fairly and in good faith. An insurance company is obligated by law to do so through statute and regulation.
If that’s not happening and if you’re still being ripped off by the insurance company, call me with further questions, Gary Burger, www.burgerlaw.com. My 800 number, my toll-free number is 866-599-2222. My Illinois number is 618-272-2222, Missouri 314-542-2222. Thank you.