Thursday, December 17, 2015





There are certain "claims resolution customer service words" that claims customers respond to favorably when assisting them with their claim  

Consider these key words:


- People respond positively to words that are active rather than passive. There is a world of difference between "I can" and "I will."
- Words of genuine compassion and empathy suggest that you are not just carrying the company line or reading from a memo.
- Delivering those words in a cheerful, upbeat, and most importantly, natural manner (appropriate to the circumstances, of course) suggests one human being's desire to help another, not just an equivocal, noncommittal suggestion that something "may" be possible.

The words and phrases best suited for use during a call’s conclusion are largely dependent upon the actual outcome of the conversation. Where, for example, a satisfactory resolution has been provided to the customer, it is possible to further bolster the existing rapport by amicably offering support in other areas. In doing so, your agent will illustrate that he or she has genuinely enjoyed helping the customer – and can be trusted to do so again in the future.
Everyday phrases
As a claim representative, it is your job to make the customer feel at ease from the minute you say “hello”. Good use of these phrases will help to reassure your customer that you are the life-saving, sympathetic ear that they hoped for.

6. “Rest assured Mr……”
7. “I do understand the inconvenience you have faced……”
8. “I will be more than glad/ happy to assist you….”
9. “I completely understand the reason why / your situation….”
10. “I will ensure that…”
11. “What I will do for you right away is……”
12. “I assure you I will try my best…..”
13. “What I can do for you right now is ….”
14. “I’m sorry for the inconvenience that you have faced, what I can do for you is

Key phrases

“I’m (very glad/so sorry) to hear that, Mrs Brown…”
Constructing a sense of personal empathy, and suggesting the agent’s intention to act.

“Thank you so much for letting us know about this…”
Creating the unspoken suggestion that your company values feedback, and takes matters of this kind extremely seriously.

“I’d just like to ask for a little further information, Sir/Madam…”
Always request – never tell.

“Hopefully, we should be able to help you, Mrs Brown…”
Reaffirming the agent’s intention to provide a swift resolution.

“You’re absolutely correct, Sir/Madam…”
Demonstrating your respect for the customer’s opinions and your sympathy for his or her personal predicament.

Now that your caller has confidence in the agent’s telephone etiquette, it’s time to show that your company’s compassion is not just skin-deep.

Provide a sense of immediacy


As the following phrases show, words which give a sense of immediacy can also prove incredibly helpful in the construction of rapport.

“We’ll look into this for you right away, Sir/Madam…”
Displaying a recognition of the urgency of the matter.

“Let’s see what we can do to fix this, Mrs Brown…”
The collective “we” suggests partnership, and implores reciprocal cooperation.

“I can see where the problem is, Sir/Madam…”
Demonstrating the agent’s experience in such matters, and hinting at his or her ability to provide a solution.

“What I’m doing for you right now is…”
Asserting control and hinting towards spontaneous, possibly discretionary action.

“That’s now been done, Mrs Brown…”
Providing a pay-off and showing that the caller’s trust had not been placed in vain.


Claims interaction involves precise and careful communication, I hope the aforementioned helps achieve that outcome.

Robert

 

Sunday, November 22, 2015

What would you like your adjuster to?


                                                                                                                       
 
By Robert Carper
I would like my adjuster to:

keep me informed

Multi-task to serve me better

Calls me back

Makes contacting them easy

Talks to me in laymen's terms

Explains every thing to me in a through manner

Makes me feel they are walking side by side with me

Cares about what I care about

Respects my time

Is in a good mood

Treats me the way they would want to be treated

Gives me a reason to stay with my company

Makes me want brag about my company and refer others

Do a great job

 

Thursday, November 12, 2015

Court trials explained (3 parts)


 

 Court trials explained (3 parts)
Robert Carper
 
Part one: pleadings
Pleadings are statements in which parties to a lawsuit accuse and respond. Pleadings accuse of wrongdoing or deny and excuse a wrongdoing. There is no proof in the pleadings, only claims that something happened or didn’t happen as well as legal conclusions and requests for something from the court.
Pleadings are about allegations, not evidence or proof. Saying someone drove through a red light is an allegation. Saying you saw it with your own eyes is evidence. You only put the first in the pleadings, not the second. The purpose of pleadings is tell the other side what you intend to prove later, at trial. In Ontario, pleadings consist of a statement of claim, a statement of defense, and a reply.
You put material (relevant) facts and legal conclusions following from these facts in your pleadings. The legal conclusions must support your request to the court. The purpose of a lawsuit is get a court order. Your facts and legal conclusions, if proven, must give the court the power to make the order you request. Running through a red light is a material fact; negligence is a legal conclusion. You cannot claim negligence in your claim without stating material facts supporting the legal conclusion.
Part two: discovery
After the parties exchange accusations and responses, the law expects them to exchange all evidence they have to support their accusations and responses. This is discovery. There are two parts to it: documents and questions and answers in person. Both are under oath and both become part of the record of the lawsuit. So the parties can use evidence they discover during this stage to prove their case at trial.
The parties must disclose only relevant documents and answer only relevant questions. Relevance depends on the pleadings, and this is another reason why pleadings are so important. Suppose you allege that someone was negligent because they ran through a red light. Then that person’s political views are not relevant and you cannot expect them to disclose documents or answer questions about their politics. Both the document and the Q&A (known in Ontario as examination for discovery) parts of discovery happen out of court. Parties disclose their documents in sworn affidavits, and examinations under oath take place in private offices.
In theory, after the pleadings are closed and the discoveries are completed, the parties should have a pretty exhaustive idea of what’s going to happen at trial. They know the claim and defence, they know the evidence, they know the law. They should be able to predict what the court will decide fairly well. This is one reason why most civil cases settle before trial. But some do go to the final hearing, either because the evidence is ambiguous or because the law is not fully settled. Or for a million other reasons—we are humans and nothing is ever 100% certain.

Part three: trial

This is the first time the court hears the case “on the merits.” In theory, the entire case could continue until this point without any involvement of the court. (In reality, lawyers spend a lot of time in court wrangling over procedural issues.)

Trial is where the parties present their evidence to a judge or a jury. You usually present evidence through a witness who has first-hand knowledge of what happened. Or through an expert who has a professional opinion of what happened, if the issue requires such an opinion. But involvement of humans makes trials unpredictable. No one can be certain what the witness will say and how it will affect this particular judge or jury.
A good civil litigator will conduct the first and the second stages of a lawsuit as if the trial was unavoidable. A potential loss at trial is a powerful incentive for settlement. (Unfortunately, the cost of trial and pre-trial procedures is another strong incentive.) If you build a strong case for trial during pleadings and discovery, it’s irrational to go to trial.
Of course, this is only a superficial summary of what happens in a lawsuit.


 

Tuesday, October 20, 2015

Social media and claims




















Read the ArticleInsurance fraud is an issue that costs the industry $40 billion each year in non-health insurance claims alone. The fact that there are currently 850 million Facebook users should prompt claims adjusters to look at the use of social media as a tool to further claims investigations. Social networking research and investigation is a required tool

The expectation that the number of Facebook users will grow to 1 billion by the end of this year is even more of reason.

There are various investigative uses for social media including:

  •     Surveillance cases (photos, habits, activities)Locating witnesses, insured, claimant
  •     Background information like character, habits, activities, financial information
  •     Identifying relationships and/or accomplices




















“Facebook evidence will corroborate other evidence that was found, such as a statement from a co-worker or witness, and surveillance, such as video,” as well as medical records that call in to question the plaintiff’s injuries and pictures that a property in question wasn’t damaged.

Adjusters should be aware that plaintiffs firms are now warning claimants to keep off of social media sites and to post fake information and comments such as, “Wow, my back is killing me. I’ve never been in this much pain.”

Social media should be “on the table” during an insurance fraud investigation?



Robert
 

Tuesday, October 6, 2015

AUTO CLAIMS EXCLUSIONS


AUTO CLAIMS EXCLUSIONS
Auto claims is a fact of claims life if you handle that area, aside from knowing the accident facts and other information, one of the other areas to get acquainted is the auto policy itself, Today I will provide a summary of the auto policy exclusions. The policy itself may differ in some regards depending on what company you work with and what state you work in. . In general you will find the following applicable. As always, consult with your claims best practices, legal and/or manager if you are not sure. In many cases clarification is warranted and may 
require more information than what follows

Exclusions: What the policy won't cover 

Exclusions listed in a personal auto insurance policy vary depending upon what state laws permit and then the guidelines of your car insurance company.  When something is noted as excluded on the policy, it means that your policy won’t cover it.
Exclusions can be associated with a person, property, location, peril or specific situation.
These limitations to your coverage are important to know so that you don’t end up in a situation where you find out after an auto accident that you have no coverage -- or have voided your policy.  (Remember if your policy doesn’t cover you, then you’ll be stuck paying out-of-pocket usually.)


The most common exclusion regarding a person is a named driver exclusion.  With this, you and your insurer agree to exclude a specific person from your policy’s coverages.  This driver isn’t rated on your policy, and in return your insurer won’t cover the individual if found driving your car.

Here’s a look at some of the most common exclusions found in the different parts of a personal auto insurance policy.

Bodily and property damage liability exclusions
Most policies plainly state they don’t provide liability coverage:
If an insured has intentionally caused injury or property damage.
For property damage to property owned (or being transported) by the insured.  (So if you hit your own car you can’t make a liability claim)


For property damage to property that is rented, used by or in the care of the insured.
For bodily injury to the insured or any member of an insured’s family residing in the insured’s household. (Some states only allow the policy to reduce the bodily injury limits for family members to the state's minimum)

For liability arising out of the ownership or operation of a vehicle being used for “livery conveyance.”   This means using your vehicle in transportation of goods or people for payment – so don’t use your car as taxi or delivery service.   So, don’t use your car for delivering pizzas, or you may void your coverage.
In general, using your vehicle for business purposes can be a no-no according to your liability policy.

Catastrophic events or exposures are usually marked as excluded as well.  This can include items such as bodily injury or property damage resulting from:
Nuclear exposure or explosion – including the resulting fire, radiation, or contamination.
Bio-chemical attack or exposure to bio-chemical agents as a result of an act of terrorism.
War (declared or undeclared)

Vehicles that are excluded from coverage (or deemed unacceptable to cover for either liability or physical damage coverages) vary but the list may include:
One with less than four wheels

Designed for use principally off public roads or not registered for use on public roads
Any vehicle owned by you or a family member but isn’t listed as insured on your policy.
Any vehicle furnished for your regular use but isn’t listed as insured on your policy.
Any vehicle used for the purpose of competing in a race or practicing or preparing for any prearranged or organized racing or speed contest.

Some insurers have amended policies to include an exclusion for any vehicle that is operated, maintained, or used as part of a personal vehicle sharing program.  So, loaning your vehicle out for to a car-sharing service could mean you have no personal coverages.
Physical damage coverage exclusions

Collision and comprehensive coverage are the physical damage coverages offered by auto insurers.  While liability insurance covers those that you damage, collision and comprehensive cover your own vehicle if it’s damage.

Exclusions under this portion of the policy can be similar in many ways to the restrictions listed in your liability portion of your policy.  Typically, collision and comprehensive coverage exclusions include loss or damage due to:
 

Wear and tear
Freezing
Mechanical or electrical breakdown or failure
Road damage to tires
Catastrophic events - radioactive contamination, nuclear weapon discharge, war, etc.
Destruction or confiscation by government or civil authorities
Using your vehicle for livery or delivery purposes
Vehicle being used for racing purposes
Intentional damage


Vehicle used in personal car sharing programs (some insurers)
Personal items that are damaged in your vehicle or stolen from it aren’t covered, and most policies specifically mention the exclusion of coverage for losses to:
Any electronic equipment that is not permanently installed.

Custom equipment (or is covered to a specific minimal amount -- such as $2,000) unless you’ve added a custom parts and equipment endorsement to your policy.
If a vehicle is excluded from liability coverage, then typically it’s also unable to obtain physical damage coverage.   However, there are some vehicle that insurers allow to obtain liability but not collision and comprehensive -- such as vehicles with a salvage or rebuilt title.

Medical payments and uninsured motorist bodily injury
Medical coverage's you can purchase for yourself as part of an auto insurance policy have exclusions as well.  Typically, they include injuries sustained in circumstances mentioned above, such as catastrophic events, racing or livery service, as well as situations such as:
Injured on a motorized vehicle having fewer than four wheels
Injured while using the vehicle as a residence
Injuries that workers compensation benefits should cover because occurred during the course of work.Besides exclusions, a policy may have other restrictions.  


I would add that a policy exclusion should be referenced from the policy and not from memory. 

Good Exclusion article  Link:   Distinguishing between the Exclusions


Thanks

Thursday, September 3, 2015

Post Claim Underwriting

by Robert Carper
Issues such as Frequent claims, wrong driver driviing the wrong car, the business operated by someone who is not a listed insured or the business location is different than listed. Alterations to the car and questionable driving records could all (among other red flags) cause the underwriter to cancel the policy, increase the deductible, exclude a car or person or place the risk with a sub-standard carrier. A post-evaluation of claims can reveal characteristics of  the loss history that an underwriter may have not been able to detect when considering an application for insurance at the outset. Reviewing a claim can uncover operations and activities that if the underwriter had more thoroughly investigated might have led to either denial of the policy or offering it on a different basis. A number of similar claims could also alert underwriters to an emerging problem with a particular class of policies. As a claims person it is paramount that you alert underwriting of any of the aformentioned.

Robert

Tuesday, September 1, 2015

The court system - How it works

















THE COURT SYSTEM
 
PART -1- SEPTEMBER 2015



As Claims professionals, we often encounter situations where knowledge of the US court system is very important. This 5 part post seeks to explore the court system. In the first part I will provide terminology that is related to insurance claims. Some definitions may have slightly differing meanings but the terms here can serve a good research starting point. As time goes on, I will add to this list.


Robert.

 
  PART -1-  TERMINOLOGY


MOTIONS FOR SUMMARY JUDGMENT
When ruling on a motion for summary judgment, a motion for summary judgment should be granted when the pleadings/discovery, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law. After adequate time for discovery and upon motion, against a party who fails to make a showing sufficient to establish the existence of an element essential to that party's case, and on which that party will bear the burden of proof at trial. On a summary judgment motion, the record and all reasonable inferences that can be drawn from it must be viewed in the light most favorable to the nonmoving party. These motions can be filed by either party and are helpful in resolving part or even the entire case. Many times motions to dismiss are filed that are more appropriate for motions for summary judgment.


MEDIATION
This is where both parties agree on a neutral mediator. The mediator’s fee is usually split between the parties and is an hourly rate. The parties usually discuss their positions in the claim and decide what they are going to offer and what they are willing to accept to conclude the case. Many insurance coverage cases resolve this way than in litigation. More and more courts require mediation prior to allowing a trial to occur.


DECLARATORY ACTION
A declaratory judgment action is filed when a party is in doubt of his/her right and files suit to seek a judgment from the court declaring those rights. These actions can be extremely helpful in coverage litigation. Sometimes a policyholder will file such an action to ensure that he or she is not breaching any duties under the policy. Sometimes insureds and insurers file these actions to seek an answer to a question on coverage or interpretation of a policy provision.


 CASE
A case describes a dispute taken to court. An appellate court decision
published in a book of such decisions is also called a case and may be
used as guidance or precedent by other courts. A person doing legal
research will commonly say that he has to look up a case to see if its
ruling on a point should be followed by other courts. The core legal
issue in a case is sometimes referred to as the gravaman of the case.


LEADING CASE
The most important published case in a particular area of law is called
the leading case. Such important cases are used as guidance by lawyers
and judges who face similar issues later. For example, in the area of
abortion, the leading case is Roe v. Wade.

LITIGATION
Litigation is the process of bringing and pursuing a lawsuit. Litigation
often proceeds much like trench warfare; initial court papers define the
parties' legal positions as trenches define battlefield positions. After
the initial activity, lawyers sit back for several months or years and
lob legal artillery at each other until they grow tired of the warfare
and begin settlement negotiations. If settlement is unsuccessful (90% of
all lawsuits are settled without trial), the case goes to trial, and may
be followed by a lengthy appeal.
Many states have enacted reforms directed at shortening the time a case
takes to get to trial and minimizing the expense traditionally
associated with litigation. Among these reforms are:
* "fast track" rules that prohibit delays and require each phase of the
case to be completed within a particular period of time * limits on how
much information can be obtained from the opposing party * requirements
that certain types of cases be arbitrated (a simpler procedure) rather
than pushed through the court system * requirements that attorneys
inform their clients of alternative dispute resolution procedures such
as mediation, and * court-sponsored techniques such as mini-trials and
early neutral evaluation that are designed to get the parties to settle
by giving them a realistic assessment of what is likely to happen if the
case goes to trial.

ACTION
Action is another word for lawsuit, case, legal matter or litigation.
Cause of action refers to a set of facts that make up the grounds for
filing a lawsuit.

ISSUE
Issue refers to the central point of dispute in a case.

HEARING
A hearing is a legal proceeding (other than a trial) held before a judge
or court commissioner. At a trial, disputed questions of fact and law
are resolved and the case is concluded (although the parties may
appeal). At a hearing, on the other hand, preliminary issues, procedural
issues (including granting an uncontested or default divorce) and post-
trial modifications and enforcements are heard.
 
A.L.J.
Administrative hearings are informal, yet very important. Usually, the
A.L.J. meets with representatives from the agency and the applicant
seeking benefits. The applicant may choose to be or not be represented
by an attorney and in fact, many administrative agencies permit
paralegals, law students or law clerks to appear on behalf of
applicants. Each side presents its evidence and elicits testimony from
its witnesses. The hearing is often tape recorded, as opposed to taken
down by a court reporter. The A.L.J. renders a decision called an
administrative order, which may be reviewed by either a higher level
within the agency or by a court.
 
TRIAL
A trial may be before a judge only or before a jury. Virtually all
family law trials are held without juries.
 
BENCH TRIAL
A bench trial is another term for a trial before a judge only. In
general, the parties begin with the presentation of evidence, although
in some cases they make opening statements. After the plaintiff finishes
presenting his evidence, the defendant presents her case. After the
defendant concludes her presentation, the plaintiff may rebut the
defendant's case. Rarely are closing arguments made. The judge may rule
immediately, but more often takes anywhere from a few hours to a few
weeks to consider the evidence and reach a decision.
 
SUBMISSION
When a judge does not immediately announce a decision, the judge is said
to take the case under submission.
 
JURY TRIAL
In a jury trial, the jury is selected by the parties through a process
called voir dire, where the judge or parties ask jurors questions in
order to determine their biases and opinions. (Each side gets to reject
a certain number of potential jurors.) After the jury is chosen and
sworn in, the parties give opening arguments, present their evidence and
give closing arguments. The jury then deliberates; when it reaches a
decision, it returns to the courtroom and announces the verdict.
The roll of the jury is to decide issues of fact. Parties are entitled
to a jury trial by the federal constitution in those types of cases,
such as breach of contract, which existed in 1789, the effective date of
the constitution. Kinds of cases that have come into existence since
then, however, such as divorce (which in 1789 still fell under the
religious courts) and actions in juvenile courts, are not guaranteed
jury trials. States are free to make jury trials available for such
actions, but few have. In fact, only Texas and Georgia permit jury
trials for divorces.
 
WHERE THE LAW COMES FROM
There are two major ways in which legal principles are developed in the
United States. One is through appellate court decisions in individual
cases, called case law. The other is through the passage of laws by
voters and legislative bodies, called statutes.
 
CASE LAW
Legal principles that are developed by appellate courts when deciding
appeals are collectively termed the case law or common law. Since the
12th century, the common law has been England's primary system of law.
When the United States became independent, states adopted the English
common law as their law. Since that time, decisions by U.S. courts have
developed a body of U.S. case law which has superseded English common
law in most areas.


PRECEDENT
Precedent is a legal principle, created by a court decision, which
provides an example or authority for judges deciding similar issues
later. Generally, decisions of higher courts (within a particular system
of courts) are mandatory precedent on lower courts within that system--
that is, the principle announced by a higher court must be followed in
later cases. For example, the California Supreme Court decision that
unmarried people who live together may enter into cohabitation
agreements (Marvin v. Marvin), is binding on all appellate courts and
trial courts in California (which are lower courts in relation to the
California Supreme Court). Similarly, decisions of the U.S. Supreme
Court (the highest court in the country) are generally binding on all
other courts in the U.S.
Decisions of lower courts are not binding on higher courts, although
from time to time a higher court will adopt the reasoning and conclusion
of a lower court. Decisions by courts of the same level (usually
appellate courts) are considered persuasive authority. That is, they
should always be carefully considered by the later court but need not be
followed.
As a practical matter, courts can usually find precedent for any
direction they want to go in deciding a particular case. Accordingly,
precedent is used as often to justify a particular outcome in a case as
it is to guide the decision.

STATUTE
Under the U.S. and state constitutions, statutes are considered the
primary source of law in the U.S.--that is, legislatures make the law
(statutes) and courts interpret the law (cases).
Most state statutes are organized by subject matter and published in
books referred to as codes. Typically, a state has a family or civil
code (where the divorce laws are usually contained), a criminal code
(where incest, bigamy and domestic violence laws are often found),
welfare code (which contains laws related to public benefits), probate
code (where laws about wills, trusts and probate proceedings are
collected) and many other codes dealing with a wide variety of topics.
Federal statutes are organized into subject matter titles within the
United States Code (for example, Title 18 for crimes and Title 11 for
bankruptcy).


LEGISLATIVE INTENT
Legislative intent is what a legislature as a whole had in mind when it
passed a particular statute. Normally, any given statute is interpreted
by looking just at the statute's language. But when the language is
ambiguous or unclear, courts try to glean the legislative intent behind
words by looking at legislative interpretations (for instance, reports
issued by legislative committees) which were relied upon by legislators
when voting on the statute.
Statutes are often ambiguous enough to support more than one
interpretation, and the material reflecting legislative intent is
frequently sparse. This leaves courts free to interpret statutes
according to their own predilections. Once a court interprets the
legislative intent, however, other courts will usually not go through
the exercise again, but rather will enforce the statute as interpreted
by the other court.


UNIFORM STATUTES
Uniform laws, such as the Uniform Child Custody Jurisdiction Act, the
Uniform Pre-Marital Agreement Act, and others, are model laws proposed
by a national group of judges, lawyers and law professors called the
Uniform Law Commissioners. The commissioners propose the laws; states
are free to enact or reject them.
Topics covered by uniform laws are often ones in which there is much
interstate activity, such as marriage, divorce, paternity, custody and
child support and in which consistency, predictability and uniformity
are desirable. Some uniform laws have been passed by all states (for
example, the Uniform Child Custody Jurisdiction Act) whereas others have
only been enacted by a few (for instance, the Uniform Divorce
Recognition Act). Clearly, the central goal of uniformity is well served
only if a significant number of states enact a given uniform law.


ORDINANCE
An ordinance is a law enacted by a municipal body, such as a city
council or county commission (sometimes called county council or county
board of supervisors). Ordinances govern matters not already covered by
state or federal laws such as zoning, safety and building regulations.

LAWS OF SUBSTANCE AND PROCEDURE
Laws which define legal duties and rights are called the substance of
the law, or substantive law. Substantive laws include the standards for
custody, the grounds for divorce and the right to have an abortion.
On the other hand, the body of laws which tells how to go to court and
get judicial relief is generally called the law of civil procedure.
Civil procedure is predominantly made up of statutes and rules issued by
individual courts.


PARTIES
A person who sues or defends a lawsuit or any person joined in a
lawsuit, such as a pension plan administrator is called a party. A party
has the right to conduct discovery and receive notice of all proceedings
connected with the lawsuit.


PRO PER OR PRO SE
A party to a lawsuit who represents herself, rather than being
represented by a lawyer is called a party in pro per (or pro se). Both
terms mean "for yourself." Pro per and pro se litigants often find it
difficult to do their own legal work because the legal system is hostile
to self-helpers. Arizona and Colorado, however, have implemented an
automated court system that provides people with legal information and
helps them complete court documents themselves. Also, self-help law
books and paralegals who directly serve the public are increasingly
available to help pro per and pro se litigants in many states.


PLAINTIFF
The person who initiates a lawsuit by filing a complaint is called the
plaintiff. When the document that initiates a lawsuit is called a
petition rather than a complaint, the initiating person is usually
referred to as the petitioner rather than the plaintiff.


DEFENDANT
The person against whom a lawsuit is filed is usually called the
defendant. In some states, or in certain types of actions, the defendant
is called the respondent. The term respondent is also used to designate
the person responding to an appeal.


SPECIAL CONCERNS OF PLAINTIFFS AND DEFENDANTS
In Forma Pauperis. In Forma Pauperis is a Latin term meaning "in the
character of a pauper." It refers to a petition filed by a poor person
in order to proceed in court without having to pay court costs such as
filing fees.
In forma pauperis proceedings are available in every state. A person
with a low income (usually eligible for or receiving public assistance)
fills out in forma pauperis papers (indicating income and expenses)
before filing his first court paper (complaint or answer). The papers
request that the court decide whether or not the costs be paid. Although
a hearing before a judge is sometimes needed, the more usual practice is
for the court to grant or deny the request without a hearing.
Military personnel. A person on active military duty is a person who has
enlisted in the armed services and is serving out the term of his
enlistment, or is an officer in the armed services who has not
transferred to the reserves, resigned, retired or been dismissed. A
person on active military duty is prohibited by a federal law (Soldiers
and Sailors Civil Relief Act, 50 U.S.C. Section 501 et seq.) from being
subjected to any civil court action, including a divorce, unless he
consents to the power of the court to hear the case. A plaintiff who
wants to sue someone on active military duty who won't consent must wait
until he leaves active duty. The reasons for this rule are:
* it would not be fair to proceed in court against a serviceperson who
is prevented from attending because of his military duty, and * it would
be too disruptive and expensive for the military to have its members
coming and going long distances just because they have been sued.

CO-RESPONDENT
The "other man" or "other woman" named in the court papers for a fault
divorce alleging adultery is called the co-respondent.


APPELLANT
The person who objects to the trial court decision and asks the appellate court
to review the decision by filing an appeal is called an
appellant (also called a petitioner in some states).


APPELLEE
The party against whom an appeal is filed is called the appellee or the
respondent. Sometimes the appellee will also appeal certain aspects of
the lower court's decision; he then becomes a cross-appellant as well as
an appellee. In this situation, the appellant (the one who filed the
appeal) becomes a cross-appellee or cross-respondent.


TENDER  LIABILITY

Liability caused by the wrongful acts of a lending institution. Lender liability claims most frequently arise when a debtor challenges the validity of a loan agreement in a counterclaim against a financial institution after the institution has filed a collection action. Such claims typically allege: misrepresentation of repayment terms, fraud, economic duress, and withholding of promised credit by the lender.

 
 


Saturday, August 29, 2015

AUTO CLAIMS FRAUD RED FLAGS



             AUTO CLAIMS FRAUD RED FLAGS
By Robert Carper


The two kinds of fruad you will enciunter are:


       Soft Insurance Fraud. Soft insurance fraud (also called “opportunistic” insurance fraud) is the most common type of insurance fraud. Soft insurance fraud occurs when the claimant makes an inflated claim, such as exaggerating the severity of a car accident neck injury.


       Hard Insurance Fraud. Hard insurance fraud (also called “premeditated” insurance fraud) occurs when the claimant devises a way to make an insurance claim. This type of insurance fraud usually involves some sort of deliberate action, such as intentionally causing an accident or staging arson or theft of the vehicle.

Initial Claim

   ·    There are multiple occupants in the claimant vehicle.
     ·  Accident within a month of the termination of the policy.    
   ·    A rental vehicle is involved.

   ·    Accident occurred shortly after one or more vehicles.
     
    ·    Insured insists that claimant caused the accident, such as by stopping suddenly, for no apparent reason.

·     Accident is at low speed with minor physical damage, yet there are multiple bodily injury claims.

    ·     One or more claimants list a P.O. Box or a motel/hotel as an address.

·     Claimants immediately seek attorney representation.

   ·     Address of attorney, auto body shop, doctor, etc., are an unusually long distance from claimant's residence address or work location.
·     Accident occurs at an odd hour, like very late at night when there are few places to drive to at that hour, or in the middle of a weekday afternoon, when most people are at work.

Ongoing Claim

    Vehicles:
    ·     Minor collision results in excessive repair costs.
    ·     There appears to be prior damage to the vehicle.
 ·     Impact is relatively minor but repair shop wants to charge to straighten frame.
      ·     Damage does not align between vehicles. (color of paint transfers, height of damage, location of damage, motion of damage, shape of damage, etc.)
·     More than one vehicle involved in the accident goes to the same auto repair shop.
·     The appraiser has a hard time arranging an inspection of the claimant vehicle, or it is already repaired and thus cannot be inspected.
    ·     "Cash" repair invoices are offered as proof of payment for car repairs, rather than cancelled checks or credit cards vouchers.

Statements:
   ·   Claimants do not accurately describe the physics of the accident (Note: the upper body of an automobile occupant will always move toward the point of impact.)
    ·   Claimants cannot provide minor details of the accident, such as descriptions of landmarks at the accident scene, detailed descriptions of the doctor who allegedly treated them, and how their medical examination was conducted, etc., but only provide a basic story with no further details that one might expect them to remember.
·     Claimants are hesitant or overly vague in their responses to basic questions.
·     All claimants treat at the same facility.
·     The diagnosis, symptoms and length of treatment are very similar for all claimants.
·     Injuries are all of a subjective nature, such as soft tissue injuries.

Medical Reports:

·     The RVS or CPT codes used for the initial examination ends in a "4" or "5" for soft tissue injuries only.
    ·     The RVS or CPT codes for interim or final examinations do not change from the initial examination.
·     Medical treatment is extensive, ongoing for more than 2 months or so, on a minimal impact accident.
·     No claim is made for lost earnings despite extensive medical treatment which would have consumed numerous hours during the normal work week.
·     Medical reports are photocopies, or appear to be of the "cookie cutter" variety, where the claimants' names and data are placed into a computer which then spits out a pre-written report.

General:

    ·     Index returns indicate an active claims history.
·     Claimants seem overly familiar with the claims process.
·     Claimants are overly pushy for settlement.
   ·     No towing charges claimed when damage estimates suggest cars could not, be driven from the accident scene.