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

 

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