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Why is the Insurance Company Not Named as the Defendant in the Lawsuit?

I had a good question today by a reader that inquired as to why he had to file suit against the person that harmed him without putting down the insurance company that he had been dealing with.  That is an excellent question and presents so many layers of legal analysis that I am merely going to skim the top and provide a somewhat basic version.

It’s because insurance companies lobby big money to be the “man behind the curtain” without ever truly having the target on their backs.  In a trial you can not mention “insurance” for either party regardless of type, ie health insurancehomeowner’s insurance, and automobile insurance. Those are considered collateral sources and are not to be given weight by an impartial jury. Yes, yes, we all know about “insurance” even if we were in that magical jury box but it can not be talked about in court by either attorney, plaintiff, or defendant.

We all know that when you are harmed/injured in a wreck by the negligence, omission, and/or ignorance of another, that person’s liability insurance will have to assess the personal injuries and property damage that arise out of all wrecks. OR the “uninsured” policy of your automobile insurance will cover the property damage and personal injuries because the at fault person is without insurance.  Yes, that means your insurance company defends the at fault party against you.

Often times after you leave the scene of the wreck, or incident, in question you never speak with the responsible party. However, you are contacted by the responsible party’s insurance company that then gives you the cold shoulder or acts like you did something wrong.  (I appreciate them doing that because it makes my life so much easier).

OR in a really ironic turn of events, your insurance company then defends the at fault party against you because they really don’t want you to just walk away with those premiums you have paid for the past couple years.  You have to earn them by fighting your own insurance company for compensation for your injuries and property damage! Hilarious, I know.

Seek legal advice anytime insurance companies are involved. You don’t have to retain legal counsel but it doesn’t cost you anything to hear what the law really is in a personal injury case vs. what insurance adjusters reading from a computer to save their company money say it is.

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If We Only Had to Pay Insurance Reimbursed, Reduced and/or Recommended Prices

I am amazed every day with comments made by insurance adjusters or agents, servants, and/or employees working on behalf of insurance companies. Regardless of whether it has to do with my personal health insuranceautomobile insurance, property insurance, and/or other types of insurance.

It all boils down to insurance companies belittling, discrediting, discounting, ignoring, amending, omitting, and/or re-creating invoices, or bills, legitimately charged by professionals for services rendered.–Trey Mills

Let’s look at a few recent examples I have run across just this week:

  1. I needed medical treatment so I went to a medical professional, aka, a medical doctor. This medical professional went to school for over 20 years to be a licensed medical professional. The physicianprovided me with medical advice and treatment I needed. I filed it on my health insurance and when it was all said and done out of the $110.00 bill, my insurance company discounted it by $55.00 for a “network discount”.  I paid my $25.00 co-pay and because I have not met my $2,000.00 deductible, I owe the $40.00  remainder.  What the heck did the insurance company pay for? I am pretty sure if I was uninsured and had the ability to pay in cash I would have gotten a 50% reduction = $55.00. Instead, since I had health insurance, I had to pay $65.00. (Health insurance is truly for cancer and other catastrophic injuries/illnesses that happen in life. Other than that, bend over). There was a great article in the A. Times entitled “Why Require People to Buy Health Insurance”. Admittedly, I would rather have things privatized than governmentalized but what is the difference between an extra tax and mandating people pay insurance premiums? You say tomato. I say tomato.
  2. wrecked my carso I went to the only local certified manufacturer of my car within 100 miles and had the parts repaired and replaced. Since the wreck was not my fault, I notified the at fault party’s insurance company and requested they pay my repair bill (actual costs), my rental bill (loss of use), and depreciation. The at fault insurance company discounted my repair bill by over $300.00 because they felt it was over priced, offered me $10 a day for a rental car, and said that they do not recognize depreciation. (South Carolina law does and when I filed “Arbitration Pleadings” they paid me almost double their original offer).
  3. I have rental property so I needed insurance for those rental properties. One of my houses is centrally located within four houses from Falls Park in Greenville,SC. The lot alone is valuable, not to mention the “historic” two story house that is being remodeled. However, the replacement costs for the house, per the insurance estimate, is astonishingly low. I wonder what builders or estimators are providing those costs? I need to get them in there remodeling the house but then again, it would probably be put back together with glue and toothpicks.

 

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South Carolina Property Arbitration for Depreciation, Loss of Use, & Actual Damages

I have always threatened to take an insurance company to arbitration over their ridiculous offers but never had a client that could afford to take the time and roll the dice on a Battle Royal. Ask and you shall receive. *(see a recent update on this article at the bottom).

Today, I partook in my first property arbitration over depreciation, or diminution of value, due to an automobile wreck and subsequent repair of their vehicle.  This was my first because, as an attorney and business venture, it is not worth the time, effort, or eventual outcome to pursue such action, especially when there are personal injuries that arise out of the accident. The personal injury claims are a much more valuable and worthwhile effort for attorneys to assist. However, I did this one pro bono, gratis, and/or “for free”. Although I did not gain financially from this venture, I was able to gain through experience.  A much more valuable weapon against evil insurance companies.

With most every car accident arises two causes of actions.

  1. Property Damage: A claim for property damage can be in the amount of actual damages (repair costs), loss of use(not having your car/having a rental), and depreciation/diminution of value (the value of your car before vs. after the accident-given that it was in a wreck); and
  2. Personal Injury:Any injury sustained as a result of the physical, mental, and/or emotional impact of the accident, or trauma.

In my case, the plaintiff had her brand new, candy apple red convertible slammed into by a dump truck.  The defendant did not dispute that they were at fault.  The defendant repaired the vehicle and provided a rental but when the plaintiff inquired about depreciation due to the stigma of the car being in an accident, the insurance company said they did not recognize such damages. WHICH IS BULLSHIT and ILLEGAL.  Insurance companies don’t make money paying it out, they make money keeping it.

The highest offer the defendant made was only a couple hundred dollars to my client, even after I became involved.  At arbitration the plaintiff was awarded almost triple the insurance company’s highest offer and it was the insurance company’s expert testimony that helped the arbitration panel make their determination.

Why would an insurance company drag this out and only offer a few hundred dollars? That would be because 80-90% of you will go away and the 10-20% that fight them are cheaper to pay off than the 80%.  It is a numbers game. The more you roll over to the insurance companies, the more money they make, and the more they laugh at you. Don’t let them laugh at you, fight back!

You don’t have to be an attorney to request an arbitration hearing or to file a claim in small claims court. Please go to this link to learn more:

http://www.doi.sc.gov/consumer/auto.htm

South Carolina allows for persons to request an arbitration through S.C. Code Ann. 38-77-730:

 

SECTION 38-77-730. Request for arbitration; no formal pleading and process; arbitration docket; filing of claim; service of summons to defendant.

(a) Any person who is a party to the disputed property damage liability claim may submit his claim for determination through arbitration. No formal pleading or process is required. The clerk of court of each county shall prepare and keep an arbitration docket and set the cases thereon for arbitration as provided by law for the settling of cases in the court of common pleas.

(b) The claim must be filed with the clerk of court in the county in which the cause of action arose or where the plaintiff or defendant resides. The claim must be filed in triplicate with the clerk of court on forms to be provided by him. The forms shall set forth the names of the parties, the date and place of the accident, and the amount of property damage claimed. The clerk shall file one copy in his office, and one copy must be served upon the defendant as provided by law for service of summons and complaints. The sheriff, or such other person, shall promptly serve the claim upon the defendant and shall receive the sum of five dollars to defray the cost of securing this service. The sheriff, or such other person, serving the process shall promptly file an affidavit of personal service with the clerk of court on forms to be provided by the clerk.

(c) There must be attached to, or made part of, the form a summons to the defendant named notifying him that he should file a response with the clerk of court within thirty days from the date of service and that failure to file a response within thirty days entitles the plaintiff to a default judgment. The form must be signed by the party filing it or his attorney, if any, and shall by order of reference show the address of the person signing it.

 

 

SECTION 38-77-740. Hearing; notice to parties; damages to be awarded; securing attendance of witnesses.

(a) The court, or the clerk acting for the court, shall assign the arbitrators to hear the matter at the courthouse, or other designated place in the county where the claim is filed, within sixty days after the date of filing, or as soon thereafter as is feasible. The clerk of court shall, on a form provided by him, advise the parties or their attorneys of record, if any, by mail as to the place, date, and time of hearing and shall advise the parties to bring all records which may pertain to the claim, including, but not limited to, the following:

(1) Two estimates of damage to the motor vehicle or its contents signed by the estimator.

(2) Signed receipts for car repairs.

(3) Bills or receipts for other property damages claimed.

The forms shall also contain notice to the parties that, if they cannot attend because of illness or otherwise, the clerk of court must be notified as soon as possible with the request that another date be set for the hearing.

(b) Property damages must be awarded as provided by law, including, but not limited to, actual damages, loss of use, depreciation, and any other property damages which are the direct and proximate result of the accident.

(c) The parties may secure the attendance of witnesses by their voluntary appearance or may secure their attendance by subpoenas prepared and issued in accordance with the laws of this State.

 

Don’t think being an attorney affords you any differences when dealing with insurance companies. I recently had to go through the same process with an insurance company as a result of a property damage claim. They forwarded me a check significantly lower than the actual repair costs, rental car invoice, and depreciation. I requested an explanation within 7 days and received none. I filed arbitration pleadings in the proper county and had an offer almost double the initial amount within 3-4 days.  Don’t play around with them. File the arbitration papers for $5.00 and then send them an original copy with a reasonable demand.

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Insurance Companies Don’t Care About You: They Care About Your Premiums

In my article, “How Do Insurance Companies Make Money?“, I go over Profit = earned premium + investment income – incurred loss – underwriting expenses.  However, it is not my intention to be that technical this time around.

Insurance companies have many different layers, or divisions, but you as the client, or insured, interact with insurance companies on only 1-2 levels:

  1. Insurance Agent-sells varying forms of the insurance, or service.
  2. Insurance Adjuster– protects the insurance company from losing money on the service for which you paid for the insurance company to provide to you by way of a premium and insurance contract (policy). Adjusters minimize the “incurred loss” in the above equation.

As to the Insurance Agent:

It has been my experience that these professionals provide you with information on the varying types of insurance– property, casualty, life, health, and disability. They should review the different policies they have available and the coverages which those policies provide, along with the price.  However, they are not usually legally oriented or familiar with the “back door” aspect of what they are selling.  Meaning, they are doing exactly what they are suppose to be doing, “selling insurance”.  Your insurance agent will most likely refer you to the nearest consolidated insurance claims center if you were to need the service you paid for by way of an insurance claim.

For example: if you were injured in an automobile wreck, lost your shingles when a storm came through, and/or the property or person you bought insurance on was damaged/injured in anyway.  Your insurance agent does not usually handle that, they refer you to a claim center with insurance adjusters. If your insurance agent is kind enough to assist you with the insurance claim procedure they still have no authority, or impact, in how the claim is resolved.

As to the Insurance Adjuster:

They are usually not in the same state as you.  If they provide you any information about your legal rights please ask them if you can record the conversation or get everything they just “counseled” you on in writing.  Insurance adjusters have not passed any state Bar requirements to be lawyers and/or offer legal advice. They work for the insurance company that makes money when it brings in more premiums that are paid by their clients than it pays out in insurance claims.  Their interest are not aligned with your interest as they are evaluated on ensuring that insurance claim payouts are minimized.

Read-One of the factors that an insurance adjuster is evaluated on for their job and them keeping it is to offer you the least amount of money possible for your injuries and/or property so that their employer, the insurance company, maximizes its profit.

Common Misconceptions I hear all the time in my office:

  • I thought they would do the right thing;(Why would you think that? Again, your insurance agent may be the kindest person in the world but that is not who you are dealing with.)
  • I have never had a problem with my insurance company the 20 years that I have had them(How many times have you had to file an insurance claim? Oh, now the light bulb goes off.)
  • The insurance adjuster told me I didn’t need to get an attorney or another appraiser;(Now why would they not want you to get an opinion other than theirs? *hear Jeopardy music*)
  • The insurance adjuster said I couldn’t go see the doctor;(Why are you listening to anyone other than a doctor in regards to medical advice?)
  • I don’t want to sue anybody;(80-90% of the time no law suit is filed. If one is filed it may list the negligent party but that is because insurance can’t be mentioned in a trial. The insurance company is the one that actually defends any law suits you bring and pays money up to their coverage amount if a verdict is rendered.)

All I ask is that you be informed and educated on the interest of all the parties involved and not just assume anything.

“Knowledge is of no value unless you put it into practice.” — Anton Chekhov

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Where’s the Balance in Life for ________ (Attorneys, Doctors, White/Blue Collar Workers)?

This article was brought on by two separate contacts I had with friends inquiring about the satisfaction and enjoyment I obtained from doing my job. Both of these friends were fellow attorneys but working in different specialties. I was honored to be contacted by them because they are both hard working and intelligent individuals with what would appear to be great jobs. I was a point of reference as someone that truly enjoyed what they did and appeared to gain fulfillment, or satisfaction, in doing their job. That had not always been the case for me and I was delighted to know that my subconscious behaviors had eluded to the happiness in my life.

Even when I passed the SC Bar and became an attorney, my biggest goal was to pay my $125,000.00 in student loans off in three years (before I turned 30). All I worked for was money and how I could make more of it. I was looking past the people I could help, the experiences I could get, the good things I could do with my professional status, and the hard working reputation I could build. I also was fueled by hatred for insurance companies and how they had treated myself and my family when we were going through rough times (cancer). I would take my work home with me both figuratively and literally. I lived and breathed law and when I could not get any reprieve from it, I would drink until I could not think about it anymore.

I was miserable and hated who I was, what I did, and why I had not done more with the extra years I was given. Then I stopped beating myself up, stopped thinking about only myself, stopped worrying about trying to fit my whole life in what I thought was only 3 more years of living and just starting having fun. I realized I had to put my faith in myself to do the right thing instead of other people. I also concluded that whatever happens, happens and I can not control other people. The Serenity Prayer is not solely for alcoholics. It’s great for every day application for anyone. Life is so simple if you just allow it to be.

I had felt my life was in a rut and I never wanted to live like that given the second chance at life I had been given. I always wanted to travel the world, sail the seas, be in movies, date models, and live on islands. However, I also wanted to help people, earn a higher educational degree, and run my own company. In choosing the higher educational degree, I failed to think about who would pay for it and how much it would cost in resources and time.

Now that the student loans are paid down to free money (federal loans at 1% interest) and I have enough investments to pay off my debts, I guess it is time to travel the world, sail the seas, be in movies, and live on islands.   I already consider the girls I date to be more beautiful than models, if not models themselves. ; )

Or, I could continue to do what I enjoy: helping people, suing insurance companies, and getting paid to do it.

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