This article introduces a three-part series covering over a dozen largely legal and contractual principles, many of which are used by attorneys to resolve contract disputes. Most of them can also be used by agents and consultants to resolve insurance …
Step 2 of the claim resolution process involves interpreting policy provisions that are cited as the basis for a claim denial. This step (and Step 3) employs up to 12 interpretive doctrines and 17 largely legal and contractual principles for …
If you have been following this 12-part series, welcome to the home stretch. In the first six articles, we’ve examined why claims are denied and how to avoid or prevent such denials, concluding with an introduction to a four-step process …
Resolving claim disputes involves a four-step process of reading, researching, documenting, and pleading your coverage position. This process evolved from a series of seminars I introduced in the ’90s. However, when I sat down to write the book on which …
In the past two columns, we’ve examined the importance and value of avoiding or preventing claim denials so we don’t have to deal with resolving them, especially with the specter of litigation hovering over us. As Dalton, the protagonist in …
Avoiding Claim Disputes Through Prevention In last month’s column, I enumerated seven factors that enable one to avoid or prevent claim disputes: (1) Having a good historical perspective of the industry; (2) Understanding and embracing two foundational industry premises; (3) …
So, your customer has had a claim that has been denied, but you believe it’s covered. What to do? Well, if you have a time machine handy, the best thing would be to return to the time before policy inception …
While Understanding Why Some Claims Are Denied In the first column of this series, I provided an overview of what it takes to successfully resolve coverage and claims disputes without litigation. In the coming months, we will be examining each …
An independent agent in a small rural town insured a farmer whose barn burned down. The agent had failed to schedule the farm structure, so the farm policy did not cover the total loss. The agent routinely placed farm business …
