One of the standard practices by insurance companies in my experience is the delay, deny and defend method of claims handling. This is especially true in first-party no-fault car accident cases involving the payment of basic benefits, such as loss wages and the payment of medical expenses.
Delay, Deny, Defend:
The method is simple. First, delay the payment of insurance benefits by implementing any number of devices meant to complicate the case. This usually includes the insurance adjuster asking for additional medical records, requiring irrelevant paperwork from an employer, or asking for more information from a physician to substantiate the injury. As one can imagine, obtaining the information can take some time. Even worse, once the insurance company receives the information it claims it so desperately needed, it will sit on the information and do nothing to move the claim along.
After delaying the claim, the insurance company will then deny the claim. This is usually done through the use of an IME (independent medical examination). An IME is an examination of the client by a doctor hired by the insurance company who is paid to say either (1) you are not injured, (2) you may be injured but it wasn’t caused by the accident, or (3) you are injured and it may have come for the accident, but you are fine now and don’t require any additional treatment.
Sometimes this doctor may say all the above.
However, an IME is not always used by an insurance adjuster to deny a claim. I’ve come across adjusters who will simply deny a claim because it just doesn’t want to pay any more, or the adjuster doesn’t like the injured person and wants to be done handling the claim.
Once the claim is denied, the insurance company hires its army of defense lawyers to defend the denial. This team will utilize many different schemes to defend the insurance company’s usually absurd decision to deny the claim.
The delay, deny, defend procedure is obviously extremely frustrating to car accident victims, their friends and family. I think a more accurate way of describing the tactic is it’s tragic. I’ve had clients lose their homes to foreclosure. I’ve had clients their cars to repossession. I’ve had clients become depressed and despondent, unable to recognize the life they once led. Because the civil justice system works frustrating slow at times, it is also very frustrating for someone like me, who desperately wants to help my clients receive the benefits and compensation they deserve.
However, the delay, deny and defend method can prove to be treacherous for the insurance company. In Michigan, no-fault carriers can be forced to pay penalty interest if they fail to pay benefits once they receive reasonable proof. In addition, attorney fees can be obtained from the insurance company if the denial was unreasonable. Unfortunately, these types of penalties provide little comfort to the car accident victim who has gone without wage loss benefits or medical treatment for many months because the insurance company refuses to pay the benefits it was supposed to.
Fortunately, there are Michigan car accident lawyerswho are dedicated to battling insurance carriers against their nefarious and absurd activities. Our office has a staff ready to do battle against their adjusters and attorneys to get the no-fault benefits our clients need and should get.
