---- Insurance Business Model – How to Fight a Monster ----

Sums it up well

Allow me to begin with an insurance joke I have heard that will very much set the tone of the article:

An insurance representative is called out on site to inspect damage to a home for an insurance claim. Upon arrival the insurance representative sees significant damage to the homes roof and two structural walls. The home owner states that the damage was caused by meteor which crashed through the house and it was covered in his insurance policy as discussed with the insurance salesman. After reviewing the policy and claim the insurance representative informs the home owner that his policy does indeed cover him for meteor damage. However, the moment the meteor hits anything on the earths surface it becomes a “meteorite” which he is not covered for, so unless the home owners house was orbiting the earth when it was hit he would not be covered by the policy… boom boom tish !!!

Now this may be a joke but it is a great representation of what insurance is all about. Insurance companies will lean on our emotions and feed you scenarios which sound feasible and scary to experience. There are multiple psychological tactics, assault would probably be a better word, to get people to get on board with the various policies covering a multitude of possessions that anyone could potentially insure, things like home, car, pets and life insurance and much more. But this is not the focus of the article, what I want to highlight is the business model that insurance companies use to make their money and what that means for policy holders.

The insurance business model follows something like this. The insurance company sells you the fear that something horrible may happen and you should be protected from this tragedy should it happen. Insurer creates a document policy which gives the perception that should horrible situation happen your loss will be compensated quickly and without hassle. You pay considerable amounts of money for aid policy to be in place year after year. Now here is where the magic happens. When that event does happen the insurance company does everything in its power to evade its duty in fulfilling its obligation to comply with their part of the policy. To be blunt their business model is to take your money in case something happens and when that something does happen, its their job to try get out of it… that is how they make their money.

Now the means that are utilized by insurance companies to evade their responsibilities can vary, but generally involve ‘expert testimony’ from professionals in the field who are paid by the insurer to present evidence which ‘proves’ the insurer is not liable. It can also take shape in the form of ‘word play’ such as in the joke at the beginning of the article, where it is implied that coverage is present when in fact it is not. There can also be attempts to represent the claimant as a fraud trying to ‘leech’ the system. Data manipulation is a staple of building a case to dismiss the claim. Utilisation of confirmation bias, which is highlighting areas which support the insurer’s case while ignoring data which is in opposition to the insurers benefit. However, this is just the tip of the iceberg and there is much, much more in the form of tactics to be aware of.

Dr Evil

The truth is that there is an entire ecosystem build around the claims and insurance payouts, it is a vicious game that cares very little for the victims of loss and is concerned with mostly taking their pound of flesh from your claim. You are given a number and told to wait in line to be chewed up and spat out by the system.

So if the insurer tries to give you the shaft what can be done to weaken the monster? what can you do to defend yourself?

• First things first ALWAYS have legal representation, not matter how you feel about it. Those without legal representation can be easily taken advantage of, you NEED IT period.
• Document the incident in writing and in as much detail as possible as soon as possible, don’t leave anything out, explain in great detail every facet of the situation. Take photos if needed and keep all the data pertaining to the claim in one file. Back up the file on numerous devices
• Phone calls are almost impossible to present as evidence, when communicating do so in writing and request the insurer and service providers do the same. This means discrepancies are well documented if needed in the future when the truth is questioned.
• Arm yourself with data and information. The professionals hired by the insurer rest on their ‘degrees’ as proof of their word. However, they rarely cite any references in expressing their opinions. Use “Google scholar” to find scientific papers which are contemporary and peer reviewed. It is often the case that the “opinions” of these “professionals” contradict modern science… the more you know.
• Compliance, do what the insurer tells you to. Even if it makes little sense to do what they ask. The insurer is looking to close the case by any means and noncompliance is an easy out for them, when you are angry it can feel good as an act of defiance, but its exactly what they want. If you do as you are told and make notes of the unreasonable things they are asking you to do, then forward it to your legal team, it can be handled appropriately.

These are some basic guidelines that can help in collecting data to support claims. However, rules and regulations will vary depending on where you are located, country, state etc. as legislation is different worldwide. That being said it is useful to have documentation which can assist in presenting a case and you never know what can be helpful when entering the arena to battle these monsters.

the psychological impact of being consistently scrutinised, measured and weighed can be incredibly overwhelming. It is important to practise self-care in these times and seek assistance from professionals (counsellors, psychologists, etc.) if it seems that there is any mental deterioration while going through this experience. Often individuals can experience depression and anxiety, panic attacks, suicidal thoughts and more. It is important to share these thoughts and feelings so interventions can be put in place as early as possible.

It is a hard battle to fight and endure, let alone win. Hopefully some of this data has been useful to anyone going through this kind of thing right now. Sometimes it feels like these kinds of things are beyond us and that we don’t have the ability to do anything, but we can be our own best advocates in these situations. The field is fraught with complacency and you end up feeling like just another number in the system. I strongly urge everyone to do their own research and pass the data on to their legal teams, insurance companies, service providers and anyone involved in their case. You may find that you end up teaching them a thing or two about their area of expertise.

I will be expressing more in regards to my own experience in the future and displaying some of the actions i have taken to counter unfair treatment and data manipulation.

Sucker Punch