What to say to your insurer…and what not to say!
By Valerie S. Nosek
You’ve been in a car accident, you’re receiving a new medical treatment, or perhaps you’ve had a water leak in your home. The common factor is that now you’re involved with filing an insurance claim. But did you know that what you say or how you explain an incident can impact whether a claim is processed quickly or is denied?
A recent article at MSN Money, “5 Things Never to Tell Your Insurer,” highlighted five things everyone should be aware of when speaking with an insurance company. “When making an insurance claim, what you say can mean the difference between a fast payment check and a nightmarish process. Insurance companies are sensitive to certain words, and using them incorrectly could result in a claim delay or even denial,” the article said.
Of course, one should never lie or mislead an insurance carrier. Lying or misrepresenting the facts is considered fraud. Instead, use words that accurately describe your situation.
Here’s what to watch out for:
- Flood – Don’t use the word “flood” inappropriately. If the water line to your washer bursts and you don’t realize this until you’re up to your knees in water, that’s NOT a “flood.” Be aware that when an insurance company thinks of a “flood,” they think of water from a lake, river or other body of water…a true flood is not covered by insurance unless you specifically have flood insurance. So, be careful how you describe an incident of water damage in your home.
- Experimental – “Avoid using terms like ‘experimental,’ ‘investigational,’ or ‘clinical trial’ when you need a medical treatment that isn’t common practice,” said the article. Health insurance companies will typically deny treatments that fall into those categories. Always refer to required treatments as “medically necessary.”
- In my opinion – Quite simply, don’t offer your opinion. As Joe Friday from Dragnet would say, “Just the facts, Ma’am!” A common example of this type of mistake is when an accident occurs, the person involved will estimate rate of speed, distance etc. Don’t do it. “If your estimates of such things are wrong, they could be used against you,” said one expert quoted in the MSN article. This same person reported cases where clients were found “at fault” because of the information they provided. But be prepared for an insurance adjuster to try to get you to make these estimates. They will ask you the same questions a number of different ways – stay away from making “guesstimates.” Unless you were looking at the speedometer when the accident happened or you had a tape measure to record the distance between cars, you can’t accurately provide that information.
- Sorry - In the case of an accident, avoid saying “I’m sorry” because that can be interpreted as an admission of guilt, even though you were just trying to be nice. Also avoid saying “It’s my fault,” or “It’s not your fault.” Don’t interpret the situation or theorize about what happened, why it happened, or who’s at fault. Describe what happened factually and to the best of your ability, but let the insurance companies figure it out. Also, ask your insurance company if you should talk to the other party’s insurance if they call you. Some insurers will want to deal directly with the other company. Don’t allow a recorded statement unless you’ve gotten the OK from your insurer.
- Whiplash – The article warned that insurance companies often associate the term “whiplash” with exaggerated or fradulent claims, so avoid using that description. Always refer to your injuries in medical terms or wait until you receive a diagnosis from your doctor.
Some other tips of what not to do after a car accident included:
- Don’t make friendly conversation with adjusters. Stick to business – who, what, when and where – don’t even tell them the “how” it happened.
- Don’t give out information about your family members.
- Don’t give out the names of your doctors.
- Don’t sign a medical release. Medical records are protected, but if you sign a release, the insurance company may comb through all of your medical history, even reviewing care not related to the accident.
One of my duties as the EAP Coordinator for Ease@Work is to research and write informative articles related to our employee assistance program services for our bi-monthly Employee and Frontline Advisor newsletters. In preparing for the upcoming newsletters, I recently came across “5 Things Never to Tell Your Insurer” at MSN Money and thought this information would also serve our blog readers well. If you receive our Ease newsletters, you’ll find the related article in the News You Can Use section of the Jan/Feb 2010 issue.
