How to Pursue Insurance Claims

Dealing with claims - General Guidelines

1. Maintain call logs - For each call, note down
- Date, time and duration of the call
- Customer service rep's *full name, rep ID, call center location
- Supervisor's name if you got transferred
- Conversation highlights

2. Always stay calm and never be rude. Be mindful of claim center reps' situation. They spend their whole day fielding tough questions from irate customers. They will certainly help you if you are nice to them; otherwise they will play by the rules hard and fast. Explain your position and ask them to help you out. Remember, they have nothing to lose and your fight is against the company, not the rep

3. Do not call during peak hours and Mondays They will not be able to spend time with you during business hours. Avoid morning hours, lunch time and Mondays.

If you have followed the above guidelines, you can deal with most of the claims. But then there are tough claims which requires a special approach.

Dealing with tough claims - How to play the game

1. Gather all details at once before you make the call - Collect all the details such as account #, model #, service contract, claim center's 800 # etc. I prefer to keep this info online so that I will have access to the details from anywhere. You can use a draft email saved copy, or Google Notepad kind of online service. Use the same notepad to add call logs each time you make the call. If time permits, collect details of similar claim denial issues - from your friends or from the experiences posted on the web

2. Pay attention to agent's greeting message - Greet the agent and note down her/his name, call center location and time in your call log immediately. Address them using their name to make them feel respected.

3. Explain the problem patiently and ask them to help you resolve it. Understood, you are frustrated and dissatisfied with the service, but stay calm and respectful. You cannot get personal and express your anger against the agent, who is not directly responsible for the situation.

4. Provide details of your sincere efforts to resolve the issue - Justify as to why you think this claim should be processed. Explain how many times you have called before and mention the name of the rep you spoke last time.

Playing Hardball - They won't listen. What Next?

5. Call some other time - Some reps are helpful, so repeated calling will help most of the times.

6. Speak to a supervisor - This won't help much, but you can give it a try. Supervisors are specialized in dealing with irate customers and will not be of much help.

7. Loyalty Threat - Tell them you have been a loyal and long time customer and you will be disappointed if they do not honor your claims

8. Contract Termination Threat - Tell them you will terminate their service if the issue is not resolved. But do not cancel the service on the same call. Call at some other time and ask them to terminate the service as the very first thing. When they ask for the reasons, explain your problem. Your case will be considered more favorably now. Do NOT terminate the contract before you have completed remaining steps here.

9. Badmouthing Threat - Warn them that you will drag them through the mud by publicizing your bad experiences. You should be willing to report the problem to news papers, TV channels, online discussion forums, blogs and finally set up a website and collect all similar experiences about that company. Check out this video - how one homeowner won his insurance claims with the help of a TV channel

10. Official Complaints with BBB - You can complain with Better Business Bureau (BBB), which will be happy to resolve the complaints and mediate between businesses and customers. BBB is not a govt. organization but it does promote integrity and business ethics in the marketplace. It will also keep public records of all complaints and companies do not want to be blacklisted there.

11. Official Complaints with State Attorney General Office - If you honestly believe that you are victimized by a business, lodge a complaint with the attorney general's office. They will launch an inquiry. Nevertheless, you can threaten your insurance company about that you will contact attorney general's office.

12. Law Suite Threat - Threaten them with personal or class action law suite. Do not use this threat unless it is really necessary. Most of the companies have their position covered legally and this may not work unless they are engaged in unlawful practices

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