I got burgled and my insurance company think it wasnt a geniune burglary and i dont know who to turn to.?

Question

my insurance company have got a consultant to deal with case and the consulant doesnt believe this a genuine burglary, i have been upset with the nasty letters they have sent me, querying everything that i put in my claim, not once but twice. i have provided him with the answers but he still aint happy. has anyone been in this situation themselves with Privilege insurance?

Answer 1

I would suggest that you ignore the first answer. I'm not sure what happened to him in the past but he is way off base. The insurance industry is one of the most highly regulated industries at the state level. Every word in your policy has to be approved by the state, Every rate structure has to be approved by the state. The fines for improperly denying claims are too high to make it worthwhile to deny them as a regular course of business. I'll get of my soapbox now and try to give you some help.

I'm a claims adjuster and assuming you are in the U.S. here are some suggestions. If you are not in the U.S. you can stop reading this now.

You need to understand that fake theft claims are one of the most common fraud claims out there. Especially, when the economy takes a dive like we are starting to see now. I'm not saying your claim is fraudulent, I have no clue, but any theft claim is going to be looked at very carefully. Any "red flag" that comes up will lead to a more thorough investigation into the claim.

We don't just deny claims for the heck of it. When you have 200+ claim files the only good ones are the ones you can pay and close. A denied claim is much more work than a paid claim. Many adjusters have too many files and will look for a reason to PAY your claim because it is quicker and allows them to move onto the next claim. A denied claim leads to long, angry phone calls, lawyers and Insurance Commissioner complaints. Very few adjusters have time for that stuff and will try to avoid them if they can.  

Many people over report what was stolen as far as amount of stuff and the value. If the list of stolen items includes a bunch of high end stuff without receipts, photos or owners manuals as proof of ownership. The company will push harder for other documentation such as credit card bills etc. to prove ownership. I have handled claims where people were paid for  higher end stuff, but when the thief was caught and the items were found they weren't high end things at all.

You claim can be totally legit but still have some "red flags" so you might get stuck with a more complete investigation like you are seeing. Although it is hard, try not to take it personally.

If you haven't already done so get a copy of the police report and read it carefully. Many times the insurance company will see something in the police report that can get a fraud investigation going. You need to know what the police said about this theft because if there is incorrect info in the report  you need to see if you can get it corrected.    

Also, if you haven't already done so talk to the investigator and find out exactly what their concerns are. That way you can figure out what you can provide to erase those concerns.

The state insurance commissioners office might be able to help also. If you file a complaint with them they can contact the company and see what is going on. Filing a complaint is not a guarantee that you will get paid the next day, but claim adjusters hate doing the reports that the Insurance Commissioner requires to answer a complaint.

You might also want to try talking to the claim manager at the insurance company. If you do so, stay calm and professional. Screaming and the like will get you nowhere in a hurry.  

Regarding getting a lawyer. That is only going to cost you money. No lawyer I am aware of will take a case like this without billing you on an hourly basis. Most lawyers don't have a clue how theft claims work and they don't scare insurance companies. The only time to get a lawyer in a theft claim is if you get charged with fraud by the county/district attorney.  

Good Luck and if your claim is legit it will get paid. It may take more time than you care for, but it will get paid.

Answer 2

Well said Fighting.

I second every thing you said.

I can also confirm that it is much easier to pay a claim than deny it.  I would much rather pay a claim and boogie on to the next one than have to deal with a denial. I've got more claims to work than hours to work them in.

Get your documentation together. Do you have photos that might show that tv in the back ground? Does not matter if little Johnny opening his Christmas present is the focus of the picture-- if you can see that tv in the back ground, that's proof you owned it. If the item was a recent purchase, you can usually go back to the store you bought it from and get them to print another receipt for you.

Good Luck and Fighting really did give you sound advice.

Answer 3

Yes, insurance companies will try to weasel out of paying claims.  This is common.

It sounds like the insurance company has already targeted you, and doesn't plan on meeting their contractual obligations to you.  They may offer you a little money to shut you up, and it's your call whether you take their first offer or not.

If you want, you can fight them.  If it is a large claim, you can probably get a lawyer who specializes in bad faith insurance to work on contingency for you.  If it is a smaller claim, you probably won't find someone to work on contingency for you, but it might be worthwhile to speak to an attorney and have them write a threatening letter or two on your behalf.  Don't be intimidated into not calling an attorney - almost every lawyer will give you a free initial consultation where they will try to determine if you have a case or not.

I have a link in the links section to a nonprofit that provides information about bad faith insurance, and it can also provide referrals to attorneys in your area.

Oh, and ignore the thumbs down on this post - they probably come from insurance agents who actually believe that insurance companies pay claims without hassle.

Answer 4

Nice answer by Fighting!  I agree that adjusters would rather pay and close a claim than deny it.  Denying a claim usually only ends in suit.  Litigation is a long drawn out process, and takes up way too much time.  Time adjusters do not have with pending case loads of 200 or more.  

There is obviously a reason why your claim has been red-flagged.  I suggest you contact this consultant and/or adjuster and ask them if your claim has been accepted.  If not, why not.  Do not become belligerent, you WILL NOT get anywhere with a bad attitude.  They are contractually obligated to at least provide you with the current status of your claim.   If you still feel that you are getting the run around, consider file a complaint with you state's Insurance Commissioner.