See the full video at https://youtu.be/QgrIYI0K_SQ  Professional insurance adjustment and insurance fraud
At the turn of the century, insurers decimated their profits professional staff. They fired experienced staff and replaced them with young, uneducated and unprepared people.
A virtual clerk replaced the old professional damages manager. Process and computers replaced skill and judgment.
Insurers intentionally forgot that promises from an insurance policy are kept by the professional claimant. A professional tort staff is a cost-effective method of avoiding disputes.
The professional tortfeasor is an important part of the insurer's defense against disputes against insurers for breach of contract and for detecting and defeating attempts at insurance fraud.
A staff of claims personnel dedicated to high-quality skills management is a profit center for an insurance company. Experience shows that professionals resolve more claims for less money without any of the parties having to involve advisers. A happy insured or tortfeasor who is happy with the outcome of his or her claim will never sue the insurer.
Incompetent or insufficient claims staff force insured and claims to lawyers. Every study carried out on damages shows that damages with an insured or tortfeasor represented by a lawyer cost more than those where counsel is not involved.
Excellence in Claims Handling
Excellence in claims handling is a program that can help insurers to avoid charges for bad faith in both first and third party claims.
An insurance company must understand that it cannot fulfill the promises it makes to the insured and the law of fair claims that exists in almost all states, when dealing with tortfeasors without excellence in claims. management. An insurer must work intelligently and vigorously to create a professional claims department.
Insurance managers are:
- People who can read and understand the insurances issued by the insurer.
- They understand promises from and their obligation, as the insurer's indemnity staff, to fulfill the promises.
- They are all competent investigators.
- They have empathy and recognize the difference between empathy and sympathy.
- They understand medicine related to traumatic injuries and are sufficiently knowledgeable in tort law to treat lawyers as equals.
- They understand how to repair damage to real estate and personal property and the value of the repairs or property.
- An insurance company whose claims staff consists of persons less than insurance claims professionals will be destroyed by costly and counterproductive disputes.
A proposal to create professionals for damages
To of oid allegations of bad faith; to avoid punitive damages to avoid losses; and to make a profit, insurers must maintain damages that are dedicated to excellent skills management. This means that they will ensure that all promises made in each insurance are fulfilled.
What resources are available for education?
Insurance training is available throughout the country through correspondence, in local colleges and universities and from law firms that will provide the training as a marketing tool. None of these sources are aimed at producers of insurance claims. They provide the basic background information needed to begin the process of becoming a professional liability insurer. In that regard, I have created electronic training programs on professional damages management that are available from experfy.com and another set of courses from illumeo.com.
An excellence in the claims handling program may include a series of web-based lectures. is supported by text materials such as my claims books available on amazon.com and through the insurance claims library on my website https://zalma.com.
The web lectures must be supplemented with meetings between supervisors and injury staff on a regular basis to reinforce the information learned in the lectures.
In addition, the insurer must set up a regular program for reviewing claims files to determine compliance with the substances studied. There is no quick and easy solution. The training takes time. Learning takes longer. The insurer's management must support and strengthen the training regularly.
It takes courage to fight insurance fraud
The various legislatures, the United States Congress, the National Association of Insurance Commissioners, the National Insurance Crime Bureau and insurance industry groups have finally decided that the war on insurance fraud is worth fighting.
Until the states, the local police authorities, the district attorneys, the United States attorneys and the attorneys general of the various states participate in the battle, it will fight to the death. The insurance industry cannot successfully fight insurance fraud alone.
Insurance industry sources estimate insurance fraud ranges from low levels of $ 80 billion ($ 80 billion) per year to a peak of $ 300 billion ($ 300 billion) per year. Regardless of which, if any, estimate is correct, the money that goes to insurance offenses is staggering and approaches no less than 3% to 10% of the premium collected.
Insurance fraud is not a local problem. It is an impoverishment of wealth throughout the country. The lawyer for the insurance department in each state is the public prosecutor. A special unit could be set up in the office of the Minister of Justice, funded by money from the insurance industry to support the war on insurance fraud. The unit should be given a simple mandate: Register and prosecute all insurance frauds committed to the unit by the fraud division that has more than a 50% chance of success.
Individual bills should be prosecuted. When prosecutors file several charges against individual defendants, the case becomes a major measure that requires a lot of time to be prosecuted. Judges and juries do not want to be involved in a prosecution that takes several months to prosecute.
If there are multiple bills available, the prosecutor should only charge the one where the evidence of fraud is overwhelming. If the jury finds for the defendant, the prosecutor can debit the next bill continuously until the statute of limitations expires.
Opinions across the state must be consistent and true punishment. I have seen such an inconsistency where the criminals, after conviction, received sentences ranging from 24 hours to 24 years.
It is not enough for the state to say that insurance companies must investigate and work to combat fraud. The state must also aggressively and vigorously fight insurance fraud.
If legislators really want insurers to fight insurance fraud. whether legislators want to maintain their strong and viable important industry; if legislators want to reduce the insurance premiums paid by their constituents, they will practically have to wage the war on insurance fraud. As long as the damage of bad faith and the exposure of punitive damages hang over the insurance companies, the war will be a decay where no one wins.
The stories I have fictionalized in my book " It's time to write Abolish The Tort of Bad Faith to show how insurance fraud takes money out of the pockets of innocent and honest people who buy insurance. For every dollar that taken by a fraud, the insurer must collect two dollars in premiums.Every person in the United States who does not commit fraud pays to support those who do.At least $ 20.00 for every $ 100.00 that each insured pays in premiums goes to the insurance criminal If the stories in this book make the reader angry, write to your local District Attorney, Attorney General, Attorney General, or U.S. Attorney and let them know about your anger. Think of the summary of the case that follows as an example of how difficult it is to fight effectively. insurance fraud when a fraud that has been proven with overwhelming evidence is still needed to go through trial and appeal before the insurance crime the nal was sent to prison.
© 2020 – Barry Zalma
Barry Zalma, Esq., CFE, now limits his practice to employment as an insurance consultant specializing in insurance coverage, insurance claims handling, fraud and insurance fraud almost equally for insurers and insurers. He also acts as an arbitrator or mediator for insurance-related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims lawyer and more than 52 years in the insurance industry. He is available at http://www.zalma.com and firstname.lastname@example.org.
Mr. Zalma is the first recipient of the first annual Claims Magazine / ACE Legend Award.
For the past 53 years, Barry Zalma has devoted his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to enable insurance companies and their claims staff to become insurance claims personnel.
Go to Barry Zalma videos on Rumble.com at https://rumble.com/c/ c-262921
Read posts from Barry Zalma at https://parler.com/profile/Zalma/posts  Listen to the podcast: Zalma on Insurance https://anchor.fm/dashboard/episodes Zalma on Insurance
Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg/ [194590gotoinsuranceclaimslibrary-https://zalmacom/blog/insurance-claims-library/
https://visitor.r20.constantcontact.com/manage/optin?v=001Gb86hroKqEYVdo-PWnMUkV7pkuOtkiv6oakpgK33CNlNAYW-WBlLCOZFtgvpSdcL7R-tsWKfMVqG6fEuvmM7Hh7gUEJ7yKOdgHDbGl_cGAU%3D  like this:  Like  Loading …  Related