In many ways, insurance is a lot like a game. The goal? Trying to get a payment for a claim since you have been paying insurance for that very purpose: Protection against large expenses due to unforeseen events. However, opposing you is the insurance company, which will be on the look out for red flags and indications that fraud may be at work. What you say to your insurance agent can mean a delayed claim — or even one that ends up denied. If you want to come out on top and be the winner, here are four things to avoid saying to your insurance agent:
It is important to realize that most standard homeowner’s policies do not cover floods. You have to purchase separate coverage to protect against flood damage to your home. So, using “flooded” as a description of what your bathroom looks like, thanks to a burst pipe immediately gets your claim flagged. As far as the insurance company is concerned, a flood is something that happens when weather is involved or the nearby pond overflows. And that is not covered by your homeowner’s policy. So before you frantically call and mention that you’ve got a “flooded” room, consider your word choice. If you have a burst pipe or some other water-related problem that is covered by your homeowners insurance, mention that. “My water main burst” is all the description you need.
One of the biggest red flags when it comes to auto insurance is the word “whiplash.” Fraudulent claims related to this neck condition are quite numerous and costly for insurers. If you say you have whiplash, then it is possible that your claim will be flagged. While it may not necessarily be denied, it could be delayed for a rather inconvenient amount of time. Realize that whiplash is, in fact, a specific medical term for a particular condition. Unless your doctor has actually diagnosed you with whiplash, describe your condition as “neck pain.”
3. “Send a check”
The theory behind an insurance company paying a claim is that you will use the money to fix a problem. With health insurance, it is pretty straightforward: For the most part, the insurer is billed by the health care provider and pays the bill directly. However, for homeowner’s insurance, and some auto insurance, you might get a check that’s meant to defray the cost of repairs. Note though, that you don’t want to actually say the words “send a check” to your insurance agent. That could be an indication that you are not interested in getting your car’s dent repaired or your leaky roof fixed. Insurance companies don’t always check up on you, but if you seem fixated on getting a check, your claim may be red-flagged for further investigation, delaying the needed funds.
Understand that most health insurance policies do not cover true experimental procedures. If you tell your insurance agent that a treatment is investigative in nature, you may be denied coverage. It is also important to realize that when a health care provider says that s/he will experiment with a treatment, it doesn’t necessarily mean that the treatment itself is experimental in nature. Find out from your doctor whether or not the treatment has been shown to be reasonably effective, and whether the doctor sees it as medically necessary. Get the word from your doctor before classing something as “experimental.”
What This All Means
The words you use are really important, and what you say to your insurer, especially in an official statement, can come back to haunt you. When speaking with your agent about a claim, make sure that you stick to known facts. If you don’t know something, you need to say: “I don’t know.” Don’t guess. And don’t lie. Try to avoid speculating on causes of the problem. Your insurance agent doesn’t need a detailed history of why you think that pipe burst. Just say that it did, and point to your documentation of the damage, or refer the agent to the documentation from the claim representative. You should also ask for a copy of the statement your agent takes, or a transcript of any recording. This way, you can go through and check for inaccuracies or other problems.
It’s ultimately up to you to make sure that your insurance claim starts off on the right track. Knowing what will red flag your claim can help you avoid potential pitfalls.