Six Things To Avoid Saying to the Insurance Company in a Claim

by Miranda Marquit · 18 comments

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 lookout 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:

1. “Flooded”

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 the 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 homeowner’s insurance, mention that. “My water main burst” is all the description you need.

2. “Whiplash”

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.

4. “Experimental”

Understand that most health insurance policies don’t 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.”

5. “I think, or it’s probably because…”

There’s no place to play detective or medical doctor in an insurance claim. It’s very important that you stick to the facts and not assume you know why something is broken or why you have body aches. Try to avoid speculating on the 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. As anything can be used against you, it’s best to just tell the agent everything that’s happening without offering too much additional color because you never know how something you say is going to hurt you.

6. “I’m Good”

Most people will answer that things are good when someone asks how their day is going, but a response that’s too positive and peppy may give the insurance agent the impression that the situation is not as serious as it is. You don’t want to lie, but you definitely don’t want the insurance agent to believe that you are exaggerating your difficulties if, for example, your back is really bothering you.

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. 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.

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  • Vicki says:

    Never ever say too much to the assessor, or you’d be surprised when they deny your claim. And that’s not the worst because at least you know what to dispute about. The worst is that they lower your claim amount without you knowing what happened just because you decided to be a blabbermouth.

    Good article.

    • David @ says:

      Good point about not even knowing you lost out sometimes. It’s probably why there’s a whole industry that helps people get as much as they could out of a claim.

  • TeresaCampos says:

    Thanks for sharing these tips about how to communicate effectively with insurances companies. Using the wrong vocabulary or saying certain information can change a claim completely. It always right to say the truth and only state facts. When filing a claim it’s not a time to self-diagnose a situation.

    • David @ says:

      It’s definitely a case of “it’s better to be safe than sorry”!

      Don’t offer too much unnecessary info!

  • Taylor Hansen says:

    It’s good to know that the word whiplash can have a claim be flagged and it should be described as neck pain. I need to find a new insurance agent that can help me know what kind of premiums I can benefit from. I’ll be sure to keep this mind and avoid saying these things when I get a new insurance agent.

  • Lauren says:

    Everyone wants to say that Insurance companies are a-holes, but the point it, they have to be, because there are too many people out there scamming, filing false claims, or completely exaggerating when it comes to filing their “claim”. I work for an insurance company ,and far too often, you have an individual filing a claim every month. Redflag, and they are denied. Then, they get dropped. If you didn’t know, there is a criteria that underwriters follow, which could be different for every company, but one thing that they do look at, is your claim history, the more claims you have, the higher your premium will be. Even innocent people in a specific area, town, city, will pay more, the more claims that are filed within an area. You can thank your fellow freeloaders for that. If you live in an area where crime is more affluent, everybody pays more. If you’re insurance goes up at renewal and it’s for a “general rate increase for your area”, don’t call you insurance company and complain about it going up and bring up how you have no accidents or tickets. It’s because somewhere along the lines, the people in your community have been filing claims, getting into accidents, and driving wrecklessly, and unfortunately that is going to hurt your pocket. If that makes you angry, move.

  • Neklce heart says:

    Be ware from the Mid man , means Agent .A human body cannot live without making mistakes.

  • Terry says:

    I can’t believe the poor experiences you folks have had with car insurance companies. A couple of years ago myself and my brother tried to pull a stuck Volkswagen ‘Rabbit’ from the middle of the street to the side during a wicked snowstorm using a tow rope on a 4×4 pickup. Well “lucky us” we hooked the rope to the wrong part of the vehicle and wound up pulling off the entire front end — $4,200 damage.

    The insurance company processed the claim the next day providing me with a rental car, towing etc. all for $100 deductible under my comprehensive coverage instead of accident coverage. So no blemish on my record for something that was clearly my fault. And no increase in my insurance premiums.

    By your Car insurance from a ‘Broker’ — not directly from an Insurance company to avoid the problems you guys have outlined.

  • ClaimAttorney says:

    Lol at whiplash. What if you really in a whiplash accident and you are about to claim insurance?

  • Cd Phi says:

    Another thing with insurance agencies from what I’ve seen is that you constantly have to call them so that they’ll remember to work on your claim. I know that the insurance claims agents are all very busy but sometimes they may forget so it’s a nice way of reminding them.

    @Insurance paper: that is sad but definitely true.

  • Miranda says:

    Thanks for your comments, all. It is too bad that we have to worry about this stuff if we’re honest, but in a world of scammers and in a world where insurance is big business with shareholders to think about, it really is a game.

  • MoneyEnergy says:

    Kind of sad to live at a time when there are so many insurance scams that you have to be this careful of how you talk – almost invites further manipulation to make sure you’re being treated fairly. Good points though, I was not aware of any of this, although it does not surprise me at all.

    • Daniel says:

      “almost invites further manipulation.” – Absolutely right.

      Are you telling me a professional scammer (yes, these people exist) doesn’t know which type of language to use? When you try and get something free, you don’t say, “c’mon, I know you have the power to make it happen.” No, you threaten to leave and you make the person in charge believe that you’re being real.

  • Chris says:

    Pretty good tips here. I remember being in an auto accident and the person at the DMV advising me not to write down that I was fatigue because the insurance company might exploit it to not cover it.

    • MoneyNing says:

      Sadly and coincidentally, my friend had the exact same advice given to her a couple years back. It’s amazing how insurance companies try to get out of honoring what we paid for.

  • Insurance Paper says:

    Great post. Some people make a legitimate claim but get flagged because of the fraudulent people out there. So now the honest people have work harder to get the claim to go through. Something is not right with that 🙂

  • Daniel says:

    You’re absolutely right about choosing your words wisely. I work for a car insurance company and recently listened in on some sales calls. It was clear who was legitimately looking to buy a policy and who was trying to use the system to try and get a low rate. Vehemently denying from the beginning that you have no prior accidents isn’t smart, because the motor vehicle reports don’t lie. By telling the truth up front, you can avoid the accusations that might come later.

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