The factual investigation
| Author | David Frangiamore |
| Pages | 291-332 |
FACTUAL
INVESTIGATION
5-1
CHAPTER 5
THE FACTUAL INVESTIGATION
§500 ROLE OF THE CLAIMS ADJUSTER/REPRESENTATIVE AND CLAIMS MANAGEMENT
§501 Contact and Control
§501.1 Introduction of a Plaintiff’s Attorney
§502 The Preliminary Investigation—Scope of Investigation
§502.1 Favorable Facts
§502.2 Unfavorable Facts
§503 Duty to Disclose Coverage and Reservations of Rights
§503.1 Duty to the Claimant
§503.2 Duty to the Policyholder—Implied Covenant of Good Faith and Fair Dealing
§503.3 Sophistication of Policyholder as a Defense to Bad Faith Conduct
§503.4 Agent’s Duty to Insurer
§510 INCIDENT STATEMENTS (SIGNED, UNSIGNED OR RECORDED)
Sample: Automobile Loss Notice
Sample: Homeowners Loss Notice
§510.1 Checklist for Injury Evaluation
§510.2 Should Plaintiff’s Counsel Let the Adjuster Take the Plaintiff’s Statement?
§511 No Personal Contact—Just Forms
§512 Insured Driver
§513 Witness in Insured Vehicle
§514 Witness in Adverse Vehicle
§515 Known Independent Witnesses
§515.1 Police Officers’ Statements or Interviews
§515.2 Tow Truck Drivers
§515.3 Ambulance Driver
§515.4 Unknown Scene—Canvassed Witness
§520 INSURANCE CLAIM FORMS DOCUMENTATION
§520.1 Medical Authorization
Sample: Medical Authorization
§520.2 Dental Authorization
§520.2.1 Special Notice
§520.3 Employment Records Authorization
§520.4 School Records
§520.5 Advance Payments—Med Pay—Income Loss and Living Expenses
§520.6 Releases (Partial or Final)
§520.7 Indexes and Rating Bureaus
§520.7.1 Bodily Injury
FACTUAL
INVESTIGATION
How Insurance Companies Settle Cases 5-2
§520.7.2 Vehicle
§520.7.3 ISO ClaimSearch for Casualty, Property, and Auto Claims
§521 Documentation of Bodily Injury Claims
§521.1 Medical Bills
§521.2 Medical Reports
§521.3 Lost Wage Reports and Diminished Earning Capacity
§521.4 Police Reports
§521.5 Death Certificate
§521.6 Coroner’s Report
§521.7 Criminal and Civil Court Records
§522 Photographs
§522.1 Insured Vehicle (by Adjuster)
§522.2 Claimant’s Vehicle (by Adjuster)
§522.3 Police Department—Vehicles
§522.4 Police Department Scene
§522.5 Police Department—Injured Parties
§522.6 Private Photos and Videos
§530 CLASSIFICATION OF PARTIES
§531 First Party
§532 Third Party
§533 Both First and Third Party
§534 Experts and Expert Witnesses—Accident Reconstruction Experts
§534.1 Seat Belt Experts
§534.2 Auto Accident Reconstruction Experts
§534.3 Medical Defense Doctors—Can They Commit Bad Faith?
§534.4 Independent Medical Examiner (“IME”)
§535 Independent Adjusters/Investigators
§536 Examination Under Oath Statements (EUOs)
§540 A SETTLEMENT DEMAND IN EXCESS OF POLICY LIMITS
§541 Bodily Injury Claims
§541.1 Value of Each Claim
§541.2 Prorating/Compromise
§541.3 Interpleader Action in Federal Court
§542 Property Damage Claims
§542.1 Value of Each Claim
§542.2 Prorating/Compromise
§550 WHEN MULTIPLE INSURANCE POLICIES COVER THE SAME LOSS
§550.1 Insured Driver’s Policy (Third-party Coverage)
§550.2 Insured Driver’s Policy (Non-Owned Auto)
§550.3 Insured Driver’s Policy (First Party—Under/Uninsured)
§550.4 Insured Driver’s Policy (Primary, Secondary and Under/Uninsured Coverage)
§550.5 Insured Driver’s Policy (Rental Car)
§550.6 When Excess Insurers Must Pay if There Are Multiple Retained Limits or Multiple SIRs
§551 Anti-Stacking Rule and Non-Accumulation Clauses
§552 Homeowner’s Policy
§553 Drop Down Insurance
§560 ASSESSING COMPARATIVE FAULT
§561 Phantom Vehicles
§562 Landowners
FACTUAL
INVESTIGATION
5-3 The Factual Investigation
§570 MAINTENANCE OF THE CLAIM FILE
§571 30/90 Day Diary
§571.1 Reserves as a Bad Faith Tip-Off
§580 LIENS AND ASSIGNMENTS“NOTICE CLAIMANTS”
§581 Medical Liens
§581.1 Tips for Dealing with Medical Lien Claims
§582 Worker’s Compensation
§583 Prior Attorney Representation
§584 Banks/Mortgage Companies
§585 Auto Body Repair Shops
Sample: Auto Body Shop Assignment of Benefits
§586 Rights of Minors to Proceeds of Insurance Settlement
§590 UNFAIR CLAIMS SETTLEMENT PRACTICES
§591 Misrepresentation/Communication
§592 Reasonable Standards/Prompt Settlement
§593 Repetitive Documentation/Extortion
§594 Forced Litigation/Sham Arbitration
§595 Altered Application
§596 Disclosing Paid Benefits
§597 Directly Advising Against Representation
§598 Statute of Limitations—Insurers Must Generally Provide Notice of Expiration to Policyholders
§599 Improper Investigation
KEY POINTS TO REMEMBER
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