Sun | Aug 20, 2017

Insurance Helpline | Probed and prodded by insurer

Published:Sunday | June 12, 2016 | 6:00 AM

QUESTION: I was involved in an accident along Slipe Road in 2009. My vehicle was stationary. I suddenly heard the noise of an impact to the rear my car. I lost control. Rain was falling heavily. Three passengers were in my car. The person in the front seat and I were wearing seat belts. The driver of the other vehicle attempted to flee. When I caught up with the driver, she apologised and agreed to repair my car. I filed a report with the police. A few days later, I developed pains in my neck, shoulders, hand and back. My doctor recommended that an x-ray. It showed a severe whiplash injury. He also referred me to an orthopaedic surgeon. An MRI showed damage to my neck, shoulder and right hand. I am always in severe pain and have to be taking painkillers, physiotherapy treatment and acupuncture. All the passengers in my car suffered similar injuries. Throughout all of this, the insurance company had private investigators watching everyone. The third party and I are insured with the same company. The company referred us to their doctor, who told my attorney that there is nothing wrong with any of us. Can you please advise me?

- kenyonkeisha@yahoo.com

 

INSURANCE HELPLINE: You are handling a complex set of issues. The attorney that you have retained is the best person to guide you in resolving the associated problems. The only thing that I can do is provide you with information that helps explains some of the insurance issues.

Insurance companies exist to pay claims.

"Claims settlements," according to the directors of a general insurance company that recently issued invitations for some of its shares to be listed on the Jamaica Stock Exchange's junior market, "play an important role in providing financial security to policyholders" and "to the economy of Jamaica."

This area of that company's operation was considered so vital that an entire paragraph was devoted to articulating its claims philosophy in the context of its business model.

Have you accurately described your insurer's reactions to your claim for personal injuries? If so, it appears that you were treated unfairly and in a manner that is not consistent with the policy of the island's newest insurance company.

Some retailers, especially in Kingston, treat all their customers as dishonest by default. Instead of confronting persons suspected of stealing, they hire security guards to routinely compare proof of purchase - receipts - with items of goods in the bags of all shoppers. Customers are not allowed to exit the stores without accepting the suggestion that they are guilty of stealing until proven otherwise.

 

Treated as liars, fraudsters

 

Unlike examinations at Customs, the searches are anything but random! All persons who make claims for pain and suffering arising from whiplash injuries are treated by insurers as liars and fraudsters by default.

This is part of the backstory why all the passengers in your car were investigated.

Dishonesty and fraud are part of life. They occur in personal relationships - my friends, for example, tell me that DNA tests for some types of US visas have found an abundance of newly discovered 'jackets' - churches, schools, politics, institutions like the police force, banks, the distribution of water and electricity and in other areas of commerce and social activities.

Given the widespread nature of these problems in the society, insurers will argue that they have a duty to weed out fraudsters in order to protect honest citizens.

The fact that the strategy for managing suspected fraudulent claims runs counter to the principle of the presumption of innocence is often ignored.

Insurance claims for whiplash injuries are very, very difficult to handle. They should be left to doctors, lawyers and experienced claims specialists.

There was nothing in your email which suggested that the insurance company recognised the fact that the allegations of you and your passengers in relation to whiplash injuries created a conflict of interest.

This is because you and the driver of the other car were, at the time of the collision, insured with the same company. In the absence of proper safeguards, this particular claim allowed your insurance company to act as policeman, prosecutor, judge and jury, all at the same time.

I suggest that you meet with your attorney. Ask him/her to suggest - given the differing views between your medical advisers and those of the insurers - mediation as the tool to resolve this long-standing dispute.

- Cedric E. Stephens provides independent information and advice about the management of risks and insurance. For free information or counsel, write to: aegis@flowja.com.