The simple, short answer to the question is, “No!”. As you read on in this article, the reason for this emphatical “no” answer will become apparent. Unfortunately, the history of the insurance industry in this country is one largely filled with broken promises, unfair claims handling, and repeated efforts to deny and/or diminish the payment of valid claims. Most people presenting a claim to an insurance company expect that truth and justice will guide the process, and result in the payment of the full amount due them for their injuries or damages. The sad fact of the matter is, howver, that insurance companies operate with no comparable commitment to justice, and instead are motivated on a pure economic basis, meaning they are interested in determining not what they legally owe, rather, what can they legally get away with in terms of the least amount of payment, and can they even get away with no payment?
Many clients have come into this firm telling us that they thought they had nothing to worry about in terms of receiving a fair settlement because they were dealing with their own insurance company because they were lulled into the belief that after having paid premiums to their insurance company, there would be some reciprocal feeling of gratitude on the part of the insurance company. Similarly, there have been many stories of clients having trusted the adjuster for the other party’s insurance company, then feeling betrayed when the promises they thought had been made were not kept. When one considers whether or not to trust the insurance company, it makes no difference whether you are dealing with the other parties’ insurance company, or if you are dealing with your own. In each case, the insurance company is motivated to eliminate or minimize any claim payment that would be owed to you. They value you as a customer when they are taking your check, but your value to them is gone under any circumstance in which they may have to write you a check. You should deal with them, accordingly.
The predatory behavior of insurance companies against individuals who present claims has been well-documented over the years, whether it be in books, or more commonly, in actual reported and published court cases. The history of the insurance industry cheating policyholders and claimants literally fills volumes of legal books. There is the infamous case of the injured man who was entitled to a lifetime of disability payments from his insurance company, but who was told just before Christmas by the insurance company that they would refuse to make any further payments, and his family would go without Christmas, unless he accepted their “final payment” of a few hundred dollars upon condition that he sign a complete Release in favor of the insurance company. There is the equally infamous and actual case of the paralyzed woman who, though she had purchased an insurance policy covering her in the case of an automobile accident in the amount of $15,000.00, but who was told by the insurance adjuster that they never pay the full policy, and she would have to accept less or face litigating against their corporate lawyers. The most common fact pattern of all, where the insurance company knows that the responsibility to pay the claim is reasonably clear, yet refuses to pay the claim and instead forces people into lawsuits, and attempts to coerce them into taking less than the fair value of their claim, has been documented and reported over-and-over again not only in California, but across the entire nation. Though such tactics by insurance companies are clearly illegal, the industry continues to engage in such practices for the simple reason that they can get away with it and it is more profitable for them to break the law than to obey the law.
The Cooper Law Firm has personally handled cases in which the insurance company would not pay a claim for a quadriplegic accident victim who needed a motorized reclining bed and wheelchair. What was their excuse? That the bed sores and ulcers could be avoided by simply having a family member pick up the person and rotate them in the bed or chair every hour or two! The insurance company was forced to pay for the power reclining device in the case and they had to also pay substantially more because of this outrageous tactic, but the fact that any insurance company could put forth such an outrageous and inhumane ruse to deny a claim speaks volumes about how the insurance industry conducts itself.
Another example of a matter our firm has handled involved a case where an insurance company refused to pay a claim, saying that the decedent woman driver who was killed when she broadsided a dark, unlit truck backing across a roadway should have stopped for the truck (which was taking her right of way) because it was allegedly easily visible. The insurance company presented this evidence to a jury, but on cross-examination by Mr. Cooper it was shown that the pictures and movie presented in court by the insurance company had been altered, was false evidence, and reflectors and shiny polished chrome had been added to the side of the truck after the accident, to make it appear visible, and mislead the jury, when on the night of the accident the reflectors and shiny chrome were not even on the truck!
Yet another example of misbehavior by an insurance company occurred in another case handled by this law firm. The insurance company refused to pay for an emergency room visit, and instead only offered to pay for a routine office visit, claiming that the mother of a little girl should have waited for the child’s doctor to have an available appointment, rather than have her daughter checked out right away to make sure she was not in serious condition. The insurance company took this position despite the fact that the child’s doctor testified that upon the call from the mother he immediately informed the mother to take the child to the emergency room because of the child’s symptoms. The jury in that case made the insurance company pay for the emergency room visit plus the pain and suffering. The jury even ordered the insurance company to pay punitive damages in an effort to stop them from ever engaging in such actions again.
Mr. Cooper has even seen an insurance company deny full payment in a case where the client was injured and the automobile totaled while waiting at a red light when struck by a vehicle traveling in excess of fifty miles per hour and “rear-ending” the plaintiff’s vehicle. The insurance company refused to pay the full claim on the pretext that the driver, after having given a statement to the insurance company that she looked in her rear-view mirror and saw the high speed vehicle coming up behind her at the red light, should have quickly moved her vehicle out of the way and avoided the accident. This type unfair and bad faith claims handling in such an obvious case of liability is a clear demonstration that there is no fact pattern for any accident in which you should feel safe that the insurance company will not come up with some excuse to evade or diminish your claim. These are just a small, representative sample of cases this firm has handled demonstrating the complete disregard the insurance industry has for the law and people. If the insurance industry is willing to destroy families, cheat paralyzed people, and subject children to serious medical conditions without getting immediate medical care, you have to ask yourself what they may do to you or your loved ones in your particular circumstance!
Most people assume that the law in California would be that the insurance company has a duty to promptly pay a claim when responsibility for that claim payment is reasonably clear. That is in fact the law. California Insurance Code Section 790.03 mandates that an insurance company effectuate settlement once the liability of their insured is reasonably clear. It is also required that the insurance company act promptly, fairly and in good faith. What every insurance company knows, but most of the consuming public does not, is that after a political campaign, largely financed by insurance and business interests placing their preferred judges on to the California Supreme Court, that Court ruled that this law could not be enforced by any member of the public! The Court ruled that only the Insurance Commissioner has the right to force an insurance company to comply with this law and to seek penalties for failing to abide by the law. There is no known case in which the Insurance Commissioner in California has ever filed suit against an insurance company for failing to comply with this law. Since you, as the consumer, cannot enforce this law, and the Insurance Commissioner has never enforced the law, it is easy to understand why it is largely ignored, if not laughed at, by the insurance industry.
For those of us here in California who are familiar with the state’s history, we understand that big-monied interests have often preyed upon the public while being protected by the politicians and judges. California’s history includes the railroads paying off public officials to get out right grants of public land, then using those public land grants to exploit agriculture, small business, and consumer interests. Banks used similar tactics to allow them to get away with predatory lending practices, creating great wealth for their “robber baron” owners, all at the expense of the middle and working classes who did not have the money to influence the politicians and the judges. Of course, the oil companies, and their price-fixing tactics are still an integral part of any course in not only history, but also economics. Of course, the recent housing mortgage crisis is largely the result of monied interests getting regulatory laws repealed.
The age of the “robber barons” supposedly came to a close at the dawn of the twentieth century when the people finally gained enough political clout through elected representatives to break-up these cartels, outlaw their anti-competitive behavior, and newly-enacted anti-trust laws placed at least some limits on the revival of these activities.
The modern day successor to these “robber barons” is undoubtedly, and unfortunately, the insurance industry. The insurance industry, incredibly, was able to get itself exempted from the anti-trust laws of this country, and they have been very successful, mostly in the last twenty years, in gaining special privileges and immunities to allow them to run roughshod over consumers. The legally sanctioned abuses that the insurance industry is entitled to engage in has even gone so far such that a California Appellate Court has ruled that they have a “privilege” to engage in fraud and a legal “privilege” to state under penalty of perjury false insurance coverage amounts applicable to your claim!
It is impossible to explain and list in this forum all, or even many, of the disingenuous and unfair tricks used by insurance companies. If you have ever put in a claim for the repair of your vehicle, you may have found out, or you may not have even noticed, that the insurance industry instructed the repair shop to use replacement parts that do not meet the standards of the car manufacturer. If you have suffered the total loss of your vehicle, you may have wondered why they do not use the Kelley Blue Book, but instead use a so-called “independent” appraisal company. The Kelley Blue Book is the standard used by the car sales industry to determine the value of motor vehicles. Instead of using this standard, however, insurance companies often claim to have engaged an “independent” appraisal company to determine the value of your car. What they do not tell you, however, is that this “independent” appraisal company is in the business of providing appraisals to insurance companies and informing them what amounts they should pay for cars that have been declared a total loss.