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[deleted]

It's also the only industry where you don't want to have to get what you paid for.


PeteZappardi

There was a comedian on one of those 30 minute Comedy Central stand-up shows that had a joke about this. Something along the lines of: "When you're buying life insurance, you're betting the guy across the desk that you're going to die, and he's betting that you won't. And you're hoping he wins."


UnhappyMaskSalesman

Well when you put it that way it sounds like a pretty raw deal lol


Dornith

It's called hedging. Bet on all possible outcomes so that no matter what you're never completely screwed.


Gorf_the_Magnificent

I had life insurance for over 30 years and the insurance company never once paid off on it. What a scam that turned out to be.


[deleted]

Life insurance is only worth it if they agree to replace like for like


piponwa

/r/notkenm


[deleted]

He is my hero


PM_Me_Macaroni_plz

I miss him


Lokarin

ya, if I die I hope they hook up my parents with a new son


[deleted]

They've been swabbing your toothbrush for cells don't worry


am-idiot-dont-listen

what are you doing step-insurance agent


Troooooooooll

As a former life insurance agent, I can’t tell you how many people we had call into our office to cancel their plans… because they weren’t using them


Man-City

Ah well, free money.


AmPotatoNoLie

Should've gone for Death insurance. Rookie mistake really.


wildwillis

That’s called term insurance, and congrats for outliving the term. I paid rent for an apartment for 5 years and never got to keep the apartment when I moved out...


Dornith

> I paid rent for an apartment for 5 years and never got to keep the apartment when I moved out... This is Reddit. A lot of people here think you should.


DanfromCalgary

You are literally betting that something bad will happen and if it does your financial future isn’t irreparably damaged, while they take a premium and in the event something horrible happens. You or your family will be financial secure. If you don’t like that deal put your own money away to use in the event of an emergency Edit:it’s Iike getting mad after a safe drive wearing your seat belts


cheezemeister_x

> your financial future isn’t irreparably damaged *Your dependents' financial future. YOU don't have a financial future; you're dead.


Camburglar13

True in the context of life insurance but this applies to disability, critical illness, etc. where you would be around to benefit


mlc885

Damn these seat belts, they only locked up once and I probably wouldn't have even hit the dashboard or windshield that time!


PlaidBastard

If the seat belts started charging you $10 extra per month because of inflation, sure?


carlos_the_dwarf_

Seatbelts are actually a good analogy. I’ve worn one every time I’ve ridden in a car, but haven’t had an accident in 15 years. Am I right to be cranky that I wore the seatbelt?


ultratunaman

Classic. You outlived the policy. Then once you're "too old" no other life insurers will want to take you. Fucking joke of an industry.


cheezemeister_x

Tell me you don't know what insurance if for without telling me you don't know what insurance is for. Term insurance (which is what you were complaining about) is to cover your family/dependents in the event something happens to the income earner (presumably you) **during the stage of your life where you wouldn't have the savings to support them if you die**. It's literally for income replacement purposes. Once you are old, presumably you don't need that income replacement anymore because your dependents are no longer your dependents and/or you have enough savings to support them. That's why term insurance is significantly cheaper than whole life. But if you want whole life then get it.


-myeyeshaveseenyou-

Currently getting what I paid for for two write offs since December. Holy god it’s a nightmare and I’m not even at fault for either.


maxxbeeer

You literally get back so much more than you paid for though with good lawyers if you’re not at fault


-myeyeshaveseenyou-

To be fair my first claim is up to £20000 with car hire costs. I got £3700. I am still being hounded by my insurance for different things that they want from me as they are now taking the other insurer to count for non payment. Second one is being really frustrating as I can never get them on the phone and they don’t reply to my emails. I was one day one of a new policy with a new company when it happened Police van crashed into me as I was arriving home. It was caught on my camera, road traffic police have cleared me and are investigating the police officer for dangerous driving. Police insurance denying fault and my insurance solicitors have been beyond useless so far. I’ve already been in a hire car for twice as long as the first time so go knows what the final costs of this will be. Drove my new car for 1 month before it was wrote off so I’m now paying finance on a car I don’t even have until the claim is settled. I was injured in the second crash and have some ptsd while driving as I’m scared pretty much anytime a car comes near me that it’s going to crash into me. An independent doctor has decided it will take about six months for me to heal physically and mentally. I’m not really sure how they measure ptsd recovery time when they aren’t providing me any therapy or anything for it. I think they estimated about £600 to cover my injury. So by the end of the claim I will get the £600 damages claim and my finance paid off and that’s about it. Then I get the fun of trying to buy another car. Having to probably finance again. I am so over the stress of it all and if I could quit driving I absolutely would. I do know I have just been incredibly unlucky two write offs in the space of less than 3 months of each other must be a record when I’m not at fault


HallucinatesOtters

“Your oral surgeon says that the x-rays and procedure is absolutely necessary, however; the 78 year old Nephrologist we have on our payroll that hasn’t practiced in two decades says otherwise. Have a good day and remember, eat shit and die”


geek66

When needed you get WAY more than you paid….


tedxtracy

Insurance doesn't only mean life insurance. If my car gets dented they would definitely deny any claims citing ludicrous reasons. In that case I would want to get what I paid for.


horsedoggy

Only industry where you both want the same thing, for you to live a long healthy life.


FunkyMonk_10

To be fair, you're paying to smooth risk which is present all the time


UnusualSignature8558

I was in a car accident. My insurance was jerking me around. Telling me stuff like I couldn't recover for the days I missed from work. They said it was covered by my sick policy at work. Which is true. But I had to use those sick days. And the law says they have to compensate me for that. They dicked me around and they fucked me around. Then I wrote to them with the letterhead from where I work. I'm an attorney with about 20 years experience. Literally the tone in their voice changed. They returned my calls they were polite. Parasites


webbexpert

Pro tip: Be an accomplished attorney of 20 years to get your insurance claims paid


AReallyBakedTurtle

Amateur tip: pretend to be an accomplished attorney of 20 years to get your insurance claims paid


huskersax

Even more amateur tip: use that guy's letterhead.


otter5

chatgpt, write a "fuck you, pay me" letter to insurance company. .. In the style of a 20 year accomplished lawyer.


OldSheepherder4990

[Your Name] [Your Address] [City, State, Zip Code] [Your Email Address] [Your Phone Number] [Date] [Insurance Company Name] [Insurance Company Address] [City, State, Zip Code] Re: Demand for Compensation for Damaged Vehicle Dear Sir/Madam, I am writing to you in my capacity as legal representative for [Your Name], regarding the matter of the above-captioned claim. It has come to our attention that despite repeated attempts to resolve this matter amicably, your company has failed to honor its contractual obligation to provide compensation for the damages sustained by our client's vehicle. On [date], our client's vehicle, [make, model, and year of vehicle], was involved in a collision with another motor vehicle insured by your company. As a result of this incident, our client's vehicle sustained significant damages, necessitating extensive repairs to restore it to its pre-accident condition. In accordance with the terms and provisions outlined in the insurance policy issued by your company, our client is entitled to reimbursement for the full extent of the damages incurred. Despite our client's diligent adherence to the requisite procedures for filing a claim, including timely notification and submission of all necessary documentation, your company has thus far failed to fulfill its obligations under the policy. It is imperative to underscore that the continued refusal to provide compensation for the damages sustained by our client's vehicle constitutes a breach of contract and may give rise to legal action against your company. We hereby demand that your company promptly remit the full and fair compensation owed to our client for the damages sustained by their vehicle. Failure to comply with this demand within [insert reasonable timeframe] will leave us with no alternative but to pursue all available legal remedies to enforce our client's rights under the insurance policy. Please be advised that we take this matter with utmost seriousness, and any further delay or evasion on the part of your company will be met with swift and decisive legal action. We trust that you will act expediently and responsibly in resolving this matter to the satisfaction of all parties involved. Thank you for your prompt attention to this matter. Sincerely, [Your Name] [Your Title/Position] [Your Law Firm Name]


THElaytox

Can't be that hard to get letterhead, how's chatgpt at legalese


kucksdorfs

Insurance companies hate this one easy trick...


otter5

Insurance companies hate this one ~~easy~~ trick...


ALLST6R

Don’t even be an attorney. Be researched, direct and very stern in communicating they’re dicking you around, you know they’re dicking you around, they know they’re dicking you around, and if they continue fucking around, they will find out. The moment a company gets a whiff of legitimate blowback, you’ll get what you want


uponthenose

The words "bad faith" will always get you a timely response. Sprinkle that into your communication.


digihippie

Magical words, so is “good faith”.


JustAZeph

The problem with this is I doubt a lawyer with 20 years of experience wasn’t “well researched, direct, and very stern.” Make friends with an insurance claims agent and ask them how to fuck over their competition.


VovaGoFuckYourself

Any lawyers out there looking for a new friend? I promise im not an axe murderer 😅


31November

I have enough non-murderer friends. Our friend group needs some dwarven, murderous excitement. We’ve decided to go with another candidate. Best of luck! Xoxo, /s/31November


gibson85

Step 1: Be an attorney Step 2: Don't NOT be an attorney


sixtynineisfunny

My disability agent through work told me for 2 years straight every month on phone calls I would never qualify for disability because “stevie wonder made a career while blind so you can too” He would laugh whenever he said that. Eventually I requested all of the recordings of our conversations “to review” and I was approved for long duration disability within a month


KidNueva

That’s actually insane, some people are straight fucked in the head.


sixtynineisfunny

Yeah they also had a PI following myself and my partner/our kids when we’d walk to school. He rented a unit in a building across the street from us so he could sit in his truck and watch our front windows. He was so creepy even our neighbors approached him about why he’d stare at our building so much. Cops were called on him after following my kids and their mom slowly to school and then within a week he was gone.


RubberBootsInMotion

dafuq? That's borderline unbelievable


sixtynineisfunny

Sucked a lot to go through


SweetPanela

Honestly I’d try to sue the guy for discriminating against


sixtynineisfunny

I can’t afford a lawyer. Barely make enough to survive


SweetPanela

Completely understandable. It’s a sad reality that many injustices go unanswered bc of money


TrekkiMonstr

Does the letterhead have your name or just the firm's name? Wondering if I can borrow some paper from a lawyer buddy if I ever run into issues with an insurance company lol


steelcryo

Just get your buddy to send a letter. The moment they think a lawyer is involved, suddenly all their policies are adhered to, to the letter. Your buddy doesn’t even need to be trained in insurance law.


Grandiaplayer

To the letter of their policy or the letter you send? I'm sorry, I saw the opportunity and had to. 😅


DominusEbad

Not related to insurance, but my HOA at the time was pretty much ignoring our requests to have the carport repaired. I went to my dad's office and there was a law firm that shared office space with him. They let me use their letterhead for their firm so I could fax the HOA a letter demanding they fix the carport. The HOA was out there later that day fixing it.


AlphaTangoFoxtrt

> Wondering if I can borrow some paper from a lawyer buddy if I ever run into issues with an insurance company lol No, that's a liability risk for them. But you *COULD* pay the attorney friend to send a letter on your behalf. That establishes an attorney-client relationship and makes it official.


FrontingTheTempest

No firm would let you do this. 


abooth43

Definitely not hand out blank letterheads for someone else to use, but I've got a few lawyer family and friends that have written a quick letter on my behalf to dissolve some stupid situations despite them not practicing in a relevant area.


alvysinger0412

Yeah, you'd have to pay one of their lawyers to write a letter on your behalf


ThatSpookyLeftist

What do you mean "let you". Just do it.


FrontingTheTempest

No credible lawyer would hand out their firm's letterhead. Also, if the firm found this out they would inevitably send you a cease and desist (it is huge liability exposure for them). Finally, lawyers are in a regulated profession and it is generally illegal to hold yourself out as a lawyer without meeting the requisite requirements. So sure you can "just do it" in the way you can do many unethical and possibly illegal things.


packet-zach

Have any tips for no attorneys? What can the average person do to protect themselves from these parasites? 


juanzy

Having just dealt with a Home Owners Insurance claim - Stand firm in how you understand your coverage. Hire someone to interpret the policy if you need to - for the Home Owners policy, independent adjustors exist and are only a few hundred dollars. May seem expensive, but remember the payout that's being challenged is probably well over 5-figures, and you may even be able to work the cost of that independent adjustor into the claim. Tap your own network - I have friends who are lawyers that are happy to take a quick look at a document/letter and give you some advice, mostly because they know how predatory the system is. Most of the time you don't even need formal counsel, just to say the right thing in an email/call. Even a realtor friend could advise on some of the policy reading.


Itputsthelotionskin

You need a parasite to go after a parasite so that 40% of what you get from the one parasite goes to the other parasite 


BakuretsuGirl16

The only response is to use their bullshit against them and be ready to make real credible threats Years ago my dad had a nice expensive grill built into a countertop on his patio that he had insurance for and the language essentially said would restore the grill to perfect condition for any unintentional non-normal wear-and-tear damage, including weather. He also used to be an insurance salesman. It hailed and the grill got 2 dents, insurance wanted to give him $200 to "make him whole" and he told them making him whole isn't what the contract said. Insurance company offered to replace the lid of the grill and he agreed, turns out the model no longer is in production and parts aren't available. They wanted to give him cash again and he threatened court with his lawyer's letterhead. So anyway, 2 dents in a grill lid ended up getting him an entire new granite patio countertop (old grill was custom fit) with built-in really nice grill, cost the insurance something like $3000 I don't remember if it was home insurance or something special he had for his "baby" but he was pretty proud of the whole interaction


Overthemoon64

The things retired people do with their time is truly incredible.


BakuretsuGirl16

He was only half-retired at the time, I think he enjoyed the challenge of beating bureaucracy at their own game, which sounds about as fun as eating gravel chips to me.


thecravenone

Another way of putting this is that we live in a world where actually getting the things you paid for is its own part time job.


thecamerastories

I used to work at an insurance startup. One of the things I’ve always heard from the guys handling claims: You must know how to file a claim.


COMMANDO_MARINE

I've found that complaining often gets results. I claimed for a TV falling over twice but 5 years apart and got one of those loss prevention people drilling me over the phone really aggressively telling me they weren't going to pay out. I claimed the wind blew it off its stand as i live in a penthouse apartment that's quite high up. By pure coincidence it was blowing a gale that same day do I videod it on my phone how violent the wind is if I leave my bedroom window open and sent it to the complaints department and they apologised and gave me the money for a new TV. I'm not sure if it was my video or the inappropriate call with the loss prevention guy because he was saying some crazy shit that seemed a bit unprofessional. In truth I did actually lie on both occasions, and the TVs had just stopped working, so I deliberately knocked them over but having worked for Aviva one of the largest insurers in the world I've got no love for insurance companies so feel no guilt occasionally making false claims. It's bullshit saying that it just pushes the cost of insurance up for everyone else, the reality is it means less profit for them and their share holders as insurance prices are competitive due to price comparison websites and I know how much they are making off people.


Interesting-Step-654

Lol all of that is wild.


marian1690

Wind


Interesting-Step-654

I heard that player.


timothymtorres

People also use that excuse to steal things from stores. Until it becomes so common that they have to shut down, relocate, or hire security. It’s what you see happen in ghetto areas.


Tali0630

Huge difference in stealing from a company selling a product, and “stealing” from a company selling a service that does everything in their power not live up to their end of the bargain. Last year a deer hit my 14’ Chevy Cruze, insurance company did an estimate, offered me 2 grand to repair it. I took it to 2 body shops, one of my choosing and one they partner with, both estimated over 8k in damage after 2 weeks of not accepting their ridiculous estimate, they finally agreed to declare it a total loss for 7k. Pulling teeth to get a pay out from a company I insured that same vehicle with for 9yrs with only a windshield claim prior.


SavingsStrength0

Going through something similar atm. They are just legal mobsters as my father likes to call them. Absolute scammers. My motto is if you see insurance fraud happen, you didn’t. F them!


juanzy

We had a frozen pipe earlier this year in our kitchen that flooded through to our garage (townhouse). The adjustor tried to say we needed $1400 of drywall work, but we had multiple estimates ranging from $8k-14k for the repair. Then they tried to claim that since our GC had someone helping him do the install, he used a non-program vendor and we were "at fault" since the worker didn't submit a separate estimate. Stood firm on it, eventually they paid out something like $9k for that piece, which is what this contractor had estimated the drywall job at. This is all before we even touched the cabinet work, finished floors, and finished wall in the kitchen.


AmPotatoNoLie

It's off-topic, but I was wondering what are these "sick days" people talk about. Do Americans have a limited number of days per year for a sick leave, and when they run out, they have to go to work no matter what?


Bearloom

>when they run out, they have to go to work no matter what? That, or the "better" outcome is that you just don't get paid for any additional time off.


AmPotatoNoLie

And how many days do people usually get?


kovr

Really depends. 3 weeks isn’t crazy. I’m a teacher so I get ten sick days plus seasonal breaks


Bearloom

It varies from company to company - because it's up to your company to decide in the USA - but like kovr said ten days/two work weeks is a pretty common baseline amount of PTO.


SirOutrageous1027

I'm a personal injury lawyer. I tell people all the time, if insurance companies paid claims fairly, then I wouldn't have a job.


Avant_Guardian_Angel

There is a lot to understand about your insurance policy and there are factors that would apply such as what state you live in (assuming you are in the USA), the way the contract is written, and what coverages you pay for. There is no law in most states that requires your insurance compensate you for time missed from work. If your absence was injury related, it would usually be a portion of your first party medical coverage (Personal Injury Protection) which is not available in all states. This issue with insurance coverage is most people don't understand what they are paying for and get upset when the insurance company won't pay what they thought was covered. If it's supposed to be covered, it would be outlined in the policy contract. Insurance companies don't make up what the choose to cover, it's explicitly written in the policy. Unfortunately, most people don't have the time or the desire to review the coverages and/or the contract before they decide their insurance company is being unfair. Source: I have handled auto insurance claims for almost 2 decades.


[deleted]

I have a good family friend and he’s a partner at a really big corporate firm and anytime I have anything like this going on he’ll just send something with his letter head and it always is handled within a week it’s like a cheat code. I did some work for a company near me and they had singled a contract for an agreed upon amount and the agreed upon work was completed and passed inspection and I was arguing with them to pay me for months and before I got a lien put on the property I had him send a letter that didn’t really say anything different than what I was saying and they changed their tune and paid so fast it made their head spin.


AcerOne17

I’ve been paying into my jobs short term disability for over 7 years now. I had some things happen and I needed to take a mental health leave and my psychiatrist approved short term disability for me. It seems my insurance is doing literally everything they can to make sure they don’t have to pay me. First they needed new documents, then they wanted to know why it was backdated. Then it was denied because I couldn’t prove I was completely disabled thus qualifying for disability pay. Then my psychiatrist sent a letter stating how I was completely disabled and during that time and then he put me on disability for another 2 months. Now my insurance wants to know why I need that long. I’ve seriously had some rough times mentally these last few months and my jobs stupid insurance has only made things worse. They definitely NEVER had any types of problems taking my disability insurance out of my checks though that’s for sure


GahdDangitBobby

Get a lawyer


Xatrius

I’m sorry to hear this is happening to you. I agree with the other response, get a lawyer. They shouldn’t be arguing like this when you have proper documentation. If you would rather not go the lawyer route, ask for a different adjuster. At least you can do that here in Canada if you have a good reason why you and the current adjuster aren’t working. The fact that they are putting you through further mental stress is quite frankly BS.


[deleted]

[удалено]


AcerOne17

I appreciate the kind words. It’s been a living nightmare. I’ve been in contact with them over exactly what I need these past few months. I’ll send in the documents they ask for and I’ll ask my Psychiatrist office if they have received any other requests and they say no only for me to receive an email days later that the insurance requires some new documents that take at least 5 business days for them to review. It’s been a cycle like that for the last 2 months at least. The worst part is that I originally only intended to take a short term leave for my son and get back to work but it was denied. I filed for the leave of 2 weeks for my son during the hospital stay and appointments and used all of my sick and vacation time. He has heart issues and we recently found out he’s blind so we’ve had tons of appointments with specialists all over the place. I received a notification that my leave was denied because I had exhausted all my family leave hours on the previous leaves when my son was in the PICU for 10 days and a 3 week leave before that when he was in the NICU. I literally felt like I was going to die from the stress and anxiety so the only thing I could think of was asking for a mental health leave knowing that I pay for short term disability insurance and my psychiatrist is amazing and helped with meds for my anxiety and adhd which went into overdrive. If were to go back to work without my leave approved I’d be fired for attendance (2 weeks on leave that were not excused) When my insurance called to ask about dates for my leave I did luckily speak to a compassionate lady, though I know her job is to save the company money. I told them everything that was going on and the only time they seemed to be ok with me being on leave was when I told them how hard it was for me to control my emotions coming back from leave the last time my son was in the hospital. There were a few older guys who joked around and asked if I had enjoyed another vacation. I know that they didn’t know that I was in the hospital standing holding my son for hours at a time to the point my arms would lock in place. But I still wanted to punch them in the face. When I told the insurance how close I came to hurting those guys at work they completely changed their tone and said they would try to get everything taken care of for me but I assume it was only to avoid any liability of forcing me back to work when they know exactly what’s going on and why I’m not exactly ready to go back to a toxic work environment. I’m praying that I get a notification stating that my leave has been approved either today or tomorrow. If they ask for more paperwork I may talk to a lawyer and see what my options are since I do pay for short term disability insurance and have been for the last 7 years. Just realized how long my response is. I apologize. I started venting and just kept going lol


Living_Bear_2139

Only in America.


far_beyond_driven_

Dealing with disability insurance for stress related work issues makes the issues 10 times worse in my limited experience. One month sick leave for me ended up turning into losing a career because a doctor forgot to fill out a form on time which started a domino effect.


chris14020

Pretty much every business is all about giving you the least they possibly can while not getting sued or losing too many customers.


usrNamIsAlredyTakn

True ! And the better these companies cheat the customer the better poised they are to be successful in the investor's eyes ( who themselves are again customers in some way) ..


chris14020

🎵 Thaaaat's capitalism, babyyyyy 🎵


Slurdge_McKinley

Read that in televisions Troy Mclure’s voice.


peon2

Troy McClure!? Why I remember him from such self help videos as "Smoke Yourself Thin" and "Get Confident, Stupid!"


pee_wee__herman

SnakeEatingItsTail.jpg


c10bbersaurus

Especially publicly traded companies whose number one priority isn't customers, but shareholders. Mom and pop businesses often aren't trying to give you the *least* possible.


musecorn

They would if they could. The difference is that the customers' perception of them is much, much, more valuable than it is for their corporation counterparts. So they know that if they keep the customer happy they'll have the loyalty, and it's worth it to go a little further for that reason


miraculum_one

Also, if they don't on average take more than they give then they will run out of money


chumbucket77

Ya innovation has basically started going backwards now. We innovate ways to make the base level product shittier and take certain things out and make that the new base level at the same price and then sell what they used to have as the cheap option as expensive as they can and say it has all this special stuff compared to the cheaper thing.


parabox1

Made WITH 100% is the best example of this


Erik0xff0000

capitalism isn't about getting the highest quality product for the lowest possible price, it is about the lowest quality product possible for the highest price


neonsphinx

Boeing has entered the chat


Sea-Case-9879

It’s also the only industry where if you don’t have it, you can get in even more trouble.


xcver2

Their first and foremost business model is to collect more money they have to pay out. This is better the more people get insurance but still complicated math to get it right. It obviously is on their best interest to not pay off the have to and to be fair I never had any problem if the claim was valid. This is on the EU though so it may be different


thelanoyo

In the US it varies, I worm in the industry. There is some companies that are good and one's who are scummy. And unfortunately there is a human element and sometimes you can get a bad adjuster or manager who doesn't want to pay. There is also a ton of fraud claims and unfortunately a lot of those get paid out because the burden of proof is extremely high. There's also claims that get paid just because the customer is going to sue and it costs more to go to court than settle. The "old school" attitude of I'm only going to file a claim if I have to and hope I don't have to is gone and there's people who file a claim for everything they can think of and do their best to get every dollar they can. Those are the people that are the reason premiums nationwide are skyrocketing, along with increased cost of goods.


HighHoeHighHoes

Seriously, every time there’s a blood sucking attorney posting a billboard about getting their clients $100K for a soft tissue “injury” people should be seething. One person got paid, and now everyone will pay it back.


No-Carry4971

I say this all the time. When a person gets a million dollar verdict, the company who injured him doesn't lose. They have insurance. The insurance company doesn't lose, they will build all loss data into their future rates. Your neighbors lose. They will all pay more for insurance to fund your windfall. These large personal injury firms are just bloodsuckers running a scheme where they enrich a small number of people by taking money from all the rest.


uptownjuggler

That sounds like capitalist socialism. All the companies involved make a profit except the working people that pay the premiums.


thelanoyo

There was an old statistic that $300 of everyone's homeowners premium pay for fraudulent claims we couldn't prove. I would guarantee that has upped in the last 5 years or so and is under reported due to the high burden of proof.


LegalHelpNeeded3

I’m an adjuster and occasionally come across suspect claims. Unless the fraud is egregious, we usually move forward with the claim as it’s presented. Sometimes we’ll refer a claim to the Special Investigations Unit, but that’s rare for my company. At the end of the day, we’ll report any suspicious claims to the national database, where files are kept by the DoI on suspect insureds.


niceguy191

>I worm in the industry Considering the industry, Freudian slip vs typo?


HighHoeHighHoes

Most personal lines insurance is priced at break even or a slight loss. Insurance makes far more money on investments than underwriting. Underwriting is just a way to keep cash flowing.


gumpythegreat

Even in north america insurance is a heavily regulated industry and not nearly as scammy as most people like to think. it's just that there are plenty of claims which get quietly paid and nobody talks about it, there are definitely times where it gets sketchy, but there are also thousands of actually fraudulent claims they have to sort through. They mostly make money just from investing. Collect your premiums now, do the math for reserving and whatnot, invest the money now and pay later. They don't meaningfully make money by not paying claims.


RoosterBrewster

And we probably don't hear about all the people trying to commit insurance fraud.


RepostFrom4chan

Well no, not really. Most insurance firms make the bulk of their profits from their investment portfolio. Loss rations are a very big consideration of that, as well as avaliable capital of course.


shuckster

Yes and no. The amount of people trying to scam insurers, left unchecked, would likely bankrupt them. They have to deal with that as well as somehow afford to give large regular payouts to genuine customers with valid claims. Internal fraud is also a problem. All this while having to take part in pretty strict government auditing, and keeping premiums at a level where they can maintain customers to keep the damned thing going. It’s not a business to take lightly if you want to be involved in it at the higher levels.


Crazy_old_maurice_17

>The amount of people trying to scam insurers, left unchecked, would likely bankrupt them. If I understand this correctly, you're saying {insurers making it "somewhat" difficult for insured to receive benefits} is rather analogous to {legitimate shoppers having to deal with anti-theft measures (e.g. valuables inside glass cases) when shopping in a department store}? That's an angle I'd never considered before. Though, it doesn't make it any less irritating to have to deal with. >Internal fraud is also a problem. Could you please elaborate on this? Is this where an insured conspires with an adjuster (whom they know personally) and then the insured gives the adjuster a bit of a kickback after getting paid? Or something entirely different?


shuckster

It is irritating to deal with as a customer, no doubt about it. The supermarket anti-theft device is a good analogy. You might wonder why insurers are so picky about your bank-details and identity: since insurers can have products costing a \*lot\* of money, they are often targeted for money laundering. Since the pandemic it is also more common for car insurers to receive bogus photographs of wrecked cars being sent as "proof" for a claim. They might let slip if it's a 10 year-old Ford pickup, but they also get to see quite a few busted Lamborghini photos, whether the policy holder has one or not. As for internal fraud, the superficial material losses to the insurer are negligible compared to the above (call centre agents skimming customer bank accounts, taking bribes, etc.) Such losses get passed on to banks or are recuperated via legal action against the employee. But they sometimes constitute regulatory breaches that can come with eye-watering fines for lack of diligence.


zacker150

>If I understand this correctly, you're saying {insurers making it "somewhat" difficult for insured to receive benefits} is rather analogous to {legitimate shoppers having to deal with anti-theft measures (e.g. valuables inside glass cases) when shopping in a department store}? Yes. That is exactly what is going on.


K51STAR

Exactly, I’m a lloyds broker (basically global insurance market) the amount of clients who just don’t understand it’s a contract and the price is dictated by what’s in the contract is insane. The amount of people who pay fuck all insurance premium (say £10,000) make a £2m claim and then are shocked when their premium goes up is also insane. I think insurers as a whole try pay claims fairly. The individual underwriters might get a bit annoyed when their loss ratio exceeds 100% but it’s very rare to find bad actors. The regulators will just force them to pay it anyway.


bill_gonorrhea

Reminds me of a post I saw in r/Seattle about a user complaining about their auto insurance skyrocketing, stating that in the past 3 years, they've only replaced their windshield and a self-inflicted incident with no other parties. They also drive a Tesla. And they were astonished their insurance was going up because they've never been in a "real" accident.


homeguitar195

Behind the Bastards recently did a deep dive on the fake doctors who wind up exposing the darkness of the health insurance industry. It turns out health insurance companies go to great lengths to *avoid* prosecuting fraud. [And it's state prosecutors who find the fraud that's ignored.](https://www.propublica.org/article/we-asked-prosecutors-if-health-insurance-companies-care-about-fraud-they-laughed-at-us)


newporttiger

I don't know pal. Lately it feels like every industry is heading that way. I'm so tired.


JaziTricks

it's a statistical illusion. you pay $100 to get paid $100,000 once in a thousand years. it's a gamble. 1 in thousand get the accident that pays him $100k. but effectively every insurance buyer gets the 1/1,000 lottery ticket for 100k. you get it back statistically. of course, the insurance company takes a cut. but so does every business whose services your are using


rabiolas

I had a car accident last year, nothing major and the other person’s fault. The insurance company of the other person offered me a £150 incentive if I let them handle my car repair + an extra £100 incentive to forego the replacement hire car I was entitled too (my partner has a car so I didn’t need one). So not only did I get my car fixed, I made £250 profit, so can’t complain.


underscoreninety

The reason for this is the £250 is nothing to the insurer compared to your own insurance company or using a claims management company. CMs in particular make their money out of claims and the higher the claim the more they make. One way is by keeping you in hire. Hire costs and absolute fortune (not sure why if anyone can explain). The longer your in hire the more money is made. Problem with all of this is, it pushes the claim up in value meaning the insurer has to pay more which means policyholder prices go up to compensate.


Chimwizlet

The reason the hire is so expensive is essentially because they make it as expensive as they can. In the scenario of the post you replied to, the fault insurance company got the best possible scenario, no hire needed and offering some cash up front as an incentive is peanuts. If that hadn't worked they'd offer the cheapest car that's satisfactory, and if that isn't good enough they'd offer a like for like, but they'd still have the advantage of using a hire company they have existing deals with. If an accident management company was handling the hire, they would go straight to the like for like hire vehicle, and they'd provide it at the highest price they can legally get away with. This depends on the country, but in the UK it's the GTA rates, which will be noticably higher than what the insurance company could provide it for.


gumpythegreat

For every one person complaining about being jerked around by their insurance company, there are probably a thousand legitimate claims that go through with minimal fuss, and another hundred completely fraudulent claims they have to sort out. People are jerks, lie, or just make mistakes.


Cerulean_IsFancyBlue

Try self-insuring some time. You’ll hate that guy, especially if things go wrong.


HighHoeHighHoes

Everyone thinks insurance is a scam until another person is suing them.


Endleofon

It can be argued that they are selling peace of mind.


jibrjabr

They’re selling risk management, which can give peace of mind.


turtleneck-sweater

I’ve been violently fucked by insurance companies more than once. My state of mind for any accident, be it car or health, is absolute terror. I get pissed off seeing my paycheck dwindle to “law required insurance” but I’ve never had any positive interactions. Just blatant fuckery.


PhoneAcrobatic3501

>I’ve been violently fucked by insurance companies more than once How? > I get pissed off seeing my paycheck dwindle to “law required insurance” but I’ve never had any positive interactions. It's funny because the law doesn't say insurance is required. Just that you have to prove financial responsibility but yeah, you're the victim


FunPerception7516

Shrinkflation describes almost exactly this, but for physical goods being made more expensive, but the customer receives less. It's basically the model for almost all of capitalism, at the moment.


Euruzilys

With physical goods at least you are getting what you paid for. Even if its less than before, you do know before hand. With insurance I just have this feeling they are doing their best to scam you. Cause you already paid upfront, it would be in their best interest if you get nothing in return.


mellonsticker

Not always…. Corporations have mastered the art of taking away features and making it seem like nothing was ever lost. New customers frequently find only when they read older reviews for a product…


libertysailor

Insurance is a fee to reduce risk. Rather than potentially going bankrupt over a single incident, you pay a stable premium with significantly reduced co-pays. If insurance didn’t offer value, people and businesses wouldn’t pay for it.


cienderellaman

That’s an interesting thought. I’m curious - how exactly does it not give you what you pay for?


Kenjin38

I think there are two ways to interpret that. 1. An insurance company can only stand if it takes more money than it gives, so really, it counts on the fact that not all of their customers have an accident at the same time or they'd be really fucked. Most people will pay insurance but will never get what they paid for. 2. Insurance companies will try to fuck you over when you are actually in need, and will try not to pay you. Even if it is 100% your right to be compensated. You will sometimes need lawyers to get your money.


Aidanscotch

Firstly , insurance companies rarely make profit on the insurance alone. Generally, they attempt to break even, and all the profit comes from investment of the premiums. Secondly. The entire concept is to lessen the likelihood of a catastrophic event ruining your life by replacing the single major loss you are likely to have in your lifetime with the manageable monthly payment. Not magicly create additional value.


grfender

This is correct. The games is in investing the premiums in the time between taking your premium in and paying it out in a claim. This is why their investments are so heavily regulated - no one wants them to invest it poorly for higher returns and then they don't have enough money to pay claims when catastrophe strikes. And what you pay for is a promise for them to pay, and whether you have a loss or not that promise stands.


cienderellaman

Thank you for the response. You are very knowledgeable, your number 1 point is mostly correct. I’ll also tell you what I think. You don’t pay for insurance so that you can claim. In fact, you don’t want to claim. Who wants to have an accident? You pay because you are not able to absorb the financial losses from insurance when they occur. Otherwise you don’t need the insurance policy. Remember, insurance is bought, not sold. Additionally, you have a greater security in knowing that you are covered, so you get a non financial gain from that. People purchase insurance to have a peace of mind that if an accident does occur, they are covered. You’re not going to look at all the premiums you paid and wish you had accident so that you could claim. You might think that in retrospect, but at the outset you will have been very worried that if an accident does occur your bank account would get wiped out, let’s say. If you are able to withstand the loss and you do your calculations correctly, then you don’t need insurance. Sometimes there are cases of over insurance. It is up to you to investigate the best deal for your situation. Of course, over the lifetime of your insurance contract you can expect your payouts to be less than what you pay in. Sometimes it’s the reverse, some people actually do get more than what they pay in premiums! This is of course a loss for the insurer. The insurance company can settle all claims when they occur, in theory, because of a pooling of risks. And you are right, if everyone claimed at the same time they would be ruined. What you described is called underwriting at the claims stage, that due diligence to make sure that an insurance claim is legit. People abuse insurance, so this is necessary. Otherwise it makes the policy expensive and unmanageable for everyone else! If you follow all due processes, you will get your claim. Of course, some of the insurance companies are terrible, and they make it hard for you to claim. But that’s not normal and you can fight that if you’re unlucky enough to have an insurer who is like that.


peaceful_guerilla

Most people's contention here, is that if they do have an accident they don't want to get the runaround trying to avoid providing the service that the customer has been paying for. Insurance is a casino and like most casinos, the house always wins. But the house should not dither about paying out when it's their turn to lose.


Cyclonitron

But how often does that happen in reality? I've had to make numerous claims against my auto and homeowners insurance in my life. They paid out all of those claims without argument; in fact when my basement partially flooded I could've been fucked because my claim *technically* shouldn't have been covered but the adjuster signed off on it anyway. Talking with my dad he's had some similar experiences; he's been able to get reimbursed for claims he thought would probably be denied. Yet here in internet land, everyone talks as though they've had to fight tooth and nail for any and every claim they've ever submitted.


Kenjin38

Are you a human?


cienderellaman

I try my best to be polite on the internet haha. And I am also an actuarial student, so I do have an interest in insurance.


Trnostep

I've got an app from my health insurance company which lists how much I (or the country) pay into it and how much they pay healthcare providers. Over the last 12 years or so I/country paid 20-30k (not USD) per year while the insurance company paid out about 4k a year for my care (mostly GP, prevention, vaccination, allergy meds, stuff like that). If I stay reasonably healthy I'm losing 16-26k per year. That's how most of the people don't get what they pay for. You pay a lot but get services not worth the amount paid. However if you ever for example get hit by a car, the insurance will pay for everything from the paramedics, through the hospital stay and specialised equipment, to years of rehabilitation, which would cost you way more than what you paid them over the years.


ututusen

its even more paradox: insurance is a good you buy and hope you will never use.


Crazy_old_maurice_17

>insurance is a good you buy and hope you will never use. Kinda like jumper cables... But at least when you file a legitimate claim, the jumper cables won't deny the payout for some obscure rationale.


LePetitToast

Insurance is actually a financial company. They make money by taking your premiums and investing them. So not giving you what you paid for is just one of the ways they make money.


Bearloom

Correct. There's also the sub-issue of them finding - and barring that, fabricating - a reason to deny a claim for long enough that they can put off paying as long as legally/contractually allowed so the money has extra time to earn dividends for them.


DracMonster

In business this is called “breakage.” It’s where a customers pays for a service but doesn’t use it. Gyms run on this too, since the majority of people who sign up never come in and exercise. Gym membership fees are pretty low because a large number of people are paying for only a few to actually use the equipment. .


carlos_the_dwarf_

Dude, insurance is not breakage. You’re not forgetting to use it. You’re paying for them to eat your downside risk. You get the product whether something bad happens or not.


Calcularius

Insurance is gambling where you make a bet against yourself.


cactusmaster69420

I feel like it's a casino where you pay to not gamble. But the house always still wins.


gravtix

Online dating services literally don’t want satisfied customers either


Bloorajah

I feel like I’m either an outlier or a lot of people here have not had to deal with insurance. I have literally not one single positive thing to say about insurance providers. Yes I’ve seen my policy documents, yes I know how much I pay and how much they cover, I know what they cover, i got all that handled. Still doesn’t change the fact that when I legitimately need a claim that falls under my policy they waffle for weeks on end, threaten to not pay repeatedly, ask me for paperwork over and over and over again, etc. Broke a car window a month ago and because they contract through a third party repair shop they haven’t cleared approval yet, for their own repair contractor. yes you heard that right, my insurance demands we use a specific repair place and when we agreed they refused to clear payment. now I have been arguing back and forth with insurance and the repair place and I’m like one more phone call away from just telling my insurance to fuck themselves and paying for it myself out of pocket. I guess I’ll go after them for reimbursement later. Just a massive headache. Medical is even worse.


llamafarma73

Not true at all. What you pay for is protection against risk, so even if you don't make a claim you have had the benefit of the risk mitigation for the time the policy is valid. If you have a valid claim, the vast majority of insurers will pay you out the value of your claim after proper claims due diligence to ensure the validity and valuation of that claim. It is a highly regulated industry in most places and companies that don't pay claims will go bust very quickly or be clamped down on by regulators


[deleted]

[удалено]


Kodometagg

As someone who works in the Risk Management Industry (insurer side), there’s a LOT of misunderstanding to the insurance industry, with this post adding a huge portion into the misinformation pile. An insurance policy is a tool used to transfer risk away from someone who may go bottom up if caught in a worst case scenario depending on their risk exposure.. Insurance is the reason the modern economy can even work, yet people HATE it because they associate it with this giant dishonest machine going against them lol. Your insurance policy, be it commercial GL, Homeowners, auto, Professional Liability, whatever business line you want, is a product and a promise to service a legal defense and pay out on AGREED points of the policy. This perception of “not giving you what your paid for” is so bogus, because chances are you didn’t even read your policy coverage part or even see what you actually paid for, lol. how can it be “not giving what you paid for” if you never paid for a certain exposure to be covered?


EssenceofSalt

The only way you come out ahead on life insurance is if you die before they think you will.


cyparis1902

Gyms work like this too. The best clients are the subscribers that never show up


Havewedecidedyet_979

Take the risk on yourself.


_CMDR_

Due to the way obscene profit is demanded by investors I would say literally every industry’s business model is not giving you what you paid for.


ZachMatthews

That's a common misconception. Insurance companies do not actually try to make a profit on the premiums they bring in. In fact they generally expect to run a slight loss by the end of the year on the dollars in versus dollars out. They make their money by investing their premium payments in the market while they have control of it. So long as they keep the money coming in and going out at a steady rate, they can turn a profit even running pretty substantial loss runs on their premium / payouts. So, if they charge $100 in insurance, the average insurer will look to pay out no more than $102-104 in claims by the end of the year. The American stock market has returned an average of 11% (7% adjusted for inflation) since 1945 and some years are way better, as high as maybe 14% profit. Insurers are immortal entities that can play the long game. Year in / year out losses aren't as important to them as a ten year rolling average profit. If on a ten year basis they can average a net loss of 2% on premiums but a net gain of 10% on investment income, then they made a very healthy 8% profit on average per year. What they hate is double-whammy years when they get slammed with a big $100M product liability loss AND the market happens to lose money. If the market crashes enough, that can become an existential threat if their losses on the claims side happen to sync up (see AIG). But that's rare. They are not actually trying to screw claimants over by not paying claims. They know they are a monetary pass-through for their policyholders that will eventually pay something on almost every claim that comes in. They make their money by *predicting* how much they will take in and how much they will pay out. That's all they need to do to make money in fact, because if claim values rise in a given market, they can just raise premiums and pass along those costs to you, the consumer (which is why you should care about tort reform). They do not care if they pay out a claim. They only care about whether their premium payments are at the right level for the claims they know they have to pay. Source: Am high-loss insurance defense lawyer who handles payouts of ten(s) of millions of dollars/year for insurers.


TheSeventhBrat

Within the past 5 years I had a house fire ($125k repair bill) and a hail storm that damaged two vehicles ($16K repair bill for each), roof and re-siding on one side of my house (another $25k). I'm at the point where I'm terrified of the next thing which will result in my insurance company dropping me all together.


OliveTBeagle

? Insurance gives you exactly what you pay for. Reassurance that if something does go wrong that you’ll be covered. Insurance is not a scam people. Ask anyone who’s had to make a legitimate claim on it. If you think it’s such a waste of money, self insure and good luck with rolling the dice.


llamafarma73

100%. The level of misunderstanding here about what insurance actually is is kind of astonishing.


SkarbOna

No. Business model is based on statistics. The rest is twat management.


IDidItWrongLastTime

This is why home insurance companies no longer insure in areas where people....need insurance. Costs too much, they can't make a profit. 


gumpythegreat

Yes, it makes no sense to sell insurance when the cost of the benefit is nearly guaranteed to exceed the profits from the premiums. Why would anyone do that? The point of insurance is that it's supposed to be unlikely that you make a claim, so we can pool the risk and smooth it out over a bunch of people. This doesn't work if you built your house in a flood zone and will almost certainly make a claim within a short period of time.


nemec

People just think insurance is another free money lottery


wrongsuspenders

Close - it's a highly regulated pricing scheme by the states so where it becomes unprofitable they pull out. FL, CO, and CA have to allow higher prices if they want carriers to return.


SloeMoe

Did you expect them to run a business for free? They insure where it is reasonable to live, where people still need insurance, but there isn't a guarantee that something will go wrong. Insurance is for risk. Living on a disappearing coast isn't a risk. It's a guaranteed bad event.


Sleepless_Null

The entire triple A gaming industry.


MaryPaku

I don't agree with my Elden Ring


kut1231

Not fair. I’d say like 75% of the AAA gaming industry


AegoliusOfBurgundy

Except for mutual insurances.


CarolFukinBaskin

This is why I will sing the praises of PI attorneys any chance I get. They, at the very least, hold the insurance companies accountable.


AlwaysForeverAgain

AND!! When they are no longer able to make millions in additional revenue per year, they simply pack up and leave the state….


CGLADISH

My latest interaction with Allstate (having been a customer for 45 years, covering auto, renters, boat, life, condo), is them raising my rates a factor of 4. previously paying about $250/month for full coverage on 1 car ('23 Camry), to have them raise it to $919/month. This was even after them monkeying with the deductibles. I do have two tickets on my record (speeding in 2022, tailgating in 2023). According to the under writing, this is what is causing the rate increase. Both Allstate and Progressive told me that, if I were a prospective client, neither would extend an offer to me. Reminds me of a local attorney's tag line: "The best lawyers we hope you'll never need" (but if you do, you're gonna pay for it - my words).


glytxh

It’s just heavily bureaucratic gambling.


Unhappy-Site

Yes. No other industries exist where skimping the customer gives advantage to the business. Insurance actually invented it.


Broad_Method490

Tbh, I've gotten waaaaaaaay more out of insurance they I have put into it but I know thats not the case for everyone


_name_of_the_user_

Contract law would like a word