Story Time!

I haven't had a Story Time in awhile, so settle in, grab your iced tea or warm milk or hot cocoa or water with a twist of lemon. Whatever works. Tonight I'm going to tell two stories: one from my rookie cop days (all I was was a rookie so I'm a bit of an expert on rookie stupidity) and one from my veteran insurance investigator days.

The Rookie

Tonight I was watching the new show, "Rookies" or whatever it's called. I cringe at a lot of it as it isn't like any rookiehood I've ever heard of or experienced, but heck, it's Hollywood and God knows they can't tell a story right if their lives and careers depended on it. (That explains a lot of what happens to celebs, but I digress.) Obviously, screenwriters know nothing about how reality makes a far better story than their pedantic and adolescently immature daydreams about what it would be like to be a cop.

Anyway, in part of tonight's version, the rookie cop ends up being left alone at a crime scene, there to keep the woman of the house company until her husband got home. But when the stuff goes down, she realizes that for some weird reason, she forgot to load her gun that morning.

I gotta be honest here; I don't remember ever UN-LOADING my gun! It wasn't our department policy. Heck, I should have ejected the round I carried in my gun during my tour of duty and had it bronzed as the round that was chambered and then retired without ever having to explode.  But I digress.

At the end of the show, the Captain (or whatever he was according to their hierarchy), when Rookie confesses to not having loaded her gun, tells her that it's a common mistake and "that's why you have a partner."

There's truth there; it IS a common mistake, and I remember the night I made that mistake myself!  The difference was this: it wasn't that I'd forgotten to load my gun. I had rather forgotten to bring it with me!

How did that happen?

On Day 1 on the Job, my FTO (Field Training Officer) gave me a tour of the facility and the holding area, showing me the lockbox for weapons. If an arrest was made, we searched them outside of holding, then once they were clear put our own weapons in the lock box.  My FTO said that he put the key (like a gym locker key) in his rear pocket as it would remind him, when he sat on it, that he'd forgotten his gun.

I think I did as he suggested, certain that if I sat on that oddly-shaped thing I'd remember before I ever left the station that I didn't have my gun.

Well, one night we brought a guy in, processed him, and hit the road. This was a normal practice. I remember driving through the streets, my FTO giving various instructions and suddenly I became aware that something was missing.

With a gasp I put my hand to my hip and confessed that....I didn't have my gun!

You know those dreams you have where you show up somewhere public and you're naked or clad only in your underwear?

The realization that I didn't have my gun was a lot like that, but WORSE as I realized that in my role, the public depended on me to have my gun. It wasn't about humiliation; it was quite literally life and death!

In embarrassment I returned to the station and my FTO let me go back inside by myself (it must have been 30 minutes to an hour after we'd left) so that I could sheepishly collect and holster my weapon. Oh, yes, the ribbing that came my way!

I thanked God nothing had happened in that time period; after all, even though my career was short, I did have need to unsnap my .45 and withdraw it during that tenure! I think that while on the Job, I'd rather have been naked than without my gun, even though I hoped and prayed never to have to use it!

It was a serious Rookie dumb moment:  honestly, how do you NOT notice that the weight of a .45 Smith & Wesson is absent?

Y'all, pray for rookie cops; they do stupid things, and you do NOT want them to be doing stupid things when YOU are the one calling 911!

       *       *       *

The Nice Car Thief

This story isn't mine, but it's so memorable and awesome I find the need to post it for your edification and entertainment!

One day, hard at work at my desk, I got a call from a new investigator who had the most interesting case; he thought it so funny he HAD to share it, and I'm glad he did!

It was, for once, a legitimate car theft claim.  The woman reported her car stolen, she gave a good description on the maintenance that was done and, importantly, that which was needed. She described the prior damage to her car (nicks, scratches, door dings, lights out...etc.  I don't know the specifics for her car, but it was an older model so she knew a lot of the marks that would identify it.).

As with many older-model legit thefts, her car was recovered within a couple weeks. She called to inform the Investigator of the recovery and said she was going down to the Impound lot to look at it and sign the paperwork that would allow the Insurance company to inspect it and tow it if needed.

She called her Rep/Investigator from Impound, completely perplexed.

Customer: Hi, Scott. I'm out here at the impound, and I'm looking at my car right now.

"Scott":  Great!  How is it?

Customer:  Well...this is weird. I'm looking at it, and it's DEFINITELY my car, but......

Scott:  What's wrong?

Customer:  Well......remember how I told you about the damage to my bumper? That big scratch I said was there?

Scott:  Yes...

Customer:  It's GONE!  It's like....he fixed it!  But...this is DEFINITELY my car, but it looks way better than it did before!  It's driveable so...can I get it out of here and take it home?

Scott:  Yes, go ahead. Save the receipt of the impound fees so we can credit you towards your deductible, then give me a call back if you find anything wrong with it.

That's where he thought it ended. A couple hours or so later, the woman called back.

Customer:  Hi, Scott, I got my car back and I have the receipt from impound. But..this is really weird.

Scott:  Hi! What's going on with your car?

Customer:  Well....I told you about the bumper, but, you know how I said that it needed an oil change and that it was making a funny sound before?

Scott:  Yes, I remember....is it worse?

Customer:  No! Actually...it's better! It's like...he fixed my car! It's running BETTER than I ever remember it running!

Scott:  SERIOUSLY????? 

Customer:  YES!

(pause, shocked silence as neither knew how to react)

Customer:  So...I guess you can close the claim, there isn't any damage to my car. It's actually better now than before it was stolen!  The impound fees are under my deductible and I'm happy to have my car back.  He even cleaned it out!

Scott:  I'm glad it turned out so well for you. This is amazing!  I'll go ahead and close the claim, but do let me know if anything does turn up, and I would like a copy of your out of pocket expense in case something else comes up.

Customer:  I'll fax it to you for your file. I can't get over this!  (laughing)

Scott:  (laughing)

**

You'd think it's over, right?  But wait...there's MORE!

A couple days later, the customer called the Representative back:

Customer:  Hi, Scott, you're not going to believe this....

Scott:  What happened? Is everything all right?

Customer:  Well, I was putting everything back in order. My maintenance manual is missing, but I found an insurance card in the mailbox.

Scott:  Oh?

Customer: Yeah! It looked different than my card, and I looked at the date on it...it was insured through Company XYZ a couple days after it was stolen, and I want to give you all the info.  HE INSURED MY CAR!  (*LAUGHING*)

***       ***       ***

Need I go on? I'm STILL laughing over that one and hoping this guy will steal MY car!  I only wish he had stolen it before the recent (and necessary) brake job/oil change.  My tranny flush is WAY overdue, but yet another thing to hit the credit card along with the brake replacement charges.

Is there a thief out there willing to take my car, fix it, and leave it for the cops to pick up? It would be cheaper to pay impound than to actually pay for it....

(Just sayin'....)

I gotta say, that was the BEST car theft story I ever head. I only regret that it went to a rookie instead of one of we veterans in need of a serious break...

***       ***       ***

This Story Time has been brought to you by Adoro in hopes you have found comedic relief. Please show your appreciation in the combox if you would like Story Time with Adoro (TM) to be a regular feature.

Call me "Bones"

Tomorrow I graduate with my Master's degree: a day I actually thought would never come.

It's been a long 3 years. I've read a lot of books and in the meantime, I've built up a stack of "wanna-read" titles.  Right now I'm in the middle of 4 of them. Being sick of being in the middle of a stack of books once again, in the interim between our last class weekend and now, I've been immersing myself in catching up with my new favorite TV show, "BONES".

Shameful confession:  I actually fell in love with this show when I caught it sometime during my last semester of class.

Watching improbable investigations about crimes that were far more fascinating than any I ever completed has excited my good memories about law enforcement and investigation of fraud, and the other day I found myself giggling over an old memory.

I admit it: I'm still giggling a bit, especially at the similarities!

In my last couple years in Investigation, I was becoming very burned out as a result of several factors. Some of it was the fact that so many people were lying to me for very idiotic reasons. Some of it was the fact that people who were obvious criminals were lying just out of habit and their lies were so obvious it didn't even warrant an investigation. When I had legitimate fraud investigations I was just as happy as when I had legitimate customers.

As a result, I was becoming very jaded and crabby, and as a further consequence, at times I was beginning to lose my patience even while in the field.

On one occasion, we had an especially creepy (read: potentially physically dangerous) customer so my boss came out with me on a vehicle inspection that needed to take place at the suspected fraudmonger's home. As part of my boss's job was to do file reviews, he took this one as an opportunity, and part of that opportunity was to observe my customer interactions. Never mind the fact he was my "backup" in case this guy decided to act in the way his violent history portended.

This particular customer couldn't keep his own story, or his own alleged "damages" straight. He claimed he'd reported a theft, but there was no police record of his alleged report. He reported this and that damage, but when I was there, he gave me completely opposite "symptomatology" of his vehicle.

Tired of the game, I did what any good cop would have done:  I confronted him on the conflicts he was reporting in a very direct way:

 Me, being confrontational:  "That doesn't make any sense. In your statement you said X, but now you are telling me Y. Which is it?"

And then the customer stared at me and tried to hedge around the conflict. I was unrelenting and pressed him on the point.

I wanted to know what I was looking at and what I was assessing his vehicle for. What was he claiming? I did NOT have the time to come out to evaluate the next wishy-washy crappy thing he was claiming with regard to his obvious fraudulent claim.

When the customer went back inside, (tripping up his front steps in the process, only to stand up and state with great dignity, there, at 9:30 am on a weekday, "I'm drunk!") my supervisor quite literally PULLED me aside and said with gritted teeth, "QUESTION HIM ON THE PHONE, NOT IN PERSON!"

He was obviously holding in his OWN temper. (Imagine Booth and Brennan at this point.)

I feigned innocence even knowing I was totally busted in this file review.

Me, feigning innocence to my boss:  "What?  I need to know what he's claiming so I can document it. I'm just giving him a chance to explain his contradictions!"

The criminal customer was coming back down the steps, and this time managed to maintain his footing with the heavy assistance of the railing.  My supervisor stared at me balefully as I came from behind the man's  vehicle to accept some paperwork he was handing over.

I smiled sweetly and asked for clarification on certain points (i.e. I continued to drill him on his inconsistencies albeit in a bit of a softened manner.)

The customer moved into the garage to point something out, maybe some fluid drippings, and my supervisor said to me, again, with gritted teeth, "You are NOT carrying a .9mm anymore!"

Quietly and in a matter-of-fact tone I responded, "I didn't carry a .9mm, I carried a .45!"

Before my boss could brain me with his clipboard I stepped away to join the criminal customer in the garage to stare at the ancient oil stain he was claiming was a fresh transmission fluid leak.

This time I just rolled my eyes instead of responding, pretended to make serious note of the incident, and told the guy we'd be in touch, reminded him to get his forms in and that we were still waiting on the *snicker* police report (*that didn't exist*)

Once in the vehicle, my supervisor said to me again, "You need to remember that you are NOT carrying a .9mm anymore!"

And I corrected him AGAIN, "I didn't carry a .9mm! I carried a .45 !"

Boss:  "Whatever! Either way you're not carrying a gun!"

Me:  "He was lying to me! His story was drastically different in person than it was in his initial statement!"

Boss: "I know, I agree with you! I'm just saying that you aren't carrying a .9mm--"

"--.45!" (me, interrupting..)

Boss: "--anymore! This guy MIGHT have one and might blow you away!"

Me: "He's too drunk to walk up his own familiar steps, I doubt he'd have good aim."

Boss: "Then at least have the decency to protect company property from his bad aim." (half-joking out of exasperation at this point)

Me: "OK, fine."  (pause) "Why can't I have a gun on this job, considering all the customers who want me dead?"

*baleful sidewise stare from scowling supervisor*

Me: *sigh* 

...

Yeah, call me "Bones". (Only, don't call me Bones. Call me Dr. Brennan).

A Little Levity

I've been going through a very rough period this year, a lot of stuff going on and really, no end in sight.  Even some people at the parish where I work have noted that I seemed down. I used the excuse that I was just recovering from bronchitis, but that excuse can only go so far (and it was only partially true at the time!).  

But all is well, I don't want anyone to worry; we all have times in our life that seem crushing, and yes, we have to deal with them, and they come and go and I'm grateful to have friends who notice and who care and have expressed that they're available to talk if I need them.  

All that said, tonight I want to write about something a little more fun, and hopefully inspire some discussion in the combox.  Because it's something we've all experienced!  

That's right...embarrassing moments!  And so, tonight, I'm going to share with you one of Adoro's Embarrassing Moments. I may link to the others I've written about, if I can find them!  

GIVE ME BACK MY FAX!  

Intrigued?  Here's the story: 

Back when I was working as a Claims Investigator, I had a really stinky claim that we HAD to pay even though it had fraud all over it and I even had the smoking gun. But it was out of Arizona that has terrible terrible laws that basically forces the company to pay fraudulent claims.  Well, the "stolen" car showed up, the NICB (National Insurance Crime Bureau) helped to ID the VIN, and I got the call to look at it, document it, and take it to our storage area for salvage sale.  

We'd paid off the title on this leased vehicle a few weeks before, but hadn't yet received the Lien card, so the fact that the car was recovered just then was a bit problematic. 

As it was,  a lot of problems surrounded the payment of this claim to the lien holder, and even when it was recovered, the guy at the tow yard couldn't seem to get it through his head that the PLATE did not match the car (being "stolen") and so when I had to call to deal with some tow yard issues, he could never find it and insisted it wasn't there!  Even though I'd seen it, the NICB had seen it, the Auto Theft unit had seen it and towed it there...this dufus INSISTED that the car wasn't there!  

And so it went, problems like that ongoing. 

Well, we were told we'd have to produce the title in order to get the car out of storage and take it to our own free storage until it could be sold. 

So I called the lien holder. As it turned out, they claimed they hadn't received payment. I provided proof.  Honda, after doing some research, realized that they'd applied the payment to another account, and at least were able finally to apply it correctly to the fraudulent customer's account instead. 

But they STILL refused to send the Lien Card! 

As it turned out, they wanted documentation from my total loss workup, wanting the car's actual mileage and condition, etc.  I couldn't provide that because, at the time we settled the claim, the car was still missing in action.  I had to estimate mileage and condition based on what the customer reported and average condition for a car of that year and mileage.  

They wanted hard evidence, so in effect, they were asking me to create and falsify a document. 

I refused, my Manager agreed. 

I explained that without even a "Guarantee of Lien Release" I could not even MOVE the car from this expensive police impound yard, and each day, charges were mounting. 

They didn't care...they wanted the false document. 

This is the good part: 

So I wrote a very terse letter explaining our position and their obligations, as well as the consequences to THEM for not providing what we needed. In effect, the letter stated that as long as they would not send the lien card, the car still belonged to them and thus we were not responsible for charges. I provided the name of the tow yard, phone, address, etc. and told them the current charges  and MN law pertaining to when the yard could assume title for themselves. 

I took the letter to my Manager to be reviewed, he made a few changes so I took it back to my desk and edited the letter per his suggestions.  I hit "PRINT" and went to the printer to pick up the copy. That evening I was in a rush, it was nearing the end of the day and I was SWAMPED, this problem on top of it all.  

I still had the edited version in hand so that I could compare the hard copy before I sent it in case I'd missed something.  After comparing the two, I crossed the office and went to the fax machine, wrote up a cover sheet to the rep I'd been dealing with at Honda, placed the paper on the scanner, and sent the fax. 

As the last flash of paper passed into the machine and I heard the tones indicating that it was transmitting to Honda, I glanced down smugly at the paper in my hand, realizing that this was the end; either they would have to acquiesce to my request for the Lien card or realizing we would do nothing more and the stupid car was their responsibility.  

And then it hit me.  The paper in my hand was the edited version that I'd just printed off. 

In horror, I stared at the fax machine which was then spitting out the two pages it had scanned...the cover sheet...and the letter. 

The very  business-snotty letter I'd just sent was not the proofed and approved copy;  it was the one with my Manager's editing marks and suggestions. 

And it had already been received at Honda. 

All smugness left me.  I quickly re-faxed the letter, the correct one, hoping mightily that maybe someone at Honda would lose the letter. 

But I have a feeling it's likely framed and hanging on a wall there somewhere, and honestly, I'm surprised it hasn't been posted to the Internet....

Yes...it was THAT BAD....

Business-snotty FAIL! 

Other published tales of Embarrassing Moments of Adoro's Life:

BAD COP!  NO DONUT!

Slip of the Day

Embarrassing Moment in the Life of Adoro

A Warning to All Drivers!

I am departing from the regular topic of my blog in order to pass on a warning on something that almost happened to me today. And I'm thanking God for my years working in Insurance Investigation for waking me up before I became a victim of fraud.

This morning en route to class, I was driving on a four-lane street, two lanes each direction. There was a maroon late model foreign car driving slowly in front of me, and in the left lane, a white sedan, also late model, but newer, hanging pretty much in the maroon car's blind spot.

We stopped at a light and I was a bit "trapped" by both vehicles that apparently wanted to stay significantly under the limit when the light turned green. It seemed that the car on the left was dropping back so I began to accelerate in order to be able to switch lanes and clear both vehicles.

However, the white car to my left kept pace with my acceleration, and so I backed off...so did he. That's when I saw out of my peripheral vision that the man driving the car kept glancing over at me, and at the person ahead of me, and then back at me again. I immediately grew suspicious, especially considering that once again I'd crept up too close to the maroon car.

That's when the red flags triggered by the guy's inappropriate actions made me realize what MIGHT be going on; in insurance terms, it's a fraud scheme called "Swoop and Squat." It can take place with one or two other cars, and at the time I did not know if they were working together or if the guy in the white car was targeting both of us.

Basically what the criminals do is find a likely "target", maybe an unaware driver, someone alone...they don't want witnesses or passenger testimonies. They let the "target" car get into position, either by forcing it by "boxing" them in (as happened to me today), or just by taking advantage of an impatient, unaware driver. Then at the opportune moment, they hit the gas, leap ahead of the buffer car, get in front, and slam on the brakes, causing what CAN be a multiple-vehicle collision - and they're in front. They go on to get paid for the damage to their car and claim all sorts of fun soft-tissue spinal injuries and other high-dollar things that will lead to a Bodily Injury claim.  

This scenario can play out different ways...the "swoop" car can be the cause of the accident but not be directly involved, but in that case, they HAVE to be working with a partner car.

Well, once I recognized the setup this morning I backed off and refused to get close enough to either car to be taken in. At the next light, I saw that the guy kept glancing at the other driver in front of me, and eventually DID speed ahead, where, lo and behold, he almost IMMEDIATELY found another "target".

How do I know this? Because I was so intent on watching him that I completely missed my stop to get gas for my car and coffee for my class! 

I was in a great position, then,  at the next light where I witnessed Mr. White Car pull up next to the other car he'd been stalking, and there, I observed the same behavior. That car, too, had only a driver who appeared to be either elderly or at least a small-statured person, and the guy in the white car kept staring over at her, as though sizing her up. When the light turned, he kept pace, hanging slightly back, not passing, continuing to glance over as though waiting for the right moment to make some kind of a move.  

Well, I was irritated and needed to get to class, and was tired of being held up by the self-appointed criminal pace car and wanted to get away. So at the next light I made a turn, realizing as I did so that I'd FAILED to grab his license plate, and my "ditch" off to an alternate route might well give this guy the opportunity to cause the accident he was clearly looking for.

I ended up backtracking a couple blocks down, thinking that if I saw the cars pulled over, I'd stop, too (a distance away), call 911 and report the accident and the suspicious behavior to the police. My next call would be to the NICB (National Insurance Crime Bureau). Well I didn't see anything, so went on to class, but wondering if this guy would eventually find his victim.  

So, my dear readers, take caution out there on the road. Don't tailgate, don't get boxed in. If someone is "hovering", back off even if you're in a hurry so that you don't play into their plans and end up with higher insurance rates because of it!

Now, there is another possibility; it's possible that this guy wasn't after an insurance scheme, but rather, looking to cause an accident in order to victimize someone in another way. THAT'S why it's ALWAYS a good idea to call the police to report an accident especially if you're in a place devoid of a lot of foot traffic. If you don't want to get out of your car or have reservations if you ARE involved in an accident, call 911 and explain you're fearful of the other person and would like an officer on scene to facilitate or investigate the circumstances. It's not wrong to do this.

If you have ANY RESERVATIONS WHATSOEVER, DON'T GET OUT OF YOUR CAR! Don't give personal info, and wait for the police. Your safety, and your life is worth the wait.  

Let me Tell You What I Think

I ended my massive work project this afternoon, and I couldn't be happier! It was a ton of work, but the Mother of God was in charge and all went well. I'll still have some cleanup to do, mostly in my office, and prep for other events, but as of now, my work hours drop down to 10 hours per week.

I can't live on that. I do have another job for the summer, but I don't think it'll be a lot of hours and it likely won't pay much. But I think it's what I'm supposed to do. This coming week I'll have only my 10 hours, and the rest of the time I'll be off on a "vacation" much needed. On the positive side of things, at least I won't be driving 40 minutes each way every day! God is good, is He not?

Throughout this last year, I've been flying by the seat of my pants at every moment. Things have gone well, and maybe it was a lesson on surrender and trusting God, things I have great difficulty in doing. Each time I thought things were crashing, God answered. I'm certain that He hand-picked my volunteers and although I only met these blessed people this year, I feel like I've known them forever! And I love them and appreciate them like my own family!

But often, I've lamented the job I left...in insurance. Yup. It's not that I wish I hadn't quit...I think quitting was the BEST decision God ever made for me. (Yes, you read that correctly.) This year, even flying by the seat of my pants, even with irregular work hours and all the work on my Master's degree, well, I've NEVER been as stressed-out and bitter as I was in my last job.

I don't see myself remaining in my current position for long, but I'll be there at least, in all liklihood, until my Master's degree is completed (another 2 years), God willing. So this cycle will continue, but God gives us the grace to do what needs to be done...He sure did prove it this week, and I KNOW for certain that Our Lady had me by the hand all week long. But that doesn't mean I have a future where I am.

Just as I knew I didn't have a future where I was. I'm not even sure I have a future in Minnesota, but for now, we'll let that idea lie for I don't know where it's going.

This evening a friend sent me an email, and it got me fired up. Because of my last career, I have a certain level of expertise in an area, and now that I'm no longer burned out, I love talking about it. The old excitement came to me...I loved investigation. I loved typing my password into certain National databases and entering the necessary info in order that the database might spit out important records to help me in my investigation. I loved following the threads, I loved learning new things and trying to figure out the crime and I REALLY loved when we caught someone at their game...and roped them in.

Yet it frustrated me because I knew I was always looking for something negative, and in the midst of an investigation, trying to hold off indignant people who didn't seem to understand the game...that even if they were innocent, I had to ask my questions, I had to do what I had to do and no, I couldn't tell them what I was looking at because it was an investigation and I couldn't compromise it. Most of them only feigned indignance...they knew from day one they were the ones being investigated. Some of them were innocent people who had started out naive and were used to being in control...and couldn't deal with not being in control anymore. Other people really didn't have a clue how the world works and that people commit fraud...and I had to assume everyone was doing this. The trick was to try to keep everyone happy while doing the work in the background. Some days it was incredible...some days it was awful.

Some days I didn't think I could live with myself, even though I was doing nothing wrong. As time went on, I felt we were focusing too much on people who were completely innocent. I developed a "nose" over time, and knew within 5 minutes if someone was lying to me. Yeah, sometimes I got fleeced, which is why "feelings" aren't used to determine fraud. Things were awry...even as the company wanted to save money on investigations, they made us pay stuff that was clearly without merit, and they made me hold off on stuff I knew was clearly legit. And we all made errors.

I'm happy now that I know what I know, and I'm happy that my knowledge can benefit others as well as myself. And let me tell you...I'm VERY protective of claims adjusters. I don't care about the respective companies...in the end, they're all the same. (Although I learned, professionally, that there are certain companies that will NEVER have my business! No, I won't name them.) But the important thing is that they are staffed by people, human beings who are struggling to get the job done, and everywhere there is a very high rate of dissatisfaction. All of the companies are selling out their employees, the people you actually speak to on a daily basis, the people, when you have a claim, that you call, "The Insurance Company."

Individuals aren't "The Company". They are compassionate people with varying levels of experience trying to keep both YOU and their employers happy. They are the ones always thrown under the bus. They are the ones working their fingers to the bone and being villified in the process, being called "incompetent" on behalf of the actions the people above their heads make. Insurance is a very regulated field...adjusters, unless they are independent, are slaves to a system, and in speaking of my past co-workers, they're doing their best. And their work is necessary.

I still get fired up about some of the stuff I learned, and I really get fired up about the people, because if there is ONE thing I learned from my years there, it was to work hard to treat people with respect no matter what the circumstances, whether they were co-workers, co-professionals, competitors, or customers in ANY circumstances. The customer doesn't have to be right in order to deserve respect...they can be wrong and teach you a whole lot about being human.

This post has not gone where I expected, but I hope I said what someone needs to hear, so for now, I'll sign off with a salute to all those who work in the thankless profession of claims adjusting.

No-Fault and Liability

I'd like to preface this installment with the following disclaimer:

I am citing mainly Minnesota Law. There are several states that are known as "No-Fault" states. Those states that do not have "No-Fault" are "Tort" states and so are subject to differences in how this is handled. If you live in a "No-Fault" state, then most of what I'll be saying applies.

NO-FAULT

Somewhere in my first year on the job, when I was still a Generalist, I handled a very simple claim: Car A rear-ended Car B. We insured Car A, and as liability was clear, I contacted the other parties and we got their car into the shop for repairs, paid for a rental, all up front.

The damage to their car was minimal, but the passengers reported some stiffness and one party did visit the doctor. So, per company policy, I went out to meet with the parents (one of them was the injured party) and discuss Minnesota's No Fault law and how injuries are handled.

Raise your hand if you've ever heard someone say with regard to an accident, "No one is at fault...this is a "no fault" state." Raise your OTHER hand if the person you heard that from was a cop.

Seriously, the police in this state need to be educated on this very simple fact. And so does everyone else, so listen closely:

The term "no fault" has NOTHING to do with liability. Typically in an accident, SOMEONE is at fault in an accident. And what always amazed me was that even after I had written a check to someone, that person would be saying something about "no fault" and "he's not going to pay because this is a "no fault" state."

OK, seriously, then, why are we talking and what insurance company is listed on that check in your hot little hand?

And that was the situation during the claim that I mentioned. As soon as I sat down with the customers to discuss their injury claim and mentioned "No-fault", the guy ducked his head, clasped his hands together and said in a low, gruff voice, "I'm just telling you right now, I'm going to FIGHT THIS!"

I took a deep breath. He wouldn't make eye contact with me, so I mildly told him that he had nothing to fight. I pointed out that there was a rental in their driveway and I was paying the bill. And would pay the bill on the accident-related repairs. It was a done deal. What was he fighting?

He finally looked up after that.

This is very simple, actually. "No-fault" simply means that, if you are involved in an accident AND you are injured, you MUST go trough your OWN insurance company to cover your MEDICAL expenses. You're paying premium on that, and utilizing the benefits DOES NOT affect your insurance rates. EVEN IF you're a PASSENGER in someone else's car and you're injured, regardless of who is at fault in the accident, you MUST call your own insurance company and report an injury-only claim.

No-fault, then, applies ONLY to injuries.

Now, if you are driving someone else's car or you are a passenger in that car, and you don't have your own car/insurance, then the car you are in will cover your medical bills. Again, this is no detriment to the policyholder. This is Minnesota State Law, and the law was designed to protect people.

There's more to say about injury claims, but it's best to discuss liability first.

LIABILITY

Liability basically means "negligent". There is always a question; who is negligent in a given loss?

What if you spin out on icy roads and hit the guard rail? Well, it's car vs. immovable object. YOU'RE at fault for driving too fast and failing to maintain control. Don't argue about the fact it's icy....in that same area, while you sat there stuck to the mangled rail, waiting for a tow truck, countless cars passed you safely, didn't they? Without crashing.

OK, what if a deer jumps out in front of you and ends up bashing into your fender?

You are NOT at fault (unless you happen to be a Foxworthy-type redneck and you were in the ditch HUNTING the deer using your car as a weapon). Seriously, deer hits are handled under comprehensive coverage, not collision, and there is no liability to you.

In the event of more than one vehicle, often liability (who is negligent) is very clear; such as when a car is stopped at a red light and another car fails to stop, resulting in a rear-end collision.

Intersection accidents can be trickier; if coming from opposing directions, SOMEONE had a red light or a stop sign, or in the event of an uncontrolled intersection, someone didn't yield in accordance with the law.

Yes, there are laws that govern uncontrolled intersections.

Anyway, now I must introduce another term, which applies under Minnesota State Law:

COMPARATIVE NEGLIGENCE

This means that BOTH or ALL drivers can SHARE in the cause of the accident. Keep in mind... "comp neg" doesn't always apply. But sometimes it does. Take the example of an intersection accident, especially if it is uncontrolled. Both drivers approach the intersection, neither sees each other and neither looks to see if anyone is coming, so they collide in the center. Both are at fault. Was one car going faster than the limit? What if one driver had a stop sign and the other didn't, and the guy with a stop sign ran it? Well, that doesn't automatically excuse the other driver. What if that other "innocent" driver saw the car coming and "assumed" that, since he had a sign, that he was going to stop?

Well, there's comp neg. That "innocent" driver is at least 10% at fault for failing to take evasive action.

I'm not going to define every scenario, and I HATED making comp neg decisons. HATED IT.

But here's a fact that a lot of people like to ignore; they often complain about insurance companies paying only 80 or 90% of a claim, and say idiotic things like: "You're 10% at fault for just BEING there!"

FALSE, FALSE, FALSE!

If you are illegally parked and your car is unattended and gets hit BECAUSE it was parked so strangely and in a location clearly marked for no parking, THEN you could be 10-30% at fault for BEING there even if you weren't in the car and driving at the time.

Other than that....no. If your car is legally parked and a drunk swipes it some night, you're not at fault. Even if your insurance company has to pay because the other car/driver can't be identified, it doesn't change the fact that you are not liable in that case.

The other complaint about insurance companies and comp neg: People blame the insurance company fr the comparatie negligence law. The reality is that this is not something made up by or for insurance companies. It's a STATE LAW. The insurance company has to ABIDE by it. So don't blame the insurance company if you are held liable for something you did wrong, which also has to be cited. List your vice: inattention, speed (by the way, it's on the books that speeding negates right-of-way), etc.

JOINT AND SEVERAL LIABILITY

When I started, the "Joint and Several" law was something I didn't understand, until I had to handle a claim involving it.

At the time, the law stated that, (in the event of a multi-vehicle or other property accident), if you are more than 15% at fault, then you can be held responsible for 100% of the damages. WHEW!

Keep in mind, this is no longer the law, and I will explain the change after I explain the scenario which only makes sense under the old law.

Here's what happened:

Car A was sitting in traffic, waiting for the light to turn. He was far back from the light. It was a divided highway, separated by a grassy median, no fence, and the southbound side was flowing freely.

Car A happened to glance in the mirror and saw a black car coming towards him, not slowing down. He KNEW that he was going to get hit and pushed into the car ahead of him. He cranked his wheel to the left, bracing for impact, hoping that the impact with the turned wheel would drive him into the median and alongside traffic so he could avoid hitting the car in front of him. He also touched his gas pedal just before impact, hoping to ultimately avoid being hit. Thus, at the time of impact, he was both steering his car TOO FAR to the left AND giving the car a little gas.

I actually commend his very quick thinking, and had he had more time, it could have worked.

As it was, it didn't. Car B hit him, and because he had turned his wheel TOO FAR to his left, AND because of the hard impact and even the small acceleration he gave his car, Vehicle A literally SAILED over the grassy median, airborne, and T-boned a car in the southbound lane.

The southbound car couldn't have done ANYTHING to avoid the accident. Who could have seen THAT coming?

The driver of Car A stated to me that he felt that the driver of Car C was fully innocent. He believed that Car B was 100% responsible for the accident. The driver of Car C ALSO agreed that Car A was innocent, and felt that Car B was 100% at fault for causing the rear-end collision.

I as the rep for Car C agreed, (Call me Company C), the rep for A agreed, and we both tried to find the company for Car B.

I can't remember, but I do think I got a statement from Driver B. She first told us she'd get her insurance info...she was later to admit that she did not have insurance on her vehicle at the time of the loss.

Well, that left 2 very seriously damaged vehicle, and 2 companies who agreed neither was actually at fault in the loss. In other words, the proximate cause of the entire accident was Car B, and we would have difficulty collecting from this individual who had no insurance.

That's where joint & several came in.

I hated to do it, but I finally understood what it meant. The reality was that Driver A HAD made errors that caused him to sail over the median. Ironically, if he'd not tried to do anything, he would have been 100% innocent.

Unfortunately, it was his evasive actions that caused him to crash into my customer. Would he have hit her if he hadn't been rearended so hard? No. But under this law, he was more than 15% at fault for my customer's damage...and so we sent a subrogation (insurance term for collection) claim against that company.

Remember, we didn't make the law. And it is the Subro department that ultimately determines whether joint & several apply...and it did.

Now, as I understand it, that did not mean that the driver of Car A was HIMSELF 100% liable for the loss...he was 15-20% liable for MY CUSTOMER'S loss, and had Car B had insurance, we would NEVER have brought a claim against his company. And that's exactly what was going on..we were bringing the claim against the company.

That company, then, would be responsible for collection of all of the damages from the actual at-fault party. But first they had to pay us. And as I recall, the claim went to arbitration and Company A had to pay us.

NOW...in August of 2005, I believe, that law changed.

As it stands, now, only if you can be held 50 or 51% (I think it's the latter) liable for a loss, you can be held responsible for 100%. Therefore, in the case I cited, if it happened now, Company A would NOT have been subrogatable. So, this was a change in the law which is greatly beneficial for the average person whose evasive moves go weirly awry.


OTHER LIABILITY LAWS AND ISSUES

When I first began my job, my company sent me to another state to learn the generalities of policies everywhere. So I learned that some states have laws that make you pay for the percentage you are at fault. So if you are 30% at fault, you pay for 30% of the damages (in a multi-vehicle accident).

I don't remember much about that stuff as I promptly forgot about it since it didn't apply in my state and we don't handle out of state claims.

However, thare are some general things all people, at least in Minnesota (and check the laws in your own state) should know:

If you are involve in a multi-rear-end collision, and you are car 4 out of 7, your claim is against the guy who hit everyone so hard so as to involve 7 vehicles. You cannot collect against the guy immediately to your rear...he wouldn't have hit you unless he was pushed into you. UNLESS it was one of those rare situations where he hit you first, and then another idiot hit everyone harder and the first guy was pushed into you again. And in that case, the "chain breaks.

And likewise, then you'r not liable for the damages of the person ahead of you.

HOWEVER, TAKE NOTE! In a multi-vehicle crash, get EVERYONE'S INFORMATION! Get license plates, car make/model/year, insurance company and policy, driver's name, DL#, some kind of phone number, some address (even work), etc. Get everyone...your insurance company needs all of it in order to make a proper liablity decision and collect from the correct company. AND, plan to go through your own company and pay your deductible. It will save you time and get you back on the road.

I can understand not giving out your own info, but many people have cell phones, use work addresses, or in the case of law enforcement, use the police to do a "driver exchange" form. In the case of my recent accident, I gave the guy one of my business cards. I was NOT going to hand him my home # and address.

BODILY INJURY CLAIMS

In Minnesota, under the No-fault laws, you MAY still have a bodily injury claim. There are "thresholds" that apply:

* $4,000+ in treatment (does not include diagnostic tests such as MRI's)
* Death - your family collects.
* Dismemberment - in the former, your family collects. In the latter, it's evaluated based on what has been dismembered, long-term prognosis, etc.
* Severe injury - if you have broken bones or scarring, you have a BI Claim.

This differs from "Tort" states, where you'll see on your policy the term "Medpay $5,000" In Tort states, if you are injured, from the moment you or your insurance company spends $1.00 as a result, you have a bodily injury claim.

In this regard, No-fault is a bad thing...it's why PI attorneys are so rampant here. They will literally counsel their clients to run up treatment bills at chiropractors so they'll reach a $4,000 threshold, qualifying for the BI claim, which the attorney will then get paid to settle for you.

Now, a lot of people think they have to get attorneys to handle their claims. And they LOVE to use attorneys as a threat against an insurance company for ANY conflict in a claim, injury or property damage only.

So, I gotta tell ya...that's not a threat. I LOVED it when people got attorneys. First of all, it meant that the claim went buh-bye to the Casualty unit. (That's a definition I forgot earlier...they specialize in massive injury and litigation, also separated by sub-specialties. So they handled all attorney-repped claims). Anyway, often I also LOVED dealing with the attorney of an injured party because then I could get things done like settle the total loss with the attorney, who knew market values and wouldn't ask for $5,000 for a car worth $500 and claimed as a "show car" from 1979.

A claim is not handled differently if an attorney steps in; the only thing that changes is that all correspondance goes through the attorney. And sometimes clients did not understand this and would call to speak to the rep. We COULDN'T answer their questions without their attorney being on the line, so we'd have to either try to reach the attorney or have the person call the attorney to call us for the answers. What a ridiculous system. But we didn't create it; we had to follow it so as to avoid any accusation of manipulating the client or other such thing in the attorney's favor.

Also, an attorney will charge 30-40% of the settlement. And the settlement offer evaluates only the individual's injuries, prognosis, "pain and suffering", and other things, NOT the amount the attorney is taking off the top. So, people who do not get an attorney get paid more.

Now, I also realize that some companies don't follow an ethical code. Some of my own trainers came from a company that did things incorrectly and skimped on settlements. That's why she left. And I also had co-workers involved in accidents and garner BI claims (one had cracked ribs and other injuries), and was offered a paltry amount. He took the offer to our casualty unit and they were SHOCKED at what that company was offering. My friend, by that time very well versed in what SHOULD be happening, at a professional level, tried to negotiate for himself. He ended up resorting to getting an attorney, one recommended by the Casualty reps.

So, there IS a place for attorneys, and contrary to popular opinion, the business relationship between companies and attorneys is NO one of animosity. There are exceptions, certainly, but overall, the attorneys I worked with were decent.


TANGENT

I didn't work with ANY attorneys in connection to injuries - it wasn't my job. But I DID have clients get attorneys when they realized that we were investigating them for fraud. Thus, my conversations with those attorneys were very guarded, yet cordial. We knew one another's positions, and the main point of our contact was keeping updated, passing documentation back and forth, making and answering demands.

In the beginning, this intimidated me somewhat. After awhile, I got used to it and even though we "opposed" each other, our conversations were very friendly.

One in particular, just before I quit, was weird. I had inhereted a very old claim, very fraudulent, which had been closed for non-cooperation of the customer who refused to provide certain information. At first contact, the attorney was not formally representing the client, but was calling with him in his office, trying to understand the status of the claim, whether it had been denied or not, and if not, why not. He asked for a copy of the policy, which I provided. At the time, he was evaluating whether there was a case or not.

Well, he ended up taking the case. The attorney realized I was not the original file owner, realized that the file had to be gotten out of a remote location due to the fact it had been closed for a couple years, and we had a very candid conversation when I continued to stick to our position that Customer X needed to cooperate with a particular demand on our end. We could not continue our investigaion without it.

Well, during that conversation where the attorney stated that he was moving to litigation if we did not provide a certain thing by a certain date 5 days down the road, and we both realized that we were not going to cave (our own case was very strong). As it was, I also had to reveal to the attorney that, yet again, the file was being assiged because I was leaving my position. I defined to him what I was doing in the meantime to meet the demands that I could and set an expectation as to when the newly assigned rep could contact him. I also told him I'd have my manager reassign the file ASAP so the new rep could review the file.

Well, that attorney and I by then had gotten to know each other, and so he asked me why I was leaving? To go to school, make a career change, etc. He wished me luck...as it turned out, he'd gone to the Lutheran Seminary some years ago, and truly valued the experience although he determined he was not called to be a Pastor, but to the practice of Law.

It was fascinating, and I must say, a great way to end my business relationship with an opposing attorney!

So! Although this may seem to be anti-attorney, I must say that they are necessary in some cases, they fulfill a role, but they are not necessary in ALL cases. And they DO turn some clients down.

I've also had attorneys as my own customers and found them to be some of the best because they knew how things worked so it was very easy to proceed and get things accomplished.

OK, end of THAT tanget. And my fingers are tired from typing.

There will be further posts on the topic of women and body/repair shops, not just involving my work in insurance, but also as a customer. But for now...let's just go with what we have, shall we?

And again...please don't use the combox as a form for airing grievances, please don't name any companies or persons. I'm providing this info for your education so that YOU can be more informed. If you are in another state, some of the above may differ via state law, via company (if the info was company-specific). And I'm willing to answer any questions I am able.


And I'm already remembering why I was so burned out and why I quit that job.

Auto Insurance

This is the 2nd installment on my Auto Insurance and Repair series.

I worked in auto insurance so, while I also handled a few other things on occasion, I am not an "expert" in those matters so I am limiting this discussion to auto insurance only.

AGENTS AND BROKERS

A lot of people are just endeared to and in love with their agents, because they think their agents are in charge of everything, right down to getting paid for the claim. They think this often because the agent gives them that impression. It's called "salesmanship", which isn't always entirely honest. But it sure did work to sell you the policy and make you think he or she is god, did it?

So, first myth debunked - The job of your agent is to sell you your policy, explain general terms of the policy to help you understand that you have a deductible, etc. This is a VERY IMPORTANT service, because I've had customers whose agent either did not clearly explain things, or at the very least, make sure the customer understood.

Agents can indeed step in to help resolve matters or clarify issues between an adjuster and the customer, however, they have absolutely NO AUTHORITY over the adjuster. The adjuster does not work out of the agent's office. The adjuster has a totally different supervisor in a totally different department and geographical location. There MAY be some exceptions to this, but offhand, I can't think of any in all of my dealings with companies all over the country, large and small.

I will discuss agents and claims in more detail at a later point.

Keep in mind that SOME agents are licensed to sell only ONE companie's insurance, and so that agent may become pretty well versed in the policy terms. However, there are many agents out there who are licensed to sell insurance for several companies, in which case they actually DON'T know the differences and similarities in a policy.

I was actually surprised when I learned this. There was a dispute with a customer who had misunderstood his policy...but that's because he hadn't read it. The agent hadn't read it either, and confessed that he DID NOT HAVE A COPY of our policy! I asked how that could be? And he explained the above...they sell the policies, but they don't know the changes or differences, it's impossible to read and know all the policies they sell, etc etc. Now, I can tell you that my company had the policy online in a database accessable to agents and adjusters alike, but it's possible not all companies function in that manner.

So...that knowledge was very helpful to me as an adjuster when people said that their agent couldn't explain those details of the policy. Nor, really is it the job of the agent to do this.

Remember...when you purchase a policy and give your signature, you are signing a legal contract, that you understand the terms of the contract. And in a policy, there is a section of clearly laid out exclusions. Also, under "Collision" and "Comprehensive", etc., it also lays out what is covered. If something is not mentioned...it's not covered. Check for other coverages. For example, "Rental" is not necessarily included under Comprehensive. SOME companies include this; others do not. This is a VERY IMPORTANT difference which requires you to READ your policy. Reading up front could save you massive headaches and misundersandings later.

Know what it is that you are purchasing from your agent. If nothing happens to your car, then it may not matter. But don't rest on your laurels, ever...that's when the world turns upside-down.


One important detail about agents in relation to claims: If your claim is at-fault, the agent may be reluctant to take it down. Why? Because those losses are a detriment to the agent. They are self-employed, and there's all sorts of things that involve an agent's overhead. They don't even want to take your claim down if you are NOT at fault, because they don't want the company to pay you...they want the other company to pay you. So they'll tell you to wait, which is a HUGE disservice to you especially if the other guy doesn't have insurance, if there is a problem with his insurance, if something on his claim needs to be investigated, etc. So don't EVER let an agent tell you not to report a claim.

I will have to discuss fault and liablity in another post.



CLAIMS ADJUSTERS

Claims adjusters work en-mass out of a Dilbert-like environment involving cubicles that look a lot like ice trays from afar. There are different titles and types of adjusters, so here are a few:

Generalists handle anything and everything (within auto) which may be defined, expanded, or limited in scope by the company. When I started as a generalist, it meant that I was the sole contact on the claim. I spoke with all parties, I inspected the cars and wrote estimates, I negotiated with the shops, and I settled Bodily Injury claims (minor ones). There are also Generalists in the Injury unit (will define this further later), and they specialize in handling the medical portions of auto claims. While I worked for the company, the generalist positions changed a bit, although I can't speak to the medical side very much as I was not involved in that unit. However, on the property damage side of the coin, several reps were forced, in addition to their property damage and liability investigation workload, to take on certain injury claims as well, meaning that that portion of the claim would remain with them, not be referred to a med rep specialists.

You may hear the terms "Inside Rep" and "Outside Rep", or terms similar to that. Some companies hire adjusters who work only in the office, making calls, taking statements, determining liability. The outside reps are those who drive around all day writing estimates and negotiating with shops. Of course they work closely with the inside reps.

Some companies do not assign a claim to an individual, but rather, have a team approach. A batch of claims is sent to a particular team, perhaps consistent with a particular specialty. Anyone on that team is responsible for the resolution of the claim.

Claims Investigators, which is what I was for the last four years, deals with specialized types of claims. This title and position would vary from company to company, so be aware of this. Sometimes generalists handle the high-fraud claims, but in my company, those were passed to a group of investigators. My job in that unit was the same as before, however, it was far more complex. Each claim required further investigation to rule out fraud (which is what usually happened). In that case, the claim was handled like any other, although with a few extra steps on our end, which were explained to the customer. Most customers understood this especially when it was explained up front, some chose to argue, anyway. On occasion red flags were all over the place which caused us to launch a full investigation, involving forensic experts, criminal record searches, requesting financial documents, etc. Whatever was proper. Not all of the same things were requested on all files; our scope was limited to the concerns we had. If in the process of a full investigation fraud was ruled out, we ended the investigation and resolved the claim. If it was not resolved, we continued until the questions were answered. I am not going to go into great detail on these investigations because I'd rather not teach someone how to committ fraud.

To anyone who has a claim that does go into a fuller investigation - don't worry. Cooperate, provide what you are asked to provide, realize this is happening for a reason, and the investigator will HAVE to, at the proper time, address particular questions to you regarding the concerns. However, no, you don't have a right to the documentation being obtained in the process of the investigation. There are some things you can obtain at a later date, but in the course of the investigation, nothing is released.

Also...in Minnesota, there is a law that allows insurance companies to obtain information from other companies. It's an immunity law that protects adjusters from being accused of "bad faith" if they are requesting info otherwise deemed as "private", but for the use of ruling out fraud.

Every claim you have goes on record at the National Insurance Crime Bureau. And investigators have access to this information. And the NICB can also request copies of the investigative files of the insurance company in question if an issue falls under their umbrella. This is a fairly rare occurrance and doesn't happen to people who are on the up-and-up.

Special Investigators are yet another category. They are not adjusters, but pure investigation. They canvass neighborhoods, they go to court houses and look up records, they view videos of crime scenes with the police, they are in charge of obtaining statements in person, or in some cases, of conducting depositions. (My company used attorneys to conduct depositions). I worked with someone who had formerly been in a specialized unit of US Customs, Secret Service, another was ex-Chicago Homicide. That's where retired Feds go---to work for the insurance companies in investigating fraud. And they could do amazing things both because of their professional contacts and professional experience. I'll tell you right now I'd never want to sit across the table and be grilled by one of these people!

I worked very closely with them, though, and in the beginning, that was my career goal. But I got worn out and saw the punishment they took in form of workload and realized that I wanted nothing to do with it. Also, I realized I hated cars with a passion and didn't want to spend my career dealing with fraud and cars. The very thought made me tired. You would NOT believe the amount of travel these people would have to do and the hours they had to put into their jobs. No, thank you.

And to be fair, I also came into contact with a few SIU reps who were not up to par, and they literally WRECKED investigations with their incompetence.

No field is complete without the Incompetent.

OK, this post is really long, and there's more to say, so let's just end here at definitions. If something comes up that I didn't define, I'll edit to include it.

SOME GENERAL INFORMATION:

if you do have specific questions and you have a claim, the BEST person to ask is your adjuster because they're the only ones who know what is going on with your claim. Your Agent does not have access to the claim itself. They might have access to some limited information, but don't call your agent to find out what the adjuster is doing. They can't answer that. Don't call your agent to find out how long it's going to take to fix your car. The agent doesn't know.

Depending on the system the company is using, the Adjuster or maybe a contact at the Repair Facility will answer your questions specifically. However, in the context of a CLAIM specifically, your adjuster is the person to tell you who to contact for what, IF said adjuster isn't the person for all of it.

One of my biggest frustrations was that people would not call me if they had questions, or if they did call, they didn't leave a message. I was ALWAYS on the phone when I was in the office, and the rest of the time, I was out of the office. So I couldn't always be there to answer the phone. But I checked messages from the field when I had a moment, and I returned calls as soon as I was able. But some people wouldn't reach me and just assumed I wasn't "doing anything." And they'd call their agent, who WOULD actually leave a message. Often with attitude.

I ignored agents with attitude. Sometimes I'd call them back in a timely manner, but the agent isn't my customer. If I knew who the agent was calling about (ie if they told me the name of the customer), usually it was a customer I'd been trying to reach so just tried to reach them again. The agent RARELY did anything to assist on a claim. Instead, they were usually just responding to a customer complaint, which usually had something to do with the policy, not the service. And so I'd explain to the agent EXACTLY what I'd told the customer. And then maybe the agent would explain it again to the customer. Or just say "Oh" and drop the attitude.

And then there were times when the customer would throw the agent under the bus for something. Or the agent would throw the customer under the us. Or the adjuster. Those times were always great fun for all.

My favorite was the agents who tried to tell me how to do my job. And I would explain my job to them, and define theirs to them (ie...I'll do my job and you do yours), and then I'd end up faxing a particular portion of the policy to the agent.

Some agents were awesome, and were indispensible in resolving customer disputes. Those agents admitted if they didn't know the policy in question, took time to learn the process and understand both what we were doing and what the customer was doing, and even helped to resolve total losses. I LOVED those agents, can still name some of them, and really wish ALL agents were like them. Working WITH the agents was just awesome especially when a customer was confused, or just a difficult person.

So this post should be taken as a Pro-Good-Agent post. I LOVE good agents!




Next up: "No Fault" and Liability - What some people THINK it means versus what it REALLY means. It isn't even in the same ballpark with the mythology about it.


I would like to make one request - If you comment, pleas refrain from naming any insurance companies, whether your comment is positive or negative toward them. Secondly, please don't give a laundry list of insurance complaints. No one here is your broker, your adjuster, your agent, or anyone who can help you. There is more than one side to every story.

If you have questions with limited scope that can be answered, I'm happy to try to answer. I cannot address things that are specific to your claim or policy. I couldn't even do that when I was working in insurance because I'd have to look up each individual circumstance in light of the policy. And it's not always easy as you might think.

Women, Insurance, and the Automotive Industry

This is a Public Service Announcement(PSA) / Long Post Alert (LPA)/ and First In A Series (FIAS)

[Please also check out Uncle Jim's post on this topic.]

I grew up hearing it. We all did, and some of us have had horrible experiences with cars and shops, verifying what we grew up hearing; that women are taken advantage of in mechanical and body shops. Women are stupid when it comes to cars, and insurance, and repairs.

While I won't say that's NOT true, I'm also not going to throw out a blanket endorsement of this perspective. Why? Because for the last 5 years, I was inside this industry.

And if there's anyone "lower" than a woman when it comes to cars, it's a claims adjuster. And it's not about the individual adjuster; it's about the company that's paying the bills.

Here's the reality: there are so many myths about how insurance works, how mechanical shops work, and how body shops work, especially in relation to women, that it's impossible to keep it all straight.

In this post, I'm going to address the basic mythology and answer according to the reality I saw and lived. My experience encompasses my own personal examples, my contacts with the investigation of accidents, damages, thefts, and fires, my own experience in estimating damages, and finally, my likewise extensive experience in dealing with shops.


The basic mythology goes like this:

1. Women get "taken" every time they go to a shop because they don't know anything about cars, and the shops know this so they take advantage.

Shops don't take "advantage" of women who don't know better. No more so than men who don't know any better. And it's actually men who impede legitimate repairs more often than women, because, in my experience, men are more likely than women to hold onto the myths, (out of a distorted sense of "machismo") as opposed to women, who were willing to be educated and could verify the information provided via various independent sources. So men...watch out and don't be so cocky. Listen to reason. Women...just use your heads as you always do and don't look to your men to direct you.

I don't mean to bash men, because it is knowledgeable men who have taught me by word and example all of the above.


2. If a man handles a dispute with the insurance company or body shop, it will be resolved.

Um...no. To suggest such a thing is completely demeaning to both men and women. Do you realize that it is women who are especially gifted in negotiation? In certain native communities in Mexico, in the event of, say, a vehicle accident, the women take over. Why? Because the men tend to let their emotions get into the mix and that leads to a fight. Women can negotiate with other women, because we have the ability to connect at a very personal level, and dissociate ourselves from the extension of manhood that most people refer to as their respective transportation. So women make the arrangements and take care of getting things fixed.

In America, things are different, because men like to fix things. Unfortunately, they don't get to fix things because so many of them are accountants or executives, or manicurists, and so have no idea, exactly, what a wrench or a gearbox looks like. And mention "master cylinder" and they look at the engine block! And don't even get me STARTED on the location of the rear differential!

The reality is that most men are no more knowledgeable about cars than women. The great era of the "muscle car" has passed, and the era of the metro-sexual male has actually coincided with the entrance of the androgynous female thanks to rabid feminism. This had led to a general lack of knowledge among both sexes when confronted with the great mystery of the mechanical workings and functional design of the average car or truck.

So typically, when a "male" steps in to "resolve" problems with an insurance company or a shop, he does so from a perspective of such total ignorance he does nothing other than reveal himself to be a complete fool. And his arguments are not based on knowledge of the subject matter at hand, but rather the common mythology that can be disproved through a simple vehicle diagram, record of part prices, the visual of broken parts, and calm conversation.

In other words...male or female, don't be a bully. The people on the other end of the phone are trying to help you and quoting mythology doesn't further your position and certainly doesn't do anything other than damage your dignity.


3. Insurance companies are out to screw everybody.

If I had even a penny for every time I heard that quote, I would have quit my job after the first year. Insurance companies don't care about you. They are a business. Therefore, they are out to screw only themselves. In capitalism, it's the ONLY way to survive. Look out for your own interests, but in the process, be sure to benefit others. The entire foundation of insurance is to make money by paying it out to other people, much like the credit card business. And both industries take HUGE losses every year, along with great profits. That's why people don't purchase a lot of stock in either...a bad climate or economic year is literally financial destruction. But were it not for such destruction, they would not be able to exist.

Let me give you the real scoop, from the inside: Insurance companies hire REAL PEOPLE. They are people like you and me, and those people are assigned to a particular job. If that person happens to be an agent, that agent's job is to sell you a policy in accordance with what you need. It is NOT that agent's job to explain the letter of the policy. It is YOUR job to READ your policy. Claims Adjusters are hired to fulfill various expectations, which often differ from company to company, or from various specialties. In my case, I was a "generalist" before I specialized. And the generalists in my company spoke with all parties of an accident, all witnesses, obtained police reports, inspected cars (as in writing estimates), determined liability, coordinated with shops and other insurance companies, wrote contentions if the claim went to arbitration, and put out "fires" that arose from day to day. Investigators do the same thing, but at their specialized level. There were also specialized adjusters who handed specifically mechanical issues at shops but had no part in liability determination.

Those people work REALLY HARD, they do their BEST in an industry that idolizes agents and ignores adjusters in their commercials, and in spite of being snubbed, they work hard to be sure their customers get what they need in as timely a manner as possible. And sometimes it isn't possible to get to everyone in a day, no matter WHAT the company advertises.

It's always the claims adjusters who are thrown under the bus when something goes wrong. And often, the problem is the fault of the agent or the shop. The adjuster, the average person's contact with an insurance company, in addition to everything else, is also a mediator, because the adjuster knows better than to throw the agent or the shop under the bus. Pitting people against each other actually makes everything more difficult for EVERYONE.

Besides...the adjuster is a person JUST LIKE YOU. He or she knows what it's like to have an accident, and they know that in our over indulgent society, timeliness and "need" are prized. Time is money.

That adjuster also knows that if they provide bad service to you, said adjuster is rated in numbers and "productivity" according to crazy standards. So to fail to meet YOUR expectations as a customer means that the adjuster is going to take a serious hit both in workload and in potentially losing his or her job. Ironically, the people who are the most helpful often are the first to burn out and lose their jobs...because they'd prefer to make their customer happy and serve all their needs rather than meet numbers established by financial analysts who have never done the job.

So...the next time you have a claim, imagine that your son or daughter is the person on the other end of the line. Yes, they have to follow the policy, no they are not out to "get" you, and if you work with them, they will bend over backwards to help you even if it takes extra time and lands their butt in sling with their boss.

4. Shops are out to screw everybody.

Um....no. Shops are out to make money, and screwing everybody is detrimental to ongoing income. They are out to build customer loyalty, and in my experience, they were more than happy to help me, as an adjuster, know what I was looking at. It was a mutual agreement...if I know what you're talking about, I can agree or disagree intelligently and we can have a discussion about what would be proper. Sometimes there's more than one way to go about things. Other times the right thing to do is concrete.

Oh, and if the manufacturer recommends something, it has to be done. That's a reality, especially when a warranty is on the line.

Seriously, there are only a few times when shops didn't listen to me, as a customer, and it was ALWAYS when I was throwing money at them. That's for a different post.

5. Men have no respect for the capacity of women to understand mechanical things.

Complete idiocy. I have to say that when I went to a shop and was honest in that I needed assistance in identifying mechanical parts, they were ALWAYS willing to help. Certainly, they got paid for their time, because my own management recognized that both for negotiation and part identification purposes, the shop deserves to be paid for their time. And no, I'm not a blonde. I'm not even attractive. But the shops were willing to help out professionally because they saw that I was sincere in trying to learn, and had enough knowledge so as to be able to speak somewhat intelligently, as well as recognize their own challenges in their business. It was also my job to work with the customer, without throwing the shop under the bus. They always appreciated that.

Perhaps in the past and maybe in some areas, it is customary to pass blame when something is going wrong, but it's much better, professionally, to own up to any errors and rather than focus on them, to discuss what all parties are doing to WORK TOGETHER to resolve the problem.

The automotive industry is male-dominated, no doubt. But I found most of the men I met on the job to be courteous, friendly, most were knowledgeable, most appreciated that a woman was present and was professional (they have no time for airheads).

Of the times that I was "screwed over" on the job, it had more to do with the company and the interests of the shop than it did with my female identity. That's another story, too, one that involves a family member voiding the warranty on a brand new car belonging to his neice so that he could get a chance to mess with the insurance company. (long story, but one that I need to write for you all.)

Seriously...don't follow this myth. Of course, if you choose to be ignorant, you will be taken advantage of. If you have some basic knowledge, even of your car's manual and recommended service provided by the manufacturer, you will overcome a great deal.

6. If my car has a warranty, I have to get it fixed at the dealership.

Completely, patently untrue. You very rarely HAVE to go to the Dealer for anything. If a given shop is equipped for the damage or repair in question, they can order the parts and do the work. There is a huge myth out there bullying people into thinking that they have to go the dealer in order to have access to manufacturer parts. Um....no. ANY shop can order ANY part. In fact, YOU can order manufacturer parts from home and fix your car yourself.

The warranty issues come in only via certification; a shop doing the work has to be certifiable via the warranty company. So if you know a great mechanical shop that is not a dealer, they can often check to see if the mechanical repair is via warranty, and file a warranty claim on your behalf. They certify the work as if the dealer did it.

Read my lips: the Dealership DOES NOT have the corner on the market in repairs.

In fact, the dealer usually costs you MORE to do the work.

This leads to another topic...

7. What about Aftermarket parts? Used Parts? Remanufactured Parts?

There are a few kinds of parts that can be used on your car, and it is regulated by state law.

In Minnesota, if it involves an insurance claim, if your car is less than 3 years old OR has 16,000 miles or less, then new OEM (Manufacturer) parts are the only things that can be used. You, as an owner, can request the use of other parts, but in the event of a claim, the insurance company can ONLY use those specific parts.

If the car has MORE than 16,000 miles and is older than 3 years, then used (the term LKQ) parts can also be utilized. These are parts from the same year vehicle or newer, and they can be used in an insurance claim without your permission, although they have to provide this information to you in the estimate.

Or, you can choose Aftermarket parts. Here's a dirty little industry secret that the Manufacturer doesn't want you to know:

Many of the parts sold as New/OEM with the manufacturer stamp on it are actually made to spec by other companies. So the manufacturer gets to mark it up with their brand name, even though Company X actually made them. That same company, Company X can sell that very same part, the very same specs, for the very same vehicle, at a greatly reduced cost because, say "FORD" or "CHEVY" or "BMW" isn't stamped on it. We call this an "Aftermarket" part even though it's the EXACT same part the dealer sells you with a marked up label!

Now, there are also aftermarket parts that involve cosmetics, air intakes, ground effects, rims, stereo systems, etc. that are NOT related to the dealer. So when discussing aftermarket parts, just be aware that this encompasses a lot, and is not necessarily the myth-driven idea of a "defective low-quality part".

In fact, if given the choice between used and aftermarket, I would choose aftermarket. Because, say, an aftermarket headlight is going to cover both the shop warranty and the warranty from whoever made the part. A used part carries only the shop warranty and, as indicated...it's used.

People...don't be so afraid of "aftermarket." Even if you have a factory warranty on your car. It won't void it unless the aftermarket part involves weird wiring or other issues. READ YOUR POLICIES!


This is getting long and I have SO MUCH more to say...so let's just say that there is more coming with regard to these topics.

Recruitment?

This article and law firm just SMACKS of "recruitment":

Lawfirm denied access to bridge site for lawsuits

ST. PAUL (AP) - A federal judge has denied a law firm's request for access to the 35W bridge collapse site to gather information for possible wrongful death and personal injury lawsuits.

Judge Patrick J. Schiltz says the government has "an urgent interest" in recovering victims, clearing the wreckage, reopening the river and rebuilding the bridge as sLawfirm denied access to bridge site for lawsuits oon as possible. The judge says those challenges are daunting enough without turning loose potentially dozens of lawyers, expert witnesses and investigators on the site.

The firm of Schwebel, Goetz and Seiben says it's representing three people severely injured in the collapse and the families of two people who died. It was trying to gain access to the site for two of its experts and some attorneys.


(Copyright 2007 by The Associated Press. All Rights Reserved.)

AP-NY-08-15-07 1841EDT

As you know, I recently left my job with an insurance company. While I didn't handle injury claims - recently - part of my job was to handle bodily injury claims if it was proper to do so, and I've settled a good number of them in my time at that company. It's part of the insurance business, and some people specialize in handling these types of claims. Personally, I hated them, which is why I became a non-medical investigator.

Minnesota is a "No-Fault" state, which is a term often miused and misunderstood. What it means is that if you are involved in some kind of vehicle accident, you must go through your own vehicle insurance company to handle your medical bills, up to the policy limit (which is often only $20,000 but can be doubled with "stacking" insurance if you insure more than one vehicle on the same policy). However, "No Fault" has nothing to do with negligence; typically SOMEONE is at fault (negligent) when an accident occurrs. It can be both drivers, it can be a pedestrian, it can be a manufacture defect. And when negligence is determined, meaning that someone is majority at fault for the accident, then if the injured party does not bear the majority of negligence, that person may hav a bodily injury (BI) claim.

For example; if a semi truck rearrends a stopped Pinto at 50 mph if said Pinto is legally stopped, waiting for the light to change, said driver of the semi is negligent, and in all liklihood, the Pinto driver is injured, or dead. That person certainly has a Bodily Injury claim. Certain "thresholds" may apply as claim of an injury does not, in Minnesota, automatically entitle someone to a BI settlement. In MN, those thresholds are: treatment over $4,000 (not inluding diagnostic tests such as MRI's), serious injuries such as fractures and scarring, death or dismemberment, or permanent injury. Insurance companies are well aware of these thresholds and immediately prepare to handle them, which requires the cooperation of the injured party, that party's own insurance carrier, and, of course, any attorneys who may be involved.

So, many of the people on the bridge, especially those who were killed or were severely injured, have bodily injury (BI) claims. They are not at fault for the bridge collapse, but clearly, SOMEONE, SOMEWHERE is liable. Attorneys and Insurance Companies have to determine WHO is responsible via their investigators, expert witnesses, and the findings of the Federal investigators and MNDOT investigators as all the details are sorted out. The attorneys will go after all the negligent parties, focusing, of course, on those with the deepest pockets.

That's what this article is about; the attorneys are working on gathering evidence for their cases, as will be the insurance companies. However, as those in the insurance industry know, access to such disasters isn't automatically granted. I was an investigator and often had to wait out "holds" before I could really start following threads. It's hard for everyone, but it's extremely important to let the authorities do their job and maintain the integrity of the scene.

That's part of why the attorneys are trying to gain access; they are looking to either breach the integrity of the scene, or prove that something has been breached, so as to weaken any defense that may be taken by the negligent parties. They are also making a play for publicity, as they know well that they would not be allowed access to the collapse scene just yet. Especially considering that not all of the deceased have been recovered and laid to rest. It's also a pre-emptive move that gives them a position of strength no matter what happens in court. Because they are using the courts to request access, and the courts have shut them down (for now), they will later be able to argue in court that the "rights" of their clients were quashed by this decision and they will do whatever they can to play upon the conspiracy theorists in the jury to be chosen at a later date. That makes the government look bad; it makes those working at the site to recover the remains of the still-missing people look like bad guys while the law firm gets to look like heroes to people that are gullible enough to fall for this public relations scam. And, of course, when this goes to court or to closed-door settlements, the real reason they were denied access to the scene and the fact that, if they were allowed to enter would have compromised the scene and would have been detrimental to recovery efforts will be completely ignored or glossed over.

And of course, the law firm gets their name out there, which brings in both related and unrelated business for them.

It is not surprising that a law firm is involved; this is expected. Given what I know, I would not be likely to get an attorney if I were injured in a vehicle accident, unless an insurance company was not doing their job. I know what their job is, so perhaps I'm in a good position to be able to ascertain when something is wrong. (Overall, insurance companies DO handle their injury claims well, but there are times when they don't, and then it's time to be represented.) Many peple think that claims are handled differently with attorney representation; this is complete fallacy. Typically, if someone told me they were going to get an attorney, I'd yawn and tell them that I looked forward to this event and that the attorney would be far more reasonable and professional that they would be. (That latter was saved for especially arrogent and threatening customers). I spoke truly, for there were some difficult customers we just PRAYED would get an attorney so that we could get the job done and it would be wonderful to deal with someone who knew what we needed and wouldn't wait for us to ask. Because when the customer gets paid...they get paid.

And pay...that's another reason I wouldn't want to get an attorney; they take 1/3 of the settlement, and in many cases, that means that the customer would actually be paid less (directly) than if they were unrepped. Additionally, an analysis of customer surveys revealed that of those people who were represented by attorneys and those who were not, those who were not represented were far more pleased with how their claim was handled than if they had gone through a law firm. This is VERY telling.

But none of that is why I'm disturbed about the above article. As I said, I would expect to have law firms involved in this, and if I were that seriously injured, or I'd lost a loved one, it would be easier to get the attorney as I'd be tied up with other things such as serious recovering or grief.

Here's what disturbs me:

The firm of Schwebel, Goetz and Seiben says it's representing three people severely injured in the collapse and the families of two people who died

The SAME firm is representing a high percentage of the people directly impacted in this incident. That defies statistcs and speaks of "recruitment". Perhaps that recruitment was one family to another. Or perhaps it's a class-action type of thing (I'm not sure what constitutes class action). If so, then no problem.

But typically, anyone injured in an accident. when that info is made public, they are INUNDATED with Personal Injury attorney spam. It's completely ridiculous. Even where injury is not indicated, these vulturs crowd in to convince them they are injured and some even suggest what to do in order to cross a treatment threshold if they don't qualify under any other category. That's one of the inherent flaws in the No Fault law; the abuse entailed. We spend a LOT more on bodily injury claims in Minnesota than do Tort states such as Wisconsin where, from the first dollar spent on an injury constitutes a bodily injury claim.

But something about this just rubs me the wrong way. It could be completely legitimate, but at the same time, the statistics that the same firm would represent so many (if not class action) indicates someone was "recruiting", which is a bit unethical.

Just my humble opinion. But then again, I'm not fond of PI law firms, and even as I would consider seeking employment with a law firm, they would be excluded from my consideration.