I have been amazed through the years how insurance companies carve out ways to not pay their insureds or other claimants. They are called “exclusions” and “limitations” in insurance policies and usually those parts of the policy are much longer than the coverage sections.
I have been fussing, discussing and cussing insurance companies for more than 30 years now, so the last thing I want to do is to increase the profits of these non-breathers. I have been amazed through the years how insurance companies carve out ways to not pay their insureds or other claimants. They are called “exclusions” and “limitations” in insurance policies and usually those parts of the policy are much longer than the coverage sections.
In other words, insurance companies devote a lot more space in their policies telling you what they don’t cover and imposing limits on coverage than telling you what they do cover.
Unfortunately, most folks have no idea what the policy says because the language of the policy has no relevance until it’s time to make a claim. That is when the education begins.
So something bad happens and it’s time to use that policy that you have been paying for with hard-earned dollars for years without ever making a claim, and you learn that you really didn’t get what you thought you were getting in terms of coverage. Or you find that you don’t have some coverage that would sure be nice to have. Let me give you some examples so you can understand why I don’t like insurance companies.
I have a client who recently came to me after being seriously injured in a motor vehicle accident. He was working for his employer at the time, but since he was in a motor vehicle at the time of the accident, his own insurance has application. Unfortunately, his employer did not treat him well and provide the medical care due him, and he was forced to start seeing his private doctor. I have referred him to a worker’s compensation specialist for that part of his claim, but in the meantime he was forced to seek medical care through his own insurance.
It appears that the driver responsible for the injuries has the minimum limits of liability insurance, which are $25,000. My client has disabling injuries and may have to retire early because of his injuries. His losses already exceed $25,000. Fortunately, he has underinsured motorist coverage, which will be available to him to add to his recovery. Underinsured coverage provides additional benefits to the insured when the other driver is underinsured as in this case.
My client has a big underinsured motorist coverage limit. He also has medical payments coverage of $25,000 when he is injured while operating or occupying a vehicle, even his employer’s vehicle. Thus, he had two pools of money to look to make this bad situation better.
However, in the medical payments coverage, it says it will pay medical bills arising from the operation or occupancy of a motor vehicle, but in the exclusions, it says that it will not pay if the bills are paid or payable under workers’ compensation. He is in limbo now because his employer refuses to pay his medical bills and he will have to go to the workers’ compensation commission to force payment, but in the meantime, because the bills are payable by workers’ compensation, he cannot recover from his own insurance company even though he has paid for the coverage.
It gets worse. There is also an “exclusion” in his underinsured motorist coverage which reduces the limits of coverage in two ways. First of all, it is reduced by the amount he receives from the responsible driver’s insurance. So when the policy says he has $250,000 in underinsured motorist coverage, he will never have that much coverage because it is always reduced by the amount of the other driver’s insurance. So why do they say they are providing $250,000 in coverage? I am not finished.
The limits are further reduced by any amounts that he receives from workers’ compensation. So he gets the double whammy. He bargained for $250,000 in coverage, paid for $250,000 in coverage, the declaration page of the policy says he has $250,000 in coverage, but he truly does not have that much coverage. Do you understand why I don’t like insurance companies?
Until the law was changed a few years ago, an insurance company could sell you $25,000 in underinsured motorist coverage but never have to pay because it was always reduced by the amount of insurance the other driver had, which has to be $25,000 in insurance coverage. The law had to be changed to make insurance companies stop engaging in such nonsense.
Let’s stop for a moment while I help your insurance agent sell you some insurance. Trust me. It’s not because I want to help insurance companies make profits, but because I want to help protect you. Please take out your automobile insurance policy and check the coverages in the policy. The declaration page is the critical part of the policy. If you can’t find it, call your agent and obtain a copy. If you do not have underinsured motorist coverage, add it to your coverage immediately.
I have another client who was in a life-changing accident and he did not have underinsured motorist coverage. His agent did not offer it to him. He now has it, but it is a little late.
This coverage is not very expensive but consider what would happen if you were in a motor vehicle collision with a driver who had the minimum limits of coverage of $25,000 and you were totally and completely disabled in a motor vehicle collision. If you don’t have underinsured motorist coverage, your total recovery will be $25,000. I strongly recommend you obtain this coverage and consider getting some medical payments coverage, too, so you can make your co-payments and deductible payments as health insurance deductibles and co-payments are increasing each year.
I hate to make insurance companies more money, but you do need protection. Check out those exclusions and limits too. You will understand why I get so fussy.