Persevere in be paying

Getting health-care claims paid can be an arduous process, made worse by the penny-pinching of insurers, the complexity of policies, and inefficiencies in the health-care system, says Joseph Ditré. His advice: "Don't give up. And get help." 


Ditré's nonprofit Consumers for Affordable Healthcare, in Augusta, Me., is one of the organizations funded as "consumer assistance programs" by the 2010 federal health-care reform.

 Although not available in the 17 states that didn't apply for funding, the programs work with consumers one on one, helping them resolve difficult health-care claims.

Wait To Rebuild

When disaster strikes and a house is damaged, homeowners have two contradictory priorities: Prevent further damage, and preserve the evidence.

They might need to put up tarps or make minor repairs, but they shouldn't make any permanent repairs or clean up debris until after their insurer's claims adjuster makes a visit.

"It's important for the adjuster to see the damage in its worst state," says Altieri, the public insurance adjuster. Otherwise, homeowners might not be fully compensated for their loss.

Beware Computerized Payouts

Many automobile insurance companies use special software to determine payouts in bodily injury claims, and the Consumer Federation of America's Hunter warns that these computer systems often shave 20 percent off the claims.

The CFA says customers should ask if their auto claim offer was evaluated by computer and, if so, ask for the range of offers generated. "Don't accept any offer that is less than the high end of the range," the CFA advised in a Dec. 2010 consumer alert.

Stick up for Yourself on Insurance´s World

When making a big claim with an insurance company, Rutgers's Feinman says it's important to remember: "It's a business relationship.

"Despite marketing campaigns to the contrary,"they're not your neighbor, and they're not your friend." Sometimes professional help is necessary in negotiating with an insurer.

A public insurance adjuster can help with a time-consuming claim process, as when a house is damaged. If you're facing a fight with an insurer over a big claim, a lawyer may be necessary, says Hunter of the Consumer Federation.

Contracting a Responsive Insurer

"Companies are taking longer to pay claims and paying fewer claims," says Rutgers's Feinman. Getting information on how quickly a company will pay claims is hard, because state insurance commissioners collect but don't disclose such data, says Daniel Schwarcz, a University of Minnesota law professor.

States do post data on complaints. Also valuable, says Feinman, can be customer satisfaction surveys by J.D. Power and Consumer Reports. J.D. Power gave its highest customer award in car insurance to Auto-Owners Insurance Group and the top homeowners' insurance honor to Amica Mutual.

A 2010 Consumer Reports car insurance survey gave high marks to Amica, Auto-Owners, USAA, and NJM Insurance Group.
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Check Insurer Strength

Many forms of insurance, especially life insurance and annuities, represent a relationship between an insurer and a customer that can last decades.

It's important to make sure a company is likely to survive that long. You can check on the financial strength of insurers through rating agencies such as Moody's, Standard & Poor's and A.M. Best.

Headley, the insurance agent, recommends picking only companies with the top three or four ratings from each agency. Companies receiving A.M. Best's top financial strength rating of A++ include USAA, State Farm, Northwestern Mutual, New York Life, Chubb Group, and Berkshire Hathaway.