insurance

Thoroughness is the key when preparing a settlement brochure or demand package to attempt settlement of an injury case.

Here are 32 tips gleaned from over 20 years experience that comprise a checklist or template to make sure your booklet is as complete as possible.

(Note: in this checklist the “settlement brochure” is sometimes called the “demand.”)

1. Order PIP/MedPay payments ledger from your insurance company (the company of the car you were in at the time of the accident.)

2. Receive the PIP/MedPay payments ledger.

3. Check the ledger for any other doctors, clinics, prescriptions etc. that you had overlooked.

4. Make a complete list of all of your doctors, hospitals etc.

5. Request impairment rating or final narrative report letter from one of your treating doctors.

6. Obtain all Medical Bills.

7. Obtain all Medical Reports and records.

8. Mail or fax to your employer a LOST WAGES REQUEST LETTER. This asks your employer’s human resources department for:

1) your hourly wage at time of accident, and

2) how many hours were missed because of the accident.

9. Once you have received lost wages information from employer, calculate lost wages.

10. Check dates of service on ALL medical bills, prescriptions, reports, records, etc. Make sure bills are current and include all services to date.

11. Arrange medical bills in chronological order, keeping all of one doctor’s/clinic’s bills together, then list each doctor/clinic, and total expenses from that clinic, on MEDICAL SPECIALS SUMMARY in same order. Note: in injury cases, medical bills are known as “medical specials.”

12. Check for prescriptions. Add to MEDICAL SPECIALS SUMMARY.

13. Have any of the doctors predicted a specific need for future treatment? If so, add amounts to bottom of MEDICAL SPECIALS SUMMARY. (Place a copy of future medicals documentation in future medicals section of demand.)

14. Read medical records and reports to identify any problem areas. (In reading, if another doctor/clinic is mentioned check on it to see if there are more medical bills.

15. Organize medical records and reports in reverse chronological order.

16. If this is an uninsured/underinsured motorist case, gather information that is evidence of existence of an uninsured or underinsured motorist.

17. Obtain liability or jury verdict research. Note: if there is an issue as to liability it is helpful to enclose legal research that supports your position. This may be obtained from a law library.

18. Draft DEMAND LETTER. This is the cover letter for your brochure that summarizes all of the information.

19. Type DEMAND LETTER, MEDICAL SPECIALS SUMMARY, FUTURE MEDICALS SUMMARY, and LOST WAGES SUMMARIES.

20. Proofread DEMAND LETTER, MEDICAL SPECIALS SUMMARY, FUTURE MEDICALS SUMMARY, and LOST WAGES SUMMARY. Check date of accident on accident report against the date in letter.

21. Check verdict amounts in comparable verdicts with what is typed in demand letter.

22. Check spelling on medical terms, and on doctors’, clients’ and adjusters’ names.

23. Check to see that all dollar amounts and numbers are correct numbers.

24. Check all dollar …

1. Builder’s All Risk Insurance:

Usually during the contract negotiation stage, when it is as yet unclear as to which party will be accepting which liabilities, which party will be responsible for procuring the insurance and absorbing the deductibles, etc., both parties look more deeply into the breadth of available BAR coverage.

We can say that Builder’s Risk Insurance for the energy class of business provides coverage under three different forms:

  1. London Institute Builder’s Risk Clauses 1.6.88 (CL 351) – or American equivalent
  2. WELCAR form
  3. Custom forms tailor-made to specific risks or Owners or shipyards.

Is the protection provided under all BAR policies the same? No! For a comparison between wordings please contact a trusted insurance broker of your choice.

2. War Risks and Strikes, Riots, Civil Commotions (SRCC):

a. Institute War Clauses Builder’s Risks 1/6/88 (CL 349) –

Coverage incepts once the vessel is launched (or wet) and provides coverage for loss of or damage to the insured vessel / rig caused by:

  • war, civil war, revolution, rebellion insurrection, or civil strife arising therefrom, or any hostile act by or against a belligerent power
  • capture seizure arrest restraint or detainment, arising from perils covered above, and the consequences thereof or any attempt thereat
  • derelict mines torpedoes bombs or other derelict weapons of war.

b. Institute Strikes Clauses Builders’ Risks 1/6/88 (CL 350) –

Provides coverage for loss of or damage to the insured vessel / rig caused by:

  • strikers, locked-out workmen, or persons taking part in labor disturbances, riots or civil commotions
  • any terrorist or any person acting maliciously or from a political motive.

We recommend that this coverage be amended to include Vandalism and Malicious Mischief.

Please also review if the terrorism coverage provided under this clause is either restricted or broadened, or if there are any other applicable clauses such as Sabotage & Terrorism Endorsements. In any case, be sure that the coverage afforded is adequate for your Client so your Client makes an informed decision.

3. Liability – Insurance coverage that protects an insured against claims made by third parties for damage or injury to their property or person. These losses usually come about as a result of negligence of the insured. In marine construction, this policy is referred to an MGL, marine general liability policy. In non-marine circumstances, the policy is referred to as a CGL, commercial general liability policy. The construction contract should determine which parties are liable in which instances for losses of Third Party Liability nature.

Insurance policies can be divided into three broad categories:

  1. Product Liability – Protection against a Manufacturer’s liability for injuries or property damage after a manufactured product has been sold. Extraordinary liability accompanies the manufacture of a product.
  2. Completed Operations – Protection against a Contractor’s liability for injuries or property damage suffered by Third Parties as a result of the Contractor completing an operation.
  3. “Trips & falls & damage” – Protection against injuries or property damage on premises or hulls within care, custody, control of a party.

Let’s be honest, anyone who has had an insurance claim has had this or a similar thought run through their head. For many years insurance companies have done things to earn a bad rep. I’ve been in the insurance restoration industry for the last 10 years, and during this time I can honestly say that I have rarely met an adjuster or contractor that wanted to skimp on the settlement. The few times I’ve seen this is when the policyholder has been extremely difficult to work with. Yes, bad estimates happen, however, most of the time the feeling of being “shorted or cheated” comes from not understanding your policy and how it pays out.

The biggest misunderstanding is most often the issue of matching. Insurance policies are specifically written with terminology and phrases to avoid matching. Homeowner’s coverage is to replace the damaged items with like kind and quality. While as a homeowner and contractor I often don’t agree with this and I will fight it to the best of my abilities. To explain this policy the easiest is to give you situations where you will most likely run into this situation. Let’s say you have a flood where the carpet has to be removed in the hallway. The same carpet runs throughout the home. The living room opens and connects directly to the hallway with the same carpet and you have 3 bedrooms directly off of the hallway and an office with french doors off of the living room. The carpet in the hallway and living room will be replaced but the carpet in the bedrooms and office will most likely not be replaced as most insurance policies are written to stop at doorways.

The other situation is most often with kitchen cabinetry. If water damages your lower kitchen cabinets (or a fire, your uppers) most insurance companies will allow replacing the run of damaged cabinets (meaning all of the lowers or all of the uppers). If you have specialty/custom cabinets you will most likely be given a custom price to rebuild that run of cabinets to match what was there. Very rarely is matching kitchen cabinets likely these days, however, it is not impossible. Over the past 25 years, there are hundreds of cabinet styles and specialty finishes, from dozens of manufacturers. Unless you recently replaced the kitchen, it will take countless hours of research to find the cabinet manufacturer that made your cabinets (a good place to locate the manufacturer is on the inside of the door. Let’s say you’ve managed to find the manufacturer, companies usually discontinue a line every 4-7 years, or they make considerable changes to it. On top of the possible discontinued issue, it is very likely that the elements have changed the finish on your cabinetry. Perhaps your contractor has pointed the issues out to your adjuster, depending on the difficulty they may add extra money to allow to get a close match, perhaps a custom cabinet.

This is where you have …

Using a simplified definition, a retrospective rating plan (retro) is a pricing plan available in which your workers compensation premium is developed, in its final form, by the losses sustained during the policy period.

First let’s go over the components of a retro:

Maximum Premium: This factor represents the percentage over and above the standard premium, which can be collected in the event of adverse loss performance during the policy period. Example: A $50,000 policy with a 1.25 (125%) maximum could potentially be billed $62,500 if you had a high claims amount. This factor is part of the negotiating your agent should do on your behalf. It is subjective and set by the underwriter.

Minimum Premium: This factor represents the ultimate return to the insured in the event you had no losses. Example: The same $50,000 policy with a.60 (60%) minimum premium would pay only $30,000 in premium if you had no losses. This factor is in direct correlation with the maximum. The higher the maximum, the lower the minimum and visa versa. In other words, take more risk get more reward, take less risk get less reward.

Loss Conversion: This factor represents the cost the insurance company is going to charge you to administer the claims you incur. Example: The retro is issued with a 1.10 (10%) loss conversion factor and you incur a $10,000 claim. The insurance carrier will calculate this claim as $11,000 ($10,000 x 1.10 = $11,000). This factor is also negotiable and set by the underwriter. This factor has a direct correlation with the minimum. The higher the loss conversation factor the lower the minimum premium and visa versa.

Tax Multiplier: Because retro’s deviate from the standard policy pricing, which has the premium taxes the insurance company pays included in the premium the tax multiplier is shown separately on the retro. This factor is set by the state and is not negotiable.

Now that we have covered what the “factors” represent, here is an example of how a retro is calculated. In this example we will use a $100,000 standard premium and $40,000 in losses the following factors (The factors vary by insurance company these being used are only an example):

  • Maximum: 1.25
  • Minimum.50
  • Loss Conversion: 1.10
  • Tax Multiplier: 1.07

$100,000 (standard premium) x.50 (minimum premium) = $50,000

$40,000 (losses) x 1.10 (loss conversion factor) = $44,000

$50,000 Minimum Premium + $44,000 losses plus conversion factor = $94,000 premium

$94,000 premium x 1.07 Tax Multiplier = $100,580 final premium

In this example the final premium after the calculation was not above our maximum premium of $125,000 (standard premium x maximum premium factor) so the final premium remains as calculated.

Because the losses were high in relation to the premium size this retro did not work in favor of the policyholder costing $580 more than a standard policy would have. However, using a total claims amount of $22,000 following the same calculation formula the final calculated premium would have been $81,620 saving you $18,380 on your …

A typical investor in the taxi business in Uganda is going to encounter two key issues even before they start making their first shilling. I explain these issues below.

When I first bought a used taxi from my grandparents, I took it for repair to a mechanic in the Wandegeya suburb. He “over hauled” it and told me it was in perfect condition. One week later, the differential had developed a few problems. Next the crank shaft had a few issues. I eventually over came these issues but then came the witchcraft story.

A typical Ugandan reader is probably surprised that I haven’t raised the issue of business and witchcraft before. It seems many Ugandans firmly believe that going to the witch doctor and giving your last white goat(and with no spot of black) is going to turn your business into an overnight success even if you cannot differentiate(no pun intended) between cash as profit(which you can use as dividends) and cash from sales(which you should not use until all expenses are settled).

So the witchcraft story is this; I hired my cousin John [not real name for obvious reasons] to work as the taxi’s first conductor. He according to the family rumour mill “bewitched” the taxi because:

*Day 1. The suspension broke.

*Day 3: The crank shaft developed further problems.

*Day 5. The differential was shaking again.

*Day 7: The taxi knocked someone crossing the road at Ndeeba.

In the 1 month that the taxi was in business, I made only Shs 7,000! Oh, I used that to bail out the driver at the police station. I am not one to consider the validity of the witchcraft story but that brings me to the taxi business and factors to consider if you are to invest in it.

First the CONS (of course)

1. Mechanics without ethics

There is a possibility that when I took the taxi for refurbishment, the mechanic to whom I entrusted the repair provided me with a pro-forma invoice for parts he didn’t install, obtained them second hand or third hand or even that he didn’t carry out all the necessary repairs. How could I verify that with no knowledge of the intricacies of a car, let alone a second hand taxi from Bungokho?

You can of course get round this issue by instead taking your Toyota Hiace (the predominant model used for taxi business in Uganda) to Toyota Uganda’s repair workshop. Don’t expect of course to pay Shs. 7,000 for repair. They use computerised diagnostics and their mechanics use a logging system to bill you by the hour. Oh and of course they use new and genuine parts so forget that used crank shaft your mechanic Kakooza will find you from Kisekka market. As per the Toyota Uganda website, you can expect to start paying for servicing for a Toyota Hiace Model from Shs. 183,900.

2. Difficulty of revenue verification

Unless you are driving the taxi yourself or install cameras just like the London Buses …

Not long ago, I got an email from a gentleman wishing to set up a mobile oil change business in Florida. He was concerned about what sort of insurance he might need and was under the impression that a 1 million dollar commercial liability policy was needed up and beyond his work truck vehicle commercial auto policy. Okay so, let’s talk about this; is he correct?

It turns out that he most definitely is, you see commercial auto is not the same as completed operations or the potential liability while working. For instance, if a car catches on fire that you are working on, your commercial auto policy isn’t going to cover it. Do you see that point? So, this is the advice I explained to him;

You will need most likely want to get a commercial insurance policy; $1 million aggregate, 300K per occurrence general liability, with a “garage keeper’s liability” notation, and there will be some customer who may demand more, and also demand to be additionally insured, not just a certificate of insurance on file.

Commercial Auto Insurance is another need, but most commercial business policies will write them together as one. Find a good “commercial insurance broker” and have them scout out their sources, usually the broker-agent knows the underwriters very well (as in speed-dial) and can get you a good rate and the underwriter will understand the difference between mobile and fixed costs. Generally the commercial liability insurance is partly based on your estimated gross income.

Don’t over estimate or you will pay too much, and don’t underestimate or you may get audited by the insurance company or they might simple decide you are not a viable risk. Believe it or not most commercial insurance policies do have a clause in their insurance contracts that they may audit you and by signing the policy you pre-agree to those audits. Thus, it’s unwise to falsify information or underestimate. If you find that you may have underestimated you need to call your agent-broker and explain that, sometimes they will add to the premium, sometimes up the next year’s estimates for gross sales.

Now then, Florida is a great market for mobile oil changes, however, let’s not forget there is some competition there, some long-standing 25+ years in fact and so, insurance is only one aspect or piece of information which one needs to consider before starting a business of this type. Please consider all this and think on it, and develop a strong business plan.…

I am an insurance salesman and I think that most of the business sucks. Here is what I mean.

Daily if not almost hourly I am approached by someone new who wants me to sell their products for them. The pitch is always the same. Commissions and service.

If I sell their products I will get higher commissions. Experience has taught me that this is nothing but a lie. Almost all commissions paid by insurance companies are the same. The difference is how much are these marketing companies taking off the top. They all want me to sell their products so they can make more money off my hard work and my personal investment in marketing.

It is nice deal they have, I work and they get paid.

Think of an insurance product like a three legged stool. One leg is the client’s interest, one leg is the company’s interest and the other leg is the marketer’s interest. Anytime more is added to one leg than the other the stool is lopsided. All three legs need to be equal or someone is taken advantage of. So when a marketing company offers me an “out of whack” commission I know where it is coming from…the company, NO! It is coming from the customer. It has to!

All aspects need to be fair and if one is more than the others the stool falls over.

Then there is their other pitch….service.

I always substitute the service word with the GREED word. I mean exactly how much service do I need? I handle my own applications, I transfer my own money and I deliver my own policies. What sort of service do they offer? You are correct, nothing. For what a marketing company makes off my sales they can do a lot more than service as far as I am concerned. What could they do?

o Pay for marketing and

o Pay bonuses

Then there is this that always stops them in their tracks. I will never do business with anyone who doesn’t give me two things:

1. A pre-release so I can move anytime without their permission

2. Full disclosure of how much they make on my sales

Make them tell you and always demand full disclosure. Disclosure is not their favorite subject and very few will actually share their contracts. Hold your ground because they will eventually show you. What if they are making too much of an override, is it ever fair? The answer is yes! There are a few marketing companies out there who do a great job and provide enough benefits to actually earn the overrides. Search them out; they are the ones to do business with. Here are my favorites:

o Financial Independence Group (FIG Marketing)…North Carolina

o Northwest Planning…Spokane, Washington

o The Annuity Source…Seattle, Washington

o Brokers International…Iowa

To be honest I really like selling insurance. It provides me with a nice income as well as total management of my time. Select the best marketing partners …

Property is a prized possession, and to safeguard it from unexpected damages in the event of fire, flood, earthquake, etc. getting a home insurance is always necessary. However, if your existing health policy is exhausting your monthly income, listed below are a few sure shot ways with which you can control your home insurance costs:

1. Shop around: The decision of buying a home insurance policy should not be taken in haste. Instead, you must explore and make a list of insurance policies that are being offered by various insurance providers. You may also get insurance quotes online to estimate the costs of different policies. Choose a reliable company from which you can buy the comprehensive home insurance plan that suits your needs, and of course, your budget.

2. Increase your deductibles: Deductibles is the fraction of the claim that you have to pay before your insurer pays the claim as per the terms of the policy. The higher the deductibles you set, the lower premiums you will have to pay every month. However, you must set the deductibles as high you can afford.

3. Locate intelligently: Purchase the property in a strategic location but make sure that it is based away from the damage-prone areas. Reason being, if you live in a disaster-prone areas where flood, storm or earthquakes are a common occurrence, there are chances that your home insurance policy may have a separate deductible for such kind of damages.

4. Avoid making small claims: This is the most common mistake that many people make. You exhaust your policy in small claims thus leaving no room for bigger loss protection. Rather it is advised to deal with smaller issues on your own and keep this policy to protect your home from bigger catastrophic losses.

5. Improve home security: To avoid getting your home damaged from little mishaps, it is suggested to increase the security in your home by installing devices like smoke detectors, burglar alarm, etc.

6. Merge Policies with one Insurer: Just like you pool your internet, phone, and TV package, you can also merge your insurance policies with one insurer. Buy your health insurance, homeowners, life, and auto insurance plan from one insurance company and come out cheaper by bundling these insurance products together. You may also buy policies in a package that is less expensive as compared to single policies. It also liberates you from the trouble of policy renewal.

7. Eliminate Unnecessary Coverage: Don’t buy the coverage you don’t need. Like earthquake coverage is often unnecessary in most zones, don’t include jewelry if it is at a catchpenny price etc. Also exclude a land value from your policy. Covering land on which your house is constructed is simply of no use as it is unlikely that your land will be stolen or burnt is fire. So to save big, insure the value of your home only.

There are many insurance providers who offer age and profession discounts as well. Some times there certain discounts …

Most people and companies are often unaware that when they first contact their insurance provider to report theft, loss or damage that they are actually contacting a first notice of loss (FNOL) call center. FNOL call centers typically operate 365 days a year, round the clock, ensuring policy holders can easily report a loss, and further, that the respective insurance companies receive timely and accurate claim loss data.

First notice of loss operations are sometimes staffed internally, but more frequently these days, the operations are outsourced to a specialist. As one can imagine with any 24/7 by 365 day a year operation, staffing, training and accurate claims intake are challenging for any organization. There are different types of vendors which offer solutions for FNOL, some offer software, others offer a comprehensive call center based on a proprietary application, and still others customize their call center operation to accommodate any platform. These are platform agnostic vendors who claim to work with insurance companies’ existing platforms.

Why is first notice of loss important to both policy holders and insurance companies? Obviously the key function of a notice of loss is to alert the responsible insurance entity as to the theft or destruction of something which is covered under the terms of the policy. In some cases, notification will precede the filing of a formal claim. In certain circumstances, the insured may contact a FNOL representative and follow specific rules of engagement relating to the policy parameters. This is happens often when a provider underwrites different types of insurance coverage and uses a specific format for each type of policy offered to consumers. Herein lies the challenge for many insurers, and the frustration for many of those insured, as policy specifics dictate both the necessary information intake, and the resulting claims processing process. In many cases, speed is of the essence. For example, theft relating to jewelry would require very specific loss notification, and further, rapid notification to the authorities and insurance provider can help result in improved odds of recovery.

First notice of loss has also been undergoing a metamorphosis offering insurers an opportunity to demonstrate their relative professionalism at a time where their policy holders are likely upset and under stress. This is an optimum time, regardless of whether the call center is in house or outsourced to demonstrate a customer centric attitude increasing customer satisfaction and loyalty. Thus, first notice of loss (FNOL) is a critical component of client satisfaction and customer retention.…

If you, a loved one or a child suffer from the birth defect of Spina Bifida you may already know that obtaining term life insurance can be difficult and expensive. With recent advances in medical technology and procedures, however, many people with this defect are living longer, more productive lives and insurance companies are taking notice by beginning to offer more choices for such policies at rates that are typically lower than have been seen in the past.

When seeking out an insurer for such term life policies it is important to look at the insurer ratings given to the company by not only such companies as A.M. Best but by other consumers who have purchased policies from them. The last thing you want to have to deal with when you have to file a claim against the company is the insurer’s refusal or inability to pay.

Many organizations and support groups for this particular defect have lists of preferred companies to deal with who not only understand your unique situation, but also offer policies that are fairly priced and spell out clearly under what conditions they will pay. With any type of disease or defect that could ultimately lead to an untimely death you will find that insurers usually include clauses in the policy itself that specify that for a certain period of time from issuance the company will only pay a reduced amount. This is to protect them from issuing policies that might be claimed immediately because of the disease and seriously impacting their financial stability.

Your best bet for this type, and indeed all types, of life policies is to talk with your agent directly who can help you create a policy that meets your family needs as well as protect for the future. Agents are there to help you and are the direct liaison between you and your insurance company.…