Red Metal Insurance Claim Sign

Accidents can and do happen every day in South Carolina and across the country. After an accident, the big question becomes who is responsible for bearing the cost. The answer is usually the insurance company. Unfortunately, receiving a full and fair recovery from an insurance provider isn't always a straightforward process. This article addresses why, as well as what you can do if the insurance company is refusing to pay your claim.


How Insurance Companies Make Money

It would be a nicer world if insurance companies in South Carolina took more responsibility for the policies they offer, but the fact is, many insurance companies take as little responsibility as possible. It’s important to remember one key fact about any kind of insurance, no matter what the policy is for: insurance companies do not make money by paying out claims. Insurance companies make money two ways:

  • Collecting premiums. This is the monthly, quarterly, or annual fee that customers like you pay to the insurance company in exchange for a contract. The contract lays out the terms and conditions of when the insurance company will pay on a claim, but they will use every trick in the book to avoid paying or to pay as little as possible.
  • Investments. Insurance companies don’t just sit on the money they collect from you. Typically, insurers invest money from premiums in the market, including money market funds, bonds, and real estate. Many insurance companies even own major property, including skyscrapers, in cities across the nation. They then rent or lease office space in those buildings to other businesses to amass what is often an incredible amount of wealth. This revenue stream typically far outweighs the gain from your premiums, which makes any individual customer—like you and your family—worth very little to the company.

Those are the main two ways that insurance companies stay afloat. It’s no accident that “pay out claims on customer policies” is not on the list.


3 Ways Insurance Companies Avoid Paying Claims in South Carolina

Claims adjusters are the people you talk to from the insurance company who assess the value of your claim and decide how much to offer you in a settlement. Adjusters are typically highly trained negotiators who work exclusively to minimize the cost to the company. No matter how nice he or she may seem, the adjuster is never your friend. Here are some of the ways that adjusters in South Carolina attempt to reduce your claim or deny it entirely:


1. Intentionally stonewalling.

By drawing out the claims process as far as they legally can, the hope is that you will eventually either just accept the lowest settlement or give up your claim entirely. There’s also the chance that you’ll miss a key filing deadline and your claim will become invalid.


2. Using your words against you.

Adjusters can take seemingly innocent questions and turn them against you in court, from the very beginning of the conversation. Answering “I’m fine” when an adjuster asks, “How are you?” may be grounds for reducing or dismissing your injury claim, for example. If a person or business caused you harm, never speak to an adjuster without speaking to a South Carolina injury lawyer first.


3. Using surveillance.

That’s right—an insurer may try to spy on you. Adjusters may send a private investigator to watch your home to catch you in the middle of an activity that they can use to claim your injuries aren’t severe, such as lifting your child or unloading groceries. They may even try to covertly follow you on social media, looking for photos you’ve been tagged in for evidence they can use against you.


One other trick that an insurer might use is to suggest that you don’t need a lawyer after an accident. Depending on the circumstances, nothing could be further from the truth. The insurer knows very well that a skilled personal injury attorney can spot dirty tricks and render them useless. Often times, they don’t want you to have an attorney because it means they will have to pay more. And in cases of serious injury, that’s exactly why you need an experienced lawyer by your side.


What to Do If the Insurance Offer is Too Low

Insurance providers are notorious for making low offers to deserving people. Below, I’ve described three situations and the steps you can take to negotiate a better offer.


1. The insurance company isn’t paying a fair amount for your property damage.

The at-fault person’s insurance provider should cover the expenses for the property damage they caused. If the insurance company refuses to fully compensate you for property damage and diminished value, you can file a property arbitration claim. We have an in-depth how-to guide on how to file a claim for property damage in South Carolina here.


2. You suffered minor injuries, and the insurance offer won’t fully cover your expenses.

If you suffered minor injuries due to someone else’s negligence, you may be able to handle negotiations with the insurance company on your own. You’ll need to gather information like medical bills and lost wage forms (you can get these from your employer) and send them to the insurance adjuster. All of this information will help substantiate the costs associated with your injuries and make it easier to negotiate a fair settlement. By handling these types of cases on your own and avoiding lawyers’ fees, you may walk away with more money in your pocket.


3. There are significant injuries and medical bills. 

If you have suffered serious injuries in and are worried about negotiating with the insurance company – on top of going to doctors’ appointments, paying medical bills, and missing time from work, you would likely benefit from hiring a South Carolina injury lawyer to handle your case. An attorney can remove a lot of responsibility and weight from your shoulders, so you can focus on healing instead of navigating a legal maze. Because attorneys have experience negotiating with insurance adjusters, they’ll better understand how to present your story in the context of the law and maximize your recovery.


Putting Pressure Back on the Insurance Company

Though insurers may try to refuse payment using the tactics discussed above, if their policyholder is responsible for the accident that caused your injuries, they must pay. If the at fault person does not have insurance, you should be able to rely on your own insurance company to cover your expenses.

When insurance providers refuse to uphold their end of the bargain, we work to protect your rights and hold the insurer accountable. In some instances, that means sending a “policy limits demand” prior to filing a lawsuit. Other times, it means suing the person who harmed you and forcing their insurance company to get serious about settlement. There are also situations where we will sue an insurance company for denying your claim. This is known as a “bad faith” action. Read this article on bad faith claims in South Carolina for more information.


Get Help From a South Carolina Lawyer for Your Denied Insurance Claim

If you’ve been hurt in an accident in South Carolina and are having a difficult time dealing with the insurance company, personal injury attorney Kenneth E. Berger is here to help you.  No matter who caused your accident or how many insurance companies are involved, we know the tactics insurers will use to try and dodge their obligations to you. We believe in standing up for your rights and holding insurance companies to task for the policies they sign, so you can get a full and fair settlement.

The attorneys at the Law Office of Kenneth E. Berger have years of experience handling cases like yours, and would be honored to help you and your family with the legal recovery process while you focus on healing. Our offices are conveniently located in Columbia and Myrtle Beach, and we proudly serve the Sumter and Florence areas, as well as the entire state of South Carolina. Call us today at 803-790-2800 (Columbia, SC) / 843-427-2800 (Myrtle Beach, SC), or start a live chat 24/7 with a real, live person to arrange a free and confidential consultation.

Request a Free Consultation

Start a Live Chat

Kenneth Berger
Connect with me
Columbia and Myrtle Beach car accident and personal injury lawyer dedicated to securing justice for clients.
Post A Comment