5 Words Never to Say to Your Insurance Company

By Kat Zeman, Insure.com

posted: 2 DAYS 1 HOUR AGO

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When making an insurance claim, what you say can mean the difference between a fast payment check and a nightmarish process. Insurance companies are sensitive to certain words and using them incorrectly could result in a claim delay or even denial. Of course, lying to your insurance company or misrepresenting facts is fraud -- and your claim will surely be denied if the insurer finds out. But using the right words to accurately describe your problem is important.

"What you say initially can affect the outcome of your claim," says Allan Sabel of Sabel & Associates, a Bridgeport, Conn.-based adjusting firm.

Here are common "wrong words" that could slow down or scuttle an otherwise legitimate insurance claim. For insurers, these words often conjure up images of a claim that should be denied.

1. FLOOD

Homeowners often use the word "flood" inappropriately and it can trigger an alarm with insurers -- since flood damage is not covered under a standard home insurance policy. To an insurance company, "flood" means water from a nearby lake, stream, river or other body of water. This may seem like a minor distinction, but your insurer has a very narrow definition of flooding.

"Many people believe their house is flooded because it's full of water -- but it's not a 'flood' by the insurance definition," Sabel says.

If your water damage did not come from an overflow of a nearby lake, stream, river or other body of water, don't even say the word "flood," says Sabel.

A true flood is covered only if you have a flood insurance policy.

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If your basement is filled with water due to a burst pipe, it's not considered a flood -- even if it’s knee-high -- and would be covered.

"You just have to be careful," Sabel says. "Know exactly what is in your policy, what's covered, what's not covered, and report your claim accurately."

It may turn out that what you thought was a flood is something totally different to your insurance company.

2. EXPERIMENTAL

Avoid using terms like "experimental," "investigational" or "clinical trial" when you need a medical treatment that isn’t a common practice. Just because it isn’t common practice doesn’t mean these terms apply to it. Plus, health insurance companies typically refuse to cover treatment that falls into that category. They will cover treatments that are medically necessary and proven effective.

"Never say 'it's an investigational or experimental treatment or in clinical trials' when you contact an insurance company," says Mark O. Hiepler, a California attorney. "Always say 'it’s medically necessary' when referring to your treatment."

3. IN MY OPINION ...

Don't offer your opinion. Stick to the facts. For example, following a car accident, people can rarely provide an accurate estimate of the rate, speed and flow of traffic, says Pete Giancola, owner of Pete Giancola’s Insurance Agency Inc. in Deephaven, Minn.

For example, it's common for drivers to announce the speed at which they were traveling when the accident occurred. But, as Giancola points out, "unless you were staring at the speedometer, you don't know." Also, don’t estimate distances -- like how far other vehicles or objects were in relation to your car before the impact. Your estimate could turn out to be false -- "unless you jumped out of the car and measured it with a measuring tape," Giancola says. If you estimate such things and get them wrong, it could later be used against you. Giancola has seen clients give recorded statements about distance and be found "at fault" because the distance they estimated should have given them plenty of time to avoid the crash. However, be prepared for an insurance adjuster to try to finagle these estimates out of you.

"The insurance adjuster will try to ask you that same question in 14 different ways," Giancola says. "Stay away from it. Just give the hard, cold facts ... don’t say 'I think,' 'I feel,' 'I felt.' No touchy-feely stuff."

4. SORRY

Without sounding insensitive, try to avoid saying "I'm sorry" because it can be interpreted as an admission of fault. In most car accident aftermaths, all the facts are not immediately known. Do not interpret the situation and theorize about who's at fault. Don't use words like "it's my fault," "it's not your fault," "I made a mistake" or "I'm not sure what happened." Describe what happened to the best of your ability. If you're not sure about how something happened, let the authorities and insurance companies figure it out. Don't assume anything.

"But when you talk to your insurance company and you are not at fault, then tell them you are not at fault," says Pete Moraga, spokesperson for the Insurance Information Network of California.

It's a good idea to check with your own insurance company about how you should handle communications with the other party's insurer. Don’t give a recorded statement to anybody until you speak with your insurance company first.

"Ask [your insurance company], 'If the other party calls me, should I talk [to them]?'" Moraga says. "Some insurance companies may want to deal [directly] with the other party's insurance company."

It’s true that you are required to "cooperate with any investigation" by your car insurance policy. But you don’t need to guess, estimate or analyze information in order to cooperate. Again, stick with the facts.

5. WHIPLASH

Whiplash and whiplash-associated disorders represent a wide range of injuries to the neck caused by a sudden distortion of the neck.

Insurance companies often associate the term with exaggerated or fraudulent claims, so saying "I have whiplash" could delay the payment process.

Refer to your injuries in medical terms if you can, or wait until your doctor makes a diagnosis.

Plus: What Not to Do After a Car Accident

Do not give a recorded statement to the other driver’s insurance company. It can be used against you later on. You want to control your case and the release of information. Insurance companies must ask you for your permission in order to record an interview.

Do not make friendly conversation with the adjuster. Stick to business and only tell them the "who," "what," "when" and "where." Don't even tell them the how at this point.

Do not give out any information about your family. Do not give out the names of your doctors.

Do not sign a medical release. Federal law protects your medical records. The insurance companies may use this release to dig through all your medical history, even things not related to the car accident.

2009-06-25 18:35:05