5 Things Never to Say to Your Insurers

[cmo]

5 Things Never to Say to Your Insurers

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Some words are red flags to insurers and using them could mean that your claim might be delayed or even denied.
1. "I Think ..."
Never begin a statement regarding a claim with these words. If you aren't sure, don't guess. What you say could cause your claim to be delayed or denied, says attorney Vedica Puri. And if you're wrong -- say, you report driving at 30 miles per hour before an accident but police later prove you were going 50 -- it could hurt your credibility.
Particularly beware of speculating on blame or causation. For example, if you suggest that a water leak is due to a construction defect, you could give the insurer an out if that's a policy exclusion.


Stick to the facts. Should the insurance rep ask you a question you can't answer, simply say, "I don't know." If the person is taking a written or recorded statement, ask for a transcript to review for misstatements.

2. "I Got Whiplash"
Fraud costs auto insurers up to $6.8 billion a year, reports the Insurance Research Council. And suing for damages caused by whiplash is a fraudster favorite ("Oh, my neck!"). Merely mentioning the term is likely to get your claim flagged for further investigation, says Amy Danise of Insure.com.


Whiplash is a specific diagnosis. If a doctor says that you have it, then you should report it as such. Other wise, if you feel neck pain, just refer to it that way.

3. "It's an Experimental Treatment"
Truly experimental or investigational medical procedures are typically not eligible for health insurance coverage. So if a doctor tells you he wants to experiment with a treatment, don't represent it using those words. "In medical terms it may not actually be experimental or investigational," explains Danise. "If it's proven effective, your doctor deems it medically necessary, and it's not an exclusion, it should be covered." Verify with your doctor that it meets the above litmus tests before going to the insurer.

4. "My Basement Flooded"
With homeowners insurance, "flood" is a red flag. "The word refers to an act of weather or an overflow from a nearby body of water," says Danise. "And a standard homeowners policy doesn't cover it. You'd need flood insurance."


So don't use the f-word if your basement is knee-deep in water because of a burst pipe. Damages from such an incident should be covered by a homeowners policy. But calling it a "flood" could muddy the waters, so to speak.

5. "Just Send Me a Check"
When filing a home or auto claim, don't emphasize that you're just looking for the cash.
"If you were to say, 'I don't care about the roof leak, I just need the money,' that admission could slow things to a halt," says Puri. Technically, you're supposed to use the payout to make the repair for which you filed. While it's true that most insurance companies aren't going to check up on you, you'll certainly raise the fraud unit's suspicions if you imply that you won't. And then you might lose out on the money altogether.

Copyrighted, CNNMoney. All Rights Reserved.
source (http://finance.yahoo.com/insurance/article/108074/5-things-never-to-say-to-your-insurers?mod=insurance)

[Asher]

Here is a useful piece I found on the net:

"First, avoid saying “flood” and “mold,” according to United Policyholders. Instead, Amy Bach, executive director of the nonprofit, recommended, in the tip and on a recent local CBS report, saying something along the lines of, “There’s been an accident at my house, on my property and my property’s been damaged, and I’m filing a claim.” Then, United Policyholders recommended making arrangements to have the damage thoroughly inspected by a qualified professional.

Here are some other words to avoid, according to the CBS report: “whiplash,” when it comes to a car accident, and “experimental,” “investigational” or “clinical trial” in relation to nonstandard medical treatment.” The report recommended using “medically necessary” instead."

[q_sharon]

:thanks: for these interesting posts, cmo and Asher.

[Jeanette00]

Most employees receive medical health insurance coverage through their employer. However, if you disclose being pregnant during the interviewing process, it could be considered a pre-existing condition for insurance benefits and could even cost you the job. The same goes for purchasing any type of additional coverage, known as a “rider”. If you try to buy a maternity benefit onto your existing plan, the fetus becomes a “pre-existing condition” and will not be covered. See how it plays out and be prepared to foot the bill if need be.

Also saying sorry is an admission of guilt, so try to avoid using “I’m sorry”. Especially in car accidents, do not try to determine who is at fault or who made the mistake, leave that up to the authorities and insurance companies to figure out.

[Trentino]

When it comes to medical insurance, never use the words "experimental" or "investigational" or tell them that you want them to pay for a clinical trial. Instead, try saying, "There's medically necessary treatment that I'm seeking." Remember, words have power and insurers are all about finding limitations and exclusions if you say the wrong thing.

[chalette]

I agree with you. If you are referring to a health insurance, you should avoid the word ‘whiplash’ to describe your pain. Insurance companies know that some people are trying to scam them. So they will be alert on the word ‘whiplash’. Anyone can say that they have whiplash.

Insurance companies will further investigate to see whether you are telling the truth. It’s always better to talk about things you can prove through medical investigation.

I also think the words like ‘claim’, ‘please pay’, ‘I have paid all my premiums faithfully’ should be avoided.