You don’t have to work long in the insurance business to realize that not all claims are alike. Indeed, while most are routine, open-and-shut cases, agents, adjusters and other industry players often have to cope with unusual circumstances, bad luck or simply the human factor—any one of which can make it tough or even impossible to figure out exactly what happened when a loss is reported.
National Underwriter spoke to a few industry veterans on the front lines of claims-handling, gathering war stories involving simple misunderstandings, tragic circumstances and outright feuds hindering the resolution of mysterious or contentious claims.
One classic claim tale shared by Randy Wheeler, founder and chief executive officer of San Ramon, Calif.-based Valley Oak Systems—a claims administration and risk management solutions company now part of the Aon family—involved what he referred to as a “fertility facility.”
“Eggs were not matching up with tracking,” prompting the question of “who’s who?” he recalled, and presenting a difficult case for the adjusters.
“From a liability standpoint, how do you investigate that?” he said. “Do you ask everyone who’s been there, ‘Please do a DNA test to make sure your kid is really your kid?’ There’s no claims manual for that.”
Sometimes adjusters just find themselves caught in the middle of a larger, if more local fight.
Mike McCartin of College Park, Md.-based Joseph W. McCartin Insurance mentioned how one adjuster ended up in the middle of a “Hatfields versus McCoys-type situation” over a partially paved driveway.
“This was already an ongoing dispute” between two neighbors, he said, explaining that the insured had at one point owned both plots of land but had sold one. “There was already tension in the air.”
Since then, they had each wanted to reacquire the plot, and friction between the two was high. The two neighbors shared a driveway, and the insured had re-paved their portion of it down to the point where the driveway split to lead to each house.
The neighbor filed suit. “They claimed it created an erosion problem,” Mr. McCartin explained, adding that the suit also said the runoff from the driveway polluted the local tidal basin.
There had been some wrangling between the two parties before the claim was brought, according to Mr. McCartin, but he also noted that the suit was worded in a way that was designed to trigger insurance coverage.