BodyShop Business
Is An Insurer Not Responsible For Satisfying a Fair Claim?
4/22/2014

I've experienced an array of hypocritical statements made by insurance adjusters over my 18 years in the collision repair industry. In the most recent experience, a past satisfied client brought me a hood repair job on a 2009 Scion XB-Silver and presented me with two specific concerns: 1) could I repair the OE damaged hood to a pre-accident condition, and 2) did the insurance company write a fair amount to repair my damages? My answers were yes to his first concern and no to the second.

I noticed the adjuster, who had 20 years on the tech repair side and then moved over to the insurance adjuster side nine years ago, wrote for an aftermarket hood with no OE labels replaced. Most importantly, he did not write for blending the fenders and R&I'ing the front cover, headlamps and inner wheel liners. The adjuster later told me that, for the past nine years since he has been with this insurance company, "They do not write to blend vertical panels with horizontal panels in the field" since it may not be necessary. What? I politely informed him that was not true. He then raised his voice and stated that I was pissing him off by calling him a liar. It's interesting how anger rarely arises from a person of peace and confidence. Neither this man's attitude nor ignorance intimidated me in the least.

I apparently captured this man's attention when I asked him to name one time, other than refinishing a bumper cover, when he ever panel painted a silver hood, much less any panel, and did not blend the fenders or adjacent panels? He remained silent, and finally agreed. "Never," he said.

My question is, is the insurance carrier not responsible for satisfying a fair claim? Is there any such case law to support this concern?

Asked by Brian Hayhurst, Dings & Dents, Winston-Salem, N.C.

First, I am not an attorney and thus cannot and do not offer or provide legal advice or counsel. With that stated, I’ll gladly share my experience as a claims adjuster and working with the legal community as an expert witness for collision repair-related matters and diminished value, but even more importantly as an experienced shop owner/manager and industry consultant for more than 25 years.

Yes, insurers are obligated to conduct themselves in a 'fair and reasonable manner' to properly indemnify consumers for their losses when either caused as a result of the negligence of their insured (where liability coverage exists), an insured policyholder (third party) or when the consumer has a policy contract with the insurer to cover damages to the covered auto (first party).

Where coverage applies, the insurer is obligated, either legally or contractually, to “indemnify” the damaged party. Indemnify is defined by Merriam-Webster as: To protect (someone) by promising to pay for the cost of possible future damage, loss or injury. The indemnifier "makes compensation to for incurred hurt, loss or damage."

As far as any laws that govern an insurer’s behavior, yes, there are laws that govern the conduct of businesses and protect consumers from deceptive business practices. In most states, there are statutes and regulations that govern the specific business of insurance monitored by the Department of Insurance and/or insurance commissioner’s office, etc. In many states, there are actual regulations for “Fair Claims Practices."

Each repairer should be readily familiar with the laws, statutes and regulations in their individual state to fully understand their own company’s responsibilities as well as those of the insurance industry. Only then can one help enlighten and edify their customer to take action should their rights be negatively affected or an attempt be made to take those rights from them.

Like any afforded protection, if you don’t know what your rights are, and you can’t protect or assert those rights, you'll likely forfeit and lose them.

Many insurers know what their responsibilities are and what not to do, but the lure of windfall profits is a great motivator for some to cross the line. And the only way to get them to see the error of their ways is through accountability and the associated liabilities. The only way accountability can be applied is by knowing what an insurer can and cannot do and encouraging the consumer to take action to stop it.

As I have stated before, “Only when the risks outweigh the rewards will behaviors change!”



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