Игроки всегда ценят удобный и стабильный доступ к играм. Для этого идеально подходит зеркало Вавады, которое позволяет обходить любые ограничения, обеспечивая доступ ко всем бонусам и слотам.

10 Tips for Getting Claims Paid

Posted on by

(The following is a guest post written by Robert M. Horkovich, managing partner and shareholder in the New York office of Anderson Kill & Olick, P.C.)

Getting claims paid can be difficult and often, the larger the claim, the more difficult the process can be. In many cases, it seems like there is an invisible “seven-digit” exclusion written into all insurance policies. If the claim is $1 million or more, there is greater resistance to payment, in part because insurance companies often refer larger claims for review by counsel. This often leaves the policyholder fighting for payment of claims that should not be disputed.

Set out below are 10 tips for getting claims paid. Although there is no guarantee that if all the steps are followed, the claim will be paid, following these steps may help minimize the resistance.

1. Give Notice Early, Broadly and Often
Some first party insurance policies require the policyholder to give notice of a claim within a fixed period, sometimes as short as a week. Therefore, when a claim arises, give notice as soon as possible under as many insurance policies as may be applicable.  And supplement that notice when information about the claim becomes more available and developed.

Risk managers sometimes fear giving notice, as they believe it may impact renewal. The loss should be identified anyway in the renewal application to prevent a misrepresentation/concealment defense.

Although almost all states require that the insurance companies demonstrate prejudice (or that the failure to give notice was a material breach) if they seek to deny coverage on grounds that the policyholder failed to provide timely notice, the better practice is to give notice early, broadly and often. This minimizes the chance that late notice will become a defense to coverage.

2. Assemble the Right Team
Your team should include people familiar with your loss and with your insurance coverage. In addition to people from risk management, consider who else might be needed to assist the risk manager: accounting firms, forensic accountants, actuaries, loss adjusters, insurance brokers, engineers, environmental consultants, insurance archaeologists, and maybe even policyholder coverage counsel.

3. Gather All Information

  • Gather and inventory your company’s insurance policies. Now (before you have to handle the loss) is a very good time to gather and inventory all of your company’s insurance policies. Index them. Your insurance broker may help.  Having this done before you have to handle the loss will make providing quick and broad notice easier.
  • Gather all information regarding the loss. Notify all company departments that have documents that may be pertinent to the loss to preserve those documents. Suspend document destruction procedures applicable to those documents. Scan them. If hard copies of company records have to be destroyed, have someone review the documents before destruction so they can certify no pertinent records were destroyed. The duty to cooperate means keeping and turning over pertinent documents. Again, prejudice rules generally apply, but doing it right may help eliminate the argument.
  • Remember reinsurance. You may think that your insurance company’s request for information is unreasonable, but try to remember that your insurance company may be trying to satisfy the information demands of its own reinsurance company. Try to accommodate reasonable requests. If the requests for information are unreasonable, write to your insurance company and ask what it really needs to confirm coverage.

4. Document Everything
Document all communications with your insurance company including all requests for information, all conversations, what the insurance company is doing and what you are doing. Always have the last word – even if it is to say that you disagree. Why? If the claim is denied, you will need this written record as evidence.

5. Avoid Open-Ended Standstill Agreements
Your insurance company may say it needs time to investigate the loss and wants a standstill agreement to preserve everyone’s legal position. Avoid these if possible. You give up leverage to force your insurance company to conduct a timely investigation.

If you have to enter into a standstill agreement – and they sometimes are necessary to minimize legal costs – set a clearly defined and realistic deadline. Anything later just gives the insurance company additional “float,” as Warren Buffet calls the time lag between collecting premiums and paying claims. Do what you can to get your money quickly so that you can invest it and make profits rather than giving an added bonus to Warren Buffet. Don’t give your insurance company a license to stall.

6. Quantify the Loss
Identify and document amounts spent on the loss or the liabilities. Include defense costs for liability matters, in-house time and expenses if they can be recorded, and past, present and future loss amounts. Consider using those with expertise in identifying all types of losses that might be included. For future losses, consider using a forecaster or actuary. Such losses then can be reduced by a present value discount and included in your negotiations. Try to consider all possible contingencies.

7. Value the Insurance Asset
Look to the policy limits. Examine all potential forms of coverage and all potentially applicable coverage grants within all potentially applicable policies. Don’t forget endorsements. Look at the ultimate net loss clause and supplemental payments clauses in liability policies and consider what costs your company has incurred that fall within those coverage grants.

On the negative side, consider deductibles and self-insured retentions. Look at potentially applicable exclusions and exceptions to those exclusions. This will help you shape your company’s loss.

When valuing how much you may get back to cover your loss, consider the financial viability of your insurance companies. Taking a discount and getting paid now may have value if your insurance company has a clouded financial posture.

  • Legal/policy analysis. Look at the loss valuation and compare it to all the forms of coverage available. Apply the losses as best you can to maximize coverage. Consider forum sensitivity. Does it make any difference if your claim is pursued in one jurisdiction or another? Compare state provisions and precedents regarding late notice prejudice, application of the pollution exclusion, consent to settle exhaustion of underlying coverage, or other factors as applicable. Consider which jurisdictions would suit your claim best. Is there a mandatory arbitration provision in the policy? A choice of law provision? These must be taken into consideration.

8. Set The Target/Demand
Calculate each insurance company’s maximum potentially applicable coverage separately. While you cannot obtain a windfall or double recovery, there is no reason why you should not start by explaining to each insurance company what its exposure is.

9. Negotiate the Claim
What do you want to achieve? Cash now? A payment stream in the future? A coverage in place agreement confirming coverage for future events? Take these factors into consideration.

Negotiate with each insurance company separately. Generally, negotiations that bring all insurance companies together at the same time do not result in prompt settlements. The insurance companies generally get together to share theories of defense to coverage. That does not promote payment of the claim.

Do not press weak claims. Weak coverage claims tend to hurt, not help, claim payment.

Try to get the right people to claim settlement discussions. Ask the broker to help make sure that the appropriate claim representative is there. Make sure you have appropriate settlement authority.

Remember to mind your manners. By the time you have gotten to this point in the payment of your claim, you rightfully may be very frustrated and even angry. Try to put that anger aside for purposes of resolution of the claim. It is harder for the insurance company to pay if there is personal anger and animosity.

10. Be Careful in Documenting the Settlement
Focus on the scope of the release. Try to limit the release just to the claim being paid. If the insurance company asks for more (tying is an unfair claims practice under the NAIC Model Unfair Claims Practice Rules adopted in most states), then make sure you can quantify the value of the additional coverage you are giving up.

Make sure the payment is net of retrospective premiums adjustments or any other charge back. The last thing you want is a bill from the insurance company.

Be very careful of indemnification provisions. They easily can eat up the claim payment proceeds you are getting.

To help you through the whole process, be persistent. Don’t give up. Above all, that will allow you to maximize the value of your claim.

Transportation Department Shuts Down 26 Bus Operators for Safety Violations

Posted on by

Apex Bus station in New York's Chinatown, one of the companies shut down by the feds (photo via Yelp)

In what a Department of Transportation oversight agency has described as the “largest single safety crackdown” in its history, federal officials ordered the immediate shutdown of 26 bus operators that transported passengers along the I-95 corridor. The reason: they are “imminent hazards to public safety,” according to DOT.

The crackdown is the result of a year-long investigation into these small, poorly regulated bus companies following several high-profile crashes along the East Coast in early 2011. “These aggressive enforcement actions against unsafe bus companies send a clear signal:  If you put passengers’ safety at risk, we will shut you down,” said U.S. Transportation Secretary Ray LaHood.  “Safety is and will always be our highest priority.”

The leader of the DOT agency responsible for the shut down, the Federal Motor Carrier Safety Administration (FMCSA) had some strong words of his own. “The egregious acts of these carriers put the unsuspecting public at risk, and they must be removed from our highways immediately,” said FMCSA Administrator Anne S. Ferro. “With the help of multiple state law enforcement partners, we are putting every unsafe bus and truck company on notice to follow the safety laws or be shut down.”

The three main companies whose various operations have been shuttered are: Apex Bus, I-95 Coach, and New Century Travel, which oversaw a network of bus companies, according to DOT. The various companies included — one ticket seller, nine active bus companies, 13 companies already ordered out of service that were continuing to operate and three companies attempting to apply for operating authority — are based out of Georgia, Indiana, Maryland, New York, North Carolina and Pennsylvania.

We covered the outcry for better bus safety in May 2011 in our print publication, Risk Management. Here is an excerpt of that piece, written by Emily Holbrook, in full.

In New York, most people rely on mass transit. And for getting out of town, one of the most popular choices are the motorcoach buses that depart from Manhattan’s Chinatown. These “Chinatown buses” offer riders a cheap ticket out of town to destinations such as Boston, Philadelphia, Washington and various casinos in the area.

But these low-cost tour bus companies have a horrifying track record of safety. On March 12 that fact tragically came to light when a bus returning to Chinatown from the Mohegan Sun Casino in Connecticut overturned on a Bronx highway, killing 15 people and injuring 20. Just two days later, two people were killed in another accident involving a Chinatown bus returning to New York from Philadelphia. That bus line, Super Luxury Tours, has one of the worst driver safety ratings in the nation, according to a report from the U.S. Department of Transportation. Though Super Luxury Tours may be considered the bad seed of the tour bus industry, many motorcoach companies have a spotty safety record. In fact, the Advocates for Highway and Auto Safety reported 34 motorcoach crashes nationwide in 2010 that resulted in 46 deaths and injuries to 363 people.

These crashes have highlighted a long-standing concern over the safety of such discount coaches and, more specifically, the issue of driver fatigue, which is suspected in the Bronx crash. Currently, drivers are required to maintain handwritten logbooks to track the hours spent on the road. These have commonly become referred to as comic books, however, as many drivers allegedly falsify their records routinely.

Other concerns facing tour bus drivers are issues with licenses and medical evaluations. According to the American Bus Association, more than half of the deaths in bus accidents from 1999 to 2009 could have been prevented if the drivers involved had not been allowed behind the wheel.

In response to March’s back-to-back bus accidents, a sting was initiated by the Manhattan Traffic Task Force, which pulled over more than a dozen tour buses at a surprise checkpoint. Each of the buses failed the test when inspectors from the city’s transportation department found that nine drivers should not have been behind the wheel and 10 buses were deemed unfit for the road.

In a more sweeping move, Sen. Charles Schumer (D-NY) asked New York’s Department of Motor Vehicles to re-examine all drivers of low-cost tour buses for previous safety violations and suspended licenses. He believes if an audit had previously taken place, the March 13 crash would not have occurred. “The audit would have shown that the man behind the wheel shouldn’t have been behind the wheel, and he wouldn’t have been driving,” Schumer said.

In further action, Sen. Frank Lautenberg (D-NJ) penned a letter to U.S. Transportation Secretary Ray LaHood, saying he is “concerned that DOT is lagging behind in its progress on the Motorcoach Safety Action Plan.”

The plan, introduced back in 2007 after a motorcoach crash in Atlanta killed five members of the Bluffton University baseball team, stalled shortly after its origination. It eventually resurfaced again this January after a motorcoach accident in Ohio. Now, politicians are pushing for permanent legislation to improve tour bus safety standards.

The Motorcoach Enhanced Safety Act, co-sponsored by Schumer and Sen. Kirsten Gillibrand (D-NY), would, among other things, require buses to be less flammable and have safety belts, anti-ejection windows, tougher roofs that can withstand rollovers and increased fire resistance. The bill would also address the logbook issue by having electric, on-board recorders installed in each motorcoach.

It is not only the bus drivers or parent companies that are to blame for increased risk among buses. A recent report issued by the federal government regarding city transit buses states that it may have to rewrite safety rules due to passengers being heavier today that they were in the past. The Federal Transit Authority (FTA) proposes raising the assumed average weight per bus passenger from 150 pounds to 175 pounds, which means fewer people will be allowed to ride city buses. The changes are needed to “acknowledge the expanding girth of the average passenger,” said the FTA.

With steadily rising fuel prices, more and more people are turning to public transportation. Hopefully, for bus riders, that will not prove to be a risky decision.

Facebook IPO: The Good, the Bad and the Ugly

Posted on by

By this time, you’re probably aware of the debacle over Facebook’s initial public offering on the NASDAQ exchange last week. Let’s break it down.

The Good
There isn’t much that falls under this category, execpt for the fact that the NYSE is enjoying the controversy — it’s attempting to lure Facebook to the exchange.

The Bad
It was announced Tuesday that two U.S. financial regulators suggested reviews be launched into the social media site’s IPO, citing concerns over disclosure relating to underwriter Morgan Stanley. It was reported that Morgan Stanley analysts received information that caused them to cut revenue forecasts for Facebook. This information, however, was only shared with analysts from the 33 underwriting banks and was never made public. Simply put, “the disclosure of lower forecasts to certain big institutional investors left both Facebook and Morgan Stanley open to accusations of selective disclosure. Many smaller investors who bought Facebook shares in the IPO were left in the dark.”

This morning it was announced that Morgan Stanley and other underwriters associated with the IPO have profitted close to $100 million from stabilizing the share price, along with millions in profit more in IPO fees. Before the public offering, Morgan Stanley was given the opportunity to purchase a large chunk of shares at a discount in order to keep the share price stable through buying and selling once the shares were offered to the public. The bank not only sold every last one of the 421,233,615 shares it bought at discount, but it also shorted an additional 484,418,657, which only signals one thing — Morgan Stanley knew the share price would drop and it, in turn, would buy back the shorted shares at a profit.

The Ugly
Thus begins the wave of lawsuits. Tuesday, a Los Angeles-based law firm, Glancy Binkow & Goldberg LLP, filed a class action lawsuit on behalf of investors who suffered losses from Facebook’s IPO. And it was announced today that the law firm of Girard Gibbs LLP has filed a similar class action suit, stating that “the company, its officers and directors, and underwriters with violations of federal securities laws for false and misleading statements made in the Registration Statement and Prospectus issued in connection with the IPO.” In addition to these, several lawsuits have been brought against Mark Zuckerberg, Morgan Stanley and even Nasdaq.

In the end, the fact is that not all Facebook IPO investors received the same data. To most (i.e., small, individual investors), that’s unfair. But to many (institutional investors and underwriters), that’s just the name of the game. What’s your take?

The Greatest Risks of the Greek Debt Crisis

Posted on by

The ongoing debt crisis in Greece continues to spur unrest, move markets and threaten the very fabric that connects the eurozone. Exactly how much effect a Greek default — and the domino effect in lending costs it would have throughout Europe — would have on the U.S. business world remains unclear.

But a good rundown from CNN Money offers a list of the three biggest risks Greek default presents for the United States: (1) U.S. bank exposure to sovereign debt, (2) a pullback in U.S. exports, and (3) U.S. business slow down.

To me, the last one seems the most threatening. Only now is the U.S. economy beginning to make any headway on replacing the jobs lost after the 2008 meltdown — and even this “recovery” remains mild, at best.

Here is how CNN breaks down that risk.

Many products sold by U.S. companies in Europe are made in Europe.

And losses there are already taking a bite out of U.S. multinational firms, from automakers General Motors and Ford Motor, to cereal maker Kellogg and smaller niche companies like watch and accessories maker Fossil, whose stock tumbled 40% in a single day after reporting weak European sales earlier this month.

If the value of the euro versus the dollar continues to drop, U.S. goods are going to become more expensive by comparison to those made by European rivals. And that could cut into U.S. business sales and exports around the globe if countries can get cheaper imports from Europe.

Furthermore, if export-driven economies like China see demand from Europe slow, it increases a risk of a so-called “hard landing” for the Chinese economy.

Given the importance of emerging market growth worldwide, a hard landing in China and other export markets poses a significant threat of creating a global recession, according to a report earlier this year from the World Bank.

And the with U.S. GDP of 2.2% in the most recent quarter, it is doubtful the United States can avoid a recession of its own if there is a true global slowdown.

There’s the “R” word resurfacing. For the United States—not just economies across the pond. In 2012, there is no greater risk facing American companies.