“‘I have invented an invaluable permanent invalid called Bunbury, in order that I may be able to go down into the country whenever I choose. Bunbury is perfectly invaluable. If it wasn’t for Bunbury’s extraordinary bad health, for instance, I wouldn’t be able to dine with you at Willis’s to-night, for I have been really engaged to Aunt Augusta for more than a week.’”
-Algernon Moncrieff, The Importance of Being Earnest
A bunburyist—that word being the invention of the aforementioned Oscar Wilde character—is defined as someone who has a ready-made excuse for any occasion or circumstance they would rather avoid. Algernon’s bunburying tactics allow him to get out of social engagements with those he finds dull; Ernest’s bunburying allows him to act as a role model to his ward under an assumed name while continuing to have his fun in town; and most people outside the play employ some form of bunburying, as well. In one guise or another, everyone is a bunburyist, whether they feign illness to escape meetings, deliberately schedule vacations during the busiest time of the year, or run to the bathroom whenever someone mentions the dirty dishes. Truth be told, there probably isn’t any harm in shirking a duty or two every now and then. However, there are some situations where it is never okay to weasel out of your obligations. One such context is the insurance industry.
It seems unthinkable that a respectable business would default on the services for which they are paid, particularly when those services involve helping sick or injured people; but all too often, this is precisely what happens when people make insurance claims. A number of the largest insurance companies such as Allstate or State Farm are notorious for misleading their policyholders about their options, fighting them tooth and nail when they do insist upon compensation, and/or blithely coding their policies in such a way that requires pitifully little of them in the event of an accident.
Once you’ve chosen your insurance provider wisely, there are still things you should watch for when making a claim to see that you don’t get stuck with less than you’re due.
Table of Contents
1. Material misrepresentation
One way that unscrupulous insurers will try to circumvent payment is by saying that the medical information you disclosed when applying for insurance was fraudulent, and that you are not entitled to the rights stipulated in your contract as a result. These alleged fibs would constitute “material misrepresentation.” While material misrepresentation only covers preexisting conditions, people have occasionally been denied payment on the basis of conditions that arose well after they purchased the policy when nothing could be found to suggest dishonesty in their application. As patently unjust as this is, few people are equipped to take on this level of opposition alone, since big insurance companies are flanked by lawyers and tort reform legislation. However, personal injury attorneys may be enlisted to bring the prevaricating party to account when no amount of reason or sympathy will persuade them to do the job by which they profit (or simply to intimidate them into settling out of court).
2. Recorded statements
When an insurance adjuster requests a recorded account of the events or circumstances which cumulated in an injury or illness, they are generally doing so for the same reason police officers interrogate suspected criminals—to see if your story adds up. Whatever inconsistencies may appear, even those that can be attributed to misspeaking, they can be used to deny your claim. Many people may benefit by consulting with a personal injury attorney before they make their recorded statement so they can prepare themselves for the precision the task requires.
3. Independent Medical Exams
The misleadingly named “independent medical exams” are administered by a physician who has been hired by an insurance company to challenge the claims made by your own medical authority. These cannot be avoided, but can, again, go more smoothly with preparation from a personal injury attorney. In addition, courteous behavior and straight, short answers are best, although it is also admissible to bring a relative and/or a tape recorder.
4. Delaying Until Death
As dreadful as it sounds—and is—there are companies that employ this very practice. In an article run by the New York Times in 2007 entitled, Aged, Frail, and Denied Care by their Insurers, several insurance companies are exposed in attempts to wait out their clients in need. “They’ll do anything to avoid paying,” says former senior executive at the National Association of Insurance Commissioners, Mary Beth Senkewicz, “because if they wait long enough, they know the policyholders will die.” In fact, some companies write codes that specifically aim to confuse aged citizens. In these cases, it is vital to confer with or even retain a personal injury attorney to fish through the complex language of the policies to make sure the elderly or terminally ill are not taken advantage of.
If you think you have cause to suspect unfair dealings on the part of an insurance company with which you are trying to negotiate compensation, it can’t hurt to ask. Many personal injury attorneys offer free diagnostic conferences exploring whether or not it would be worth your time to enlist their services. A professional in your area will be familiar with the common challenges facing people in your general situation and know how to connect their expertise to your specific case. What’s more: a personal injury attorney will have no incentive to lead you on with false hopes.
Don’t waver if your gut tells you something is wrong. If something rings false, you need but ask—if you end up outing a bunburyist, you may also end up with more than you ever could have.
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