Is Essential Data for Your Insurance Claim Getting Lost in Cyberspace?

Companies of all types are saving considerable sums of money by converting from paper to digital document systems. This type of system seems efficient because documents can be searched electronically and retrieved from multiple locations. But electronic processing and storage have their drawbacks, too, and the problems can manifest in unexpected ways, particularly with the increased reliance on AI.

If your insurance company is delaying action on a claim or disputing your right to appropriate payments for a loss, electronic information issues could be at the heart of the problem. However, it’s often challenging to discern and resolve the issues. The reasons insurance companies provide are often vague or written in terms with specialized meanings in the insurance industry. 

At Ver Ploeg & Marino, we have decades of experience resolving insurance disputes, so we understand how to investigate the cause of discrepancies and find solutions that protect the rights of policyholders. We know that missing or misinterpreted information often triggers a variety of problems. If you contact us to discuss your situation, we can review the circumstances and suggest options for action. We can’t do that in a general blog like this, but here we can explain the issues that arise with digital information portals, AI evaluations, and other tech “advancements” in the insurance industry.

Hiding in Plain Sight: Information that is Not Correctly Formatted May Be Invisible

Whether a claim involves hurricane damage to a home, vandalism damage to a business, a disability that prevents you from working, or any other issue for which you’ve purchased insurance, you need to follow the appropriate steps to receive payments under your policy. This includes obvious requirements such as meeting deadlines, but also some that the insurance company doesn’t publicize well, if at all. The insurer will want to receive specific information in a format that meets their standards. And one problem is that they often do not explain what those standards are.

For instance, if they ask for a copy of a police report, they may want it submitted to a portal in a specific electronic format. If you attach it to another document or submit it in a different format or copy the information into a separate document, the information might not be recorded as received. If there is a mistake with the name of a file or if a file name is not appropriately descriptive, it may also not be recognized. In the digital realm, if something is not recognized properly, it is effectively lost. The same is true for documents saved in the wrong digital folder.

If papers were stored in physical file folders, a staff member could easily check files nearby to see if something was misrouted by mistake. This type of error can be much harder to correct in digital files, particularly if information is entered with a typographical error.

Formatting can be highly problematic. If a program searches only for PDF or DOC files, a faxed document saved as a TIFF file will not be found. Or if a program is searching for specific information only in one field of a form and the information was placed in a different field, that information can also be inaccessible and therefore invisible.

Terminology Troubles

When an insurance company is looking for specific information in an insurance claim’s documentation, it may use AI or other technology to search for particular terms. If the claimant or someone else involved in the process uses different language, it may not be recognized, and the claim could be considered deficient. For instance, if a claim includes repair bills or estimates, a contractor might use an abbreviation or industry-specific term that the insurance company does not expect or that has not been programmed. Or if pricing is submitted in units other than those for which the insurance program is calculated, the amount could be rejected as outside the policy parameters.

Problems with terminology, as with formatting programs, can cause a claim to be denied. But these problems can also simply leave a claim open and inactive, in limbo until someone takes appropriate corrective action.

Addressing the Problems

It’s often not clear why a problem has occurred with misclassified information—and it may be difficult to determine what the problem is or even that a problem exists. Insurance companies insist that processing claims takes time, and many policyholders wait far too long before acting. They tell themselves their claim is next in line for processing when, in fact, it has been rejected or stalled due to missing required input.

Quite often, a phone call from an experienced insurance attorney prompts someone at the insurance company to investigate the problem, and the information can be resubmitted in a format that meets the insurance company’s technology requirements. Other times, it may take more formal action, such as filing a lawsuit. The initiation of a legal claim allows an attorney to use discovery tools to uncover information that the insurance company might not otherwise divulge. Obtaining this information, then, can provide grounds to negotiate a satisfactory resolution to the problem.

When Insurance Companies Don’t Fulfill Their Obligations, Talk to Ver Ploeg & Marino

Insurance companies are always happy to take your premiums but very reluctant to pay claims when you’ve suffered a loss. You might be in a hurry to receive payments under the policy, but they are in no hurry to process everything. If information is missing, they might wait a long time before telling you. Or they might simply deny your claim without telling you why.

Your insurance company has obligations, and when they fail to meet them, the right legal assistance can make all the difference. At Ver Ploeg & Marino, we have experience and knowledge of the insurance industry that enable us to secure favorable results for clients across a wide array of situations. For a confidential consultation to discuss the assistance we may be able to provide in your case, call us at 305-577-3996 or contact us online now. 

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