By the time we wrote this question, we had already provided legal services for claims litigation for a large domestic insurance company for six consecutive years. From car insurance to non car insurance, from property insurance to personal insurance, from litigation property preservation liability insurance to employer liability insurance. The more insurance dispute cases we handle on behalf of insurance companies, the more we realize that it is necessary for lawyers to intervene in insurance claim cases in advance!

1、 Why?

Because the probability of insurance companies losing a lawsuit is too high! On the one hand, in judicial practice, the biased protection of insurance consumers by courts often leads to insurance companies becoming the "scapegoats" who bear all risks; On the other hand, the fixed evidence provided by insurance companies after an insurance accident is not precise enough. If the claim information obtained by the insurance company is not solid enough at the first time and on the first scene after an insurance accident occurs, it will be very passive in the subsequent handling of insurance dispute cases. It should be noted that in insurance dispute cases, insurance companies often bear a heavier burden of proof.

Why is it said that the insurance claim information obtained by insurance companies after an insurance accident is not accurate enough? Is it because the insurance claims personnel are not professional enough? Obviously not! In fact, insurance claims personnel are very familiar with insurance related professional knowledge, insurance concepts and terminology, and the design concepts behind insurance products (even more so than many insurance lawyers).

2、 The advantages of lawyers intervening in insurance claims

So, where is the problem? We believe that the problem lies in the professional barriers brought about by the specialization of the profession. Most insurance company claims personnel do not have a legal background. Although insurance claims personnel are very familiar with the insurance industry, their claims litigation lawyers do have significant professional advantages in reviewing and identifying insurance claim materials.

After all, claims lawyers can review the claims information collected by insurance company claims personnel from a perspective of examining evidence. Once the claim materials have been reviewed by the litigation lawyer, they will be more easily accepted by the court as evidence when submitted to the court in the future, or they will be better able to withstand the test of the litigation evidence rules. Moreover, if the claims litigation lawyer discovers that there is still a "gap" in the claims information, they can obtain "reinforcing evidence" as soon as the insurance accident occurs, making the claims or refusal of the insurance company more solid and secure, and giving the insurance company more confidence when appearing in court to respond.

3、 Our cooperation experience

Collaboration experience 1: Working side by side with insurance claims teams, policyholders abandon claims from insurance companies

Our experience in collaborating with insurance claims teams has shown that the early intervention of lawyers can help insurance companies avoid endless insurance dispute litigation.

In a certain motor vehicle loss insurance claim case, the policyholder purchased a family owned cargo car from BAIC Foton Company. The vehicle has been in use for less than half a year and experiences spontaneous combustion during the transportation of goods, resulting in the entire vehicle and its cargo being burned. The owner of the vehicle purchased motor vehicle loss insurance from the insurance company and reported the accident to the insurance company. Based on the "Brief Investigation and Determination of Fire Accidents" issued by the fire department, the insurance company's claims manager determined that the cause of the fire was a malfunction of the vehicle's engine electrical circuit, so the accident is likely caused by the vehicle's quality. According to the insurance terms, vehicle damage caused by vehicle quality is considered deductible by the insurance company.

Based on the above judgment, the head of the insurance claims team hopes that our lawyer can intervene and provide legal support for the insurance claims. For this reason, our lawyer searched a large number of cases related to vehicle spontaneous combustion, consulted relevant institutions for preliminary opinions, and successfully convinced the car owner to abandon the claim against the insurance company. With the assistance of our lawyers, the car owner filed a product liability dispute with BAIC Foton.

Cooperation experience 2: Refusal to claim is reasonable, and the court rejects the insured's lawsuit request

Taking a step back, even if it is difficult for insurance companies to avoid getting involved in insurance dispute litigation, insurance claims cases with lawyers conducting risk control are usually more able to withstand the test of judicial judgments.

A certain chain hotel has purchased public liability insurance from a certain insurance company. A hotel guest died suddenly while having sexual intercourse with a female visitor in the room after checking into the hotel. The hotel compensated the guest's family and claimed compensation from the insurance company. After sorting out the claim materials, our lawyer believes that the hotel was not at fault for the customer's death, and there is no legal causal relationship between the customer's death and the hotel's failure to register visitor identity information. Therefore, this accident does not fall within the scope of insurance liability.

According to the opinion of our lawyer, the insurance company has made a decision to refuse compensation. Later, the hotel filed a lawsuit with the court, demanding compensation from the insurance company. The case was tried by the first and second instance courts, and both courts rejected the hotel's lawsuit request.

Collaboration Experience 3: Make up for the lost and promptly identify issues with the appraisal report

After an insurance accident occurs, the insurance company usually entrusts an insurance appraisal agency to investigate the cause of the insurance accident and determine the loss of the insurance accident. Then, the insurance company makes claims based on the appraisal report issued by the appraisal agency.

In multiple insurance dispute cases we have dealt with, we have found that valuation reports are not always reliable first-hand information. Even the appraisal report submitted in court may become a stumbling block for insurance companies.

We have a deep understanding of this in our recent handling of employer liability insurance claims cases. The policyholder reported to the insurance company that the employee (insured) fell and died during the installation of the elevator. On the third day after the accident, the insurance appraisal agency was commissioned by the insurance company to conduct an on-site inspection. The insurance appraiser takes photos of the scene, visits and investigates workers, and forms a record. The appraiser recorded the scene of the accident in the appraisal report, without any third party or monitoring. The conclusion of the appraisal report is that it is confirmed that XX fell and died during the installation of elevators

But the question is, how did the appraisal agency come to its conclusion without any evidence of the deceased's death process? Based on the evidence at the time, the appraisal agency could only conclude that XX died. As for when the death occurred, the cause of death, and whether the death occurred during employment activities, it is not within the scope of the appraisal agency's determination. Fortunately, such an appraisal report was discovered and taken down by our lawyers in a timely manner. Otherwise, the insurance company would face greater passivity in court.

4、 Conclusion

After following up on insurance claims from insurance companies for 6 years, we found that when the insurance company makes a claim decision, its win or loss in court is already determined.

In the insurance litigation market, more and more lawyers are seizing the claims loopholes of insurance companies and focusing on representing the insured. This means that insurance companies will face greater challenges in their insurance claims.

There is a specialization in the craft industry. Insurance claims personnel have a better understanding of insurance, while insurance claims lawyers have a better understanding of the law and evidence. Rather than having a lawyer handle claims litigation after an insurance dispute occurs, it is better to have a lawyer intervene in advance and be prepared for any potential risks before an insurance dispute occurs. Insurance claims lawyers should stand at the forefront of insurance claims.