I was rearended by an underinsured driver, and suffered a back injury that I essentially ignored for about a year. When I finally had an MRI, the radiologist misread it. And when I finally went to a neurosurgeon, he took his pen and circled the location of the injury, which required spinal fusion.
After I had the surgery, my attorney (who I only sought out when the stature of limitations was running out in Pennsylvania) pursued the other company, as well as my company, since my underinsured/uninsured motorist coverage was involved. The other insurance company settled, and my company sent me to an orthopedic surgeon who specializes in providing expert testimony for insurance companies.
In the end, I had to threaten a lawsuit against my own insurance company for failing to engage in good faith negotiations. They settled.
A year later, I received a letter that I was covered under the lawsuit mentioned in the article. But in the end, my insurance company apparently was able to convince the administrator of the fund that my company did not use collosus, in calculating offers to me.

bottom line - insurance companies are in it to make money. you bet that something bad will happen to you, you house, and/or your life and the insurance companies are betting that it will not. when insurance companies loss that bet and you claim a loss, rest assured that the insurance company will adjust your loss down to the least that they have to pay. it is not surprising that they have come up with a program to reduce payout and increase their profit.

And thus, it becomes understandable why Obama and Thuggery want to own the insurance industry. Government already controls AARP, which ´sold out´ on the senior citizens who built it.
.... ObamaCare will cripple many, and a lot of those folks were too ignorant to realize they were digging their own graves by giving this president their votes.

I have little doubt that this whistleblower and his family will lose everything after they are investigated by the IRS. This guy might even end up being a cellmate to the man whose film caused the murders of American citizens in Benghazi. s/o

My letter to Bartelme:

"I don´t use Facebook (too much personal information requested), but I did want to comment on your article about computerized software for claims settlements.

I believe that state regulators do keep a close eye on the ways insurers operate. Do insurers have an interest on keeping payouts low, you bet. As someone who was paying for health insurance by myself, I know about the sham of "reasonable and customary" claims payments -- yet I was glad to have coverage even at lesser satisfaction than I felt I deserved. Do claimants lie, too many do.

I can understand the companies preferring to deal with people without lawyers. Lawyers need to get their fees covered out of the claims paid, thus automatically inflating them . Further, the extra personnel time required to handle the extra paperwork, court times, is more costly for the companies. If the insurance companies can´t make money, then they can´t stay in business providing claims when needed.

All lawyers aren´t saints, insurers and their executives are not saints either. The tension between them and the regulators by the state keep most insurers honest enough for this imperfect world in which we live.

Mr. Romano shined some light on the process that caused him stress, but it´s still not clear to me that there was any wrongdoing in the "tuning." Leaving out excessively high and low payouts is probably wise if accuracy is desired in creating a computer program. There may be extraneous factors that created the outliers and including them might lead to false conclusions."

A complex issue. If you read the article, I don´t think you can come away from it believing that insurance companies are necessarily the evil, greedy corporations the Left loves to caricature.

Rather, insurers are an institution that is struggling to stay afloat. One reason they´re struggling is the ever-burgeoning load of government regulation. This article doesn´t really go there.

But this piece does make clear that a major reason insurers are struggling is the plethora of ambulance-chasing lawyers ... who advertise ceaselessly on television, luring dubious "clients" to join in frivolous "class-action" lawsuits.

My conclusion: If anyone is "evil" here, it´s the trial lawyers. (Who, as we all know, are 1%-ers who contribute hugely to Dems.)

When hurricane Ike blew through our neighborhood, some got new roofs, some got large scale repairs, and some got localized repairs. The difference often was which adjuster got sent out to look at the roof. Our adjuster never climbed onto the roof and missed 3 holes at shoulders in the roof. A later roof inspection found the holes which were fixed at our expense because the cost of localize repair was below the $1200 deductible. Insurance companies weed out the inspectors that replace the entire roof or fail to find real damage.

Government would hire these inspectors and demand a cut.

The insurance policy for floods has using light grey ink on a grey background in very tiny print....

"No payout if damage caused by water"

Insurance companies also use CLUE.

Used to be said that downtown everywhere was owned by the big insurance companies.
It´s not just your premiums but their investments they count on. Think about their loses in this economy and your increased premiums.

With auto and homeowner´s it seems to be Use it and lose it. Isn´t that like extortion ?

All of these companies cry the blues about paying claims. No mention of actuaries who are suppose to determine premiums by the ´what if´ every policyholder had a claim on the same day ? They are suppose to have the money to pay you. Guess AIG didn´t have actuaries.

Everyone has the right to complain to their state insurance commissioner and hope they follow the law and your policy that is a signed legal contract.