On Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It by Jay M. Feinman. Jay Feinman is a lawyer, author, and professor who has written four books on law and legal studies. In Delay, Deny, Defend, Feinman explains how insurance companies increase their profits by postponing or refusing payments to their clients.
Insurance is a regular payment purposed to help protect your well-being during potentially catastrophic events. You may pay a monthly premium in exchange for a company’s promise to pay you when a catastrophic event, such as a car crash, occurs. As long as you faithfully make your insurance payments, the company is legally obligated to adhere to your insurance contract. Fairly-executed insurance contracts lead to regular premiums (i.e. payments) for insurance companies, irregular claims for those suffering injuries/catastrophes, and more peace of mind for all. But, as Feinman writes, “Insurance doesn’t work when the insurance company fails to honor the terms of the policy and its promise of security through the strategy that has become known as “delay, deny, defend.”” (Feinman, 2010, Intro)
MIST – Minor Impact, Soft Tissue or Whiplash Claims:
A client of an insurance company might submit paperwork for a motor vehicle accident that resulted in a painful neck injury. The insurance company might classify this as a minor impact, soft tissue (MIST) or whiplash claimbecause the cost of care for client injuries is too low to justify a law suit (Feinman, 2010, Ch. 2, 6).
SFXOL – “Settle For X Or eLse”:
The insurance company could present reimbursement offers below principal value – what the client’s contract says the client is owed – until the client sues – a strategy referred to as “settle for X or litigate” (SFXOL) (Feinman, 2010, Ch. 2, 6).
DOLF – “Defense Of Litigated Files”:
If the client sues, the company can practice defense of litigated files (DOLF) which involves actions designed to prolong the trial and/or increase the client’s expenses during litigation (Feinman, 2010, Ch. 2).
“Stonewalling”:
Settle for X or litigate (SFXOL) and defense of litigated files (DOLF) are stonewalling or stalling strategies (Feinman, 2010, Ch. 2). Stonewalling can occur when an insurance company refuses fair contractual payment before a law suit or drags out litigation after a law suit.
“Fight-and-delay”:
A company might even use surveillance, prolonged travel distances, and other pressure tactics in a “Fight-and-delay” approach designed to get clients to settle for less than the company may legally owe (Feinman, 2010, Ch. 2).
Feinman (2010) writes, “Delay, deny, defend violates the rules for handling claims that are recognized by every company, taught to adjusters, and embodied in law. … Traditionally, claims adjusters were taught to follow a simple maxim: “We pay what we owe.” … [But] … As the claims department became a profit center, and delay, deny, defend increased, the adjuster’s job changed, diminishing the obligation to the claimant in favor of an increased obligation to the company’s bottom line.”
In other words, some insurance company analyzed their business to find creative ways to decrease reimbursements and increase their bottom line. And what they found may have suggested injuries and strategies could be used to pay out fewer claims and retain more profits. Feinman (2010) writes, “The story of delay, deny, defend is easy to understand but hard to discover and document.” But Feinman filled his book with case-in-point examples so unsavory insurance reimbursement tactics would be easier for readers to discover and understand.
On the 4th of December, 2024, a masked gunman shot and killed a Chief Executive Officer of a subsidiary of the largest healthcare insurance company in the United States. News media reported “Delay”, “Deny”, “Depose” were written on bullets found at the scene of the crime. The similarity of those words caused used copies of Feinman’s book to rapidly sell out. And the e-book became a “top-seller” on online bookstores.
Feinman (2009) writes, “Usually, when an insurance company delays, denies, or underpays a claim that is the end of the story. The claimant might not understand that he has been shortchanged, or he may not believe that there is anything he can do about it, or he may just want to get on with his life.”
The event that occurred in Midtown Manhattan on December 4th, 2024 demonstrates what happens when people take justice into their own hands. Vigilantism or “frontier justice” is against the law. The Sixth Amendment of the United States Constitution, among other laws, prohibits individuals from serving as judge, jury, and executioner. From raids and shootouts to lynching to gang violence to extrajudicial killings by authority figures, there is a long history of ugly frontier justice in the United States.
Feinman (2010) reminds individuals of an alternative option: “In some cases, however, the claimant sees that he has been wronged and believes that it is worthwhile to get a lawyer and fight for what he is entitled to.”
If you feel you have been wronged by an insurance company, you might want to pick up one of Feinman’s books to read and see if you what you can legally do about it. In chapter 2 of Delay, Deny, Defend, Feinman writes, “If a consumer is chiseled, stonewalled, or otherwise mistreated by her insurance company, she has to identify herself as the victim of a wrong (naming), attribute that wrong to the insurance company (blaming), and then do something about it (claiming).”
In the freely available introduction to Feinman’s (2010) book, he writes, “The point of view in this book is proconsumer but it is not anti-insurance. Insurance is essential to our economic security. But if insurance is to maintain its role as the great protector of the standard of living of the American middle class, prompt and fair claim handling has to be the rule. This book explores why that doesn’t always happen, and why it is even less likely to happen today than fifteen or twenty years ago.”
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Sources:
Feinman, Jay M., Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It (April 8, 2010). Jay M. Feinman, DELAY, DENY, DEFEND: WHY INSURANCE COMPANIES DON’T PAY CLAIMS AND WHAT YOU CAN DO ABOUT IT, Portfolio/Penquin, 2010; paperback edition 2013 by Delden Press, Available at SSRN: https://ssrn.com/abstract=1586453
Phenomenology of Vigilantism in Contemporary America – an interpretation | Office of Justice Programs. (n.d.). https://www.ojp.gov/ncjrs/virtual-library/abstracts/phenomenology-vigilantism-contemporary-america-interpretation
Delay, deny, defend by Jay Feinman (2010). http://www.jayfeinman.com/author/
Deliberating Truth 