Denial of Insurance Claims

By SoftSettle Support

There may be delay in settling claims, ok the delay is delay but if the claims are denied it is truly unjustifiable. But the insurance companies have justifications. But we will find difficult to digest such arguments deemed to be the reasons for denial of claims.

We can assess the situation. Let me serve you with some hypothetical scenario.

A gentleman met with an accident. The accident is disastrous. He is seriously injured and left in a coma. When he wake nine days later, he has multiple broken bones, collapsed lungs, and are destined to spend the next few agonizing months under constant care. He regularly pays his insurance premiums. But unfortunately the insurance company denies his claim. They claim the driver who caused the crash acted negligently, and so the accident was not an “accident.” His hospital bills pile up, He is too injured to go back to work, and his insurance company has deserted him. The irony is that when the policy holder needs the insurer most, they do something like this.

So it is that. The policyholder is at fault. It is assessed and certified that the accident could have avoided.

Okay then the reasons steps up one by one. Then the claim is not covered by policy. Insurance policies are contract that define each party’s obligations. The insurer agrees to cover only certain claims as outlined in the contract.

Then again, the coverage has lapsed. If an accident occurs during gap in coverage, if the policy holder did not pay his insurance premium in correct date.

Then something most unfortunate. The policy holder’s doctor may use the wrong coder for a procedure causing the insurance company to believe that the procedure fails outside his policy coverage.

Then how can you overcome such awkward situations:

You have to read your policy carefully/ You should know exactly what is covered and how to appeal a denial by your insurance company.

Be very careful in filling the forms. Even if you make an honest mistake your insurance company may seize on that as a reason to retroactively deny your coverage.

If anytime your insurer rescinds your insurance by sending you refund for the premiums you paid, you never accept or cash them which might lead to make the court believe or may be interpreted as accepting their decision.

Talking to insurers or their representatives over telephones or directly is desperately a frustrating experience and you will fail to prove anything during litigation and it is better you insist the insurance company to put everything in writing. So that you can keep records of all bills and correspondence such as mails and other communications.

It is going to be  a mental test, sometimes even your persuasive attitude would not help you to not to abandon further attempts. Knocking at the doors and if it keeps on turning dear ear to you, never give up.

Soft Settle is there to support you. They can help you from your first knock at the door or even at your frustrated knock before you have decided to give up. As such Soft Settle with its mediation outfit (www.odrsupport.com) Mediator Affair can resolve the issues and further if everything goes well,you can also negotiate with your insurance company to make a get through in settling your insurance claims. Soft Settle and Mediator Affair can put you in a safe resort and releasing all agonies against your insurer.

 

 

Low Insurance Settlement Offer – A source for Concern & Source of Conflict.

By SoftSettle Support

Do not be surprised if the initial settlement offer is a low figure. There are many reasons why you might receive a “low” offer. The claims adjuster may have concluded that you are partially at fault for your injuries, or that your injuries were not serious enough to justify the amount of damages you included in your demand letter. He may also produce concerns about your pain and suffering demand.

Consider this a test from the claims adjuster. The insurance company has nothing to lose and everything to gain by making you a low bid settlement offers. Many people are struggling financially after an accident and are desperate to jump at the first settlement offer that comes their way. Even though it may be difficult to pass up a settlement offer, you should not accept the initial offer unless it is fair. How to evaluate and deal with a fair settlement offer is discussed at the conclusion of this article.

Do not panic over a low settlement offer. Remember, the insurance company is running a business and must maintain its profits. The claims adjuster does not expect you to accept the first offer, but rather hopes that you will. Naive personal injury claimants accept lowball offers all the time.

As soon as you receive the initial settlement offer in writing, carefully evaluate the stated reasons for the low settlement amount. You should respond to each of the points made by the claims adjuster in a written letter that includes a counteroffer. In this letter, you will reassert your position (this is the same position you carefully described in your demand letter). Focus on the extreme pain and suffering you endured. Never personally attack the claims adjuster. Be professional yet firm in explaining why you deserve more money for your injuries and other losses.

Rejecting the Low Offer

 In order to reject the initial settlement from the insurance company, you should send a details  to the claims adjuster through  the medium of Soft Settle that:

States you do not find the initial settlement offer acceptable;

Lists the reasons why you deserve a higher settlement offer; and

Includes a demand for a higher settlement offer stating reasons.

In this case you can invite the Insurance Company for negotiation so that you can tell them Soft Settle Platform offers a potential zone of agreement where they can reach a settlement acceptable to both.

In the meanwhile you can serve a letter rejecting the initial settlement offer and include your personal information about your loss or damages where applicable. This record will help you in case you are heading for court litigation if any.

The initial or later low offer from the part of the insurance company is the cause of the dispute and usually the claimants may consider entrusting lawyers to contest for them to claim and earn more which could be settle their loss.

Soft Settle thus helps both claimant and insurance company by judiciously settling their claims which could bring a harmony in respect of their relationships, otherwise would have been in peril in case the claimant proceeds to court litigation

Set Limits on Conversations

SoftSettle Support narrates the following hypothetical situation over a personal injury – auto accident insurance case as cautioning notice to the parties who will find rather difficult time with the insurance company on the occasion of an event – injury or accident.

In your first contact with an insurance adjuster (which usually comes via a phone call) make it clear that you will not be discussing much.

Let the adjuster know that, until you have finished investigating the accident, have completed medical treatment, and have fully recovered from your injuries, you do not want to discuss anything related to:

  • how the accident happened
  • what your injuries are (or how serious they are, or whether your condition is improving), or
  • what a settlement amount should be

In this first discussion with insurance adjuster, set boundaries. Ask that the adjuster communicate with you in writing until you present your written demand for compensation and actual settlement negotiations begin.

In some situations, however, it may not be practical to stop all phone conversations. For example, if you have been in an auto accident, you may need to discuss repairs to your car. If you do need to speak to the adjuster again, set whatever limits you want on the place and times — home or work, morning, evening, weekends — for telephone contact.

There are good reasons to limit your phone conversations with insurance adjusters. Some will call frequently in an attempt to get you to settle quickly, and they can become a real nuisance. It’s good to nip this in the bud.

More important, until you have had a full opportunity to investigate and think about the accident, to determine the nature and extent of your injuries, and to recover (or reach “maximum medical improvement” in insurance parlance), you will not have accurate information to provide. And, if you give incomplete or inaccurate information on the phone, the insurance company may try to make you stick to it later on. Some insurance adjusters are good at getting you to say something which could be considered an admission of some fault on your part, or which limits the seriousness of your injuries. It is therefore much better to have no discussions at all until you have made your compensation demand in writing and you are fully prepared to discuss a settlement.

 

How can Soft Settle support the parties in settling the insurance issues?

By SoftSettle Support

SoftSettle is a web-based application and it has integrated the software SS-Equity (Insurance Claim Settlement or ICS) in which fast and fair criteria (FFC) has been incorporated, could provide an efficient and result oriented resolution procedure. SoftSettle Support provides a web-based and mobile-accessible platform that offers 24/7 assistance to claimants and insurance companies to facilitate the claim settlement process.

Fortunately, the integration of element of Artificial Intelligence aided by service technology facilitating the alleviation of Case Management Procedure in the interactive portal www.softsettle.com and Soft Settle mobile application, is bent on creating new pattern of insurance claim settlement process.  Further the service technology developed by SoftSettle Support enables and expedites virtual communications so as to reach result oriented resolutions leading to win-win propositions between or among the parties.

The space is being provided for 24/7 by SoftSettle Support through portal or mobile phone application at the convenience of the parties so that they can interact or participate in the resolution process synchronous or asynchronous. SoftSettle allows you to conveniently negotiate with your disputing adversaries in a secure virtual environment.

Soft Settle channelizing the services through the product SS-Equity (ICS) enable Insurance Claim Settlement process facilitating the easy access to justice through web portals and mobile applications, without any snags. The parties can have a full control over the process and they are left with the freedom to make exchanges to the effect of their issues through virtual interactions and further accept, reject or appeal in respect of settlement of claims.

The web-portal along with mobile application provides awareness and promotions through the resource tools could make the people or consumers assimilate the procedure in respect of case management and make use of the software SS-Equity (ICS) ultimately keeps their life relieved off all soft look alike intimidating approaches from the opposite parties.

Other professional services apart from the above technical services are the following:

  1. Dealing with the claimant, insurance company, adjuster and related parties
  2. Managing the Dispute Resolution Process
  3. Legal Advice
  4. Tips for the resolving a complaint
  5. Provide or facilitate with the significant process like authentic and bona-fide Negotiation to the effect of Insurance Claim Settlement between claimant and insurance company.
  6. An Agreement is built up with reasonable clauses cause to manage settling the issues cropped up between or among the parties
  7. Facilitate the Mediation and Arbitration which ultimately keeps away the harrowing experiences and exorbitant expenditure resulting out of court litigation.
  8. An award at any stage (after the negotiation settling the claims or after the final mediation or arbitration process) is ensured which make the way for enforcement of the agreements thus generated.

Software platform provided by SoftSettle is definitely a blessing for those who have been undergoing the confusion over the settlements offer on the claimant’s part essentially and avoiding the expensive litigation would be ad added advantage for the insurance companies while settling the insurance issues under the auspices of Soft Settle.

Lawyers and Access to Justice

SoftSettle Support

According to the American Bar Association’s (A.B.A.) Model Rules of Professional Conduct, “[a] lawyer is a representative of clients, an officer of the legal system and a public citizen having special responsibility for the quality of justice.”

A lawyer’s varied roles include advisor, advocate, negotiator, intermediary, and evaluator. Lawyers are generally concerned only with legal issues and conditions that directly affect a specific case. In addition, the legal profession commonly reflects an individualistic and non-collaborative view. Finally, social justice is not an explicit goal of the legal profession. Lawyers see justice as the efficient result of an adversarial system; as long as they serve their clients well, justice is served in that process.

Attorneys have a central commitment to serve their clients. They act as advocates for their clients, help their clients determine what their needs are, and then, help them to meet those needs. Advocates use a problem-solving approach to address their clients’ needs and resolve issues. Hence these professionals could be deemed to be social workers considering the public interest and so far as focussing the life of the people with direct services which could facilitate their clients with conveniences like short period for attaining justice at most reasonable expenses and at the most stimulating vision in respect of scheming win-win propositions for the contesting parties.

So far as the lawyers are infected with the judicial system resulting out of heavy, tardy and tedious court litigation, there may be remote possibility on their part of the lawyers to get inclined towards low volume remunerated automated online dispute resolutions. Lawyers are aware of the fact that they involve in the conflict areas taken to court trials include expense, which a common client finds it difficult to co-ordinate or afford along with other discomforts like time pressure and other related legal hindrances. The lawyers may be probably in the process of realising the issues of their existing as well as prospective clients.

A lawyer’s goal is to win the case for his client, and in order to do so, it is usually necessary and appropriate to give advice to the client. Hence there is a chance for a lawyer taking the baton of a social worker rather helping his clients than merely advising them. The introduction of the platform Soft Settle could cater to the requirements of the lawyer to play the role of a social worker. He is not confined to mere advising the clients but helps the clients to come out of the troubles he has been confronted with.

Legal community is going to be encountered with certain challenges as a result of many functions traditionally performed by lawyers will be soon replaced by software systems. The integration of technology into the practice of law has been advantageous for the clients so far the basic legal activities to the effect of dispute resolution would be carried out with ease, flexibility, cost reduction, fast, fair and efficient.

SoftSettle Support has evolved research methods to create technologies, which are needed for realizing the promise of effective software support for resolving complex disputes coming under certain categorized areas. SoftSettle Support avoids human intervention to an extent to conduct the dispute resolution procedure and activities on their own. At the same time other significant issue taken into consideration while designing these devices is about the role of human dispute resolution agent or expert neutral in the online resolution system and the job better to be left over to automated (software) solutions. The execution of the justice has entered a revolutionized phase.

The access to justice has become very easy, fast, fair and efficient with the introduction of Artificial intelligence in the area of dispute resolution and www.softsettle.com has been organized with more stability and consistency so as to counter certain challenges likely to be posed by the conflicting situations in different areas.

Hence the lawyers are invited to test the automation in respect of accessing the justice straight forwardly and effortlessly. Realising the fact that litigation is adversarial, which means less regard to fair solution, court decisions might not be acceptable to either party and further adjudication of court results in win-lose scenario and not a mutually acceptable decision, it is time for the lawyers to ponder over a new means for accessing fast and fair justice.  Let the hope rests with the new beginning in the area of justice ignited with the help of artificial intelligence being promoted by SoftSettle Support.

 

Opportunities with Softsettle

SoftSettle Support

Internet connectivity facilitates the communication from any place in the globe. It further makes easy to exchange of offers and counteroffers while simultaneously managing confidential information at a neutral site. As such, the parties’ decisions are based on certain information that brings the interests and positions of the parties. The parties could reach an amenable settlement where nobody is losing anything

Soft Settle is the multiparty e-Resolution System that reduces time, cost, and stress for decision-makers in all types of cases. Soft Settle’s Internet network connects parties located anywhere in the world by means of a neutral server that manages private information and keeps it confidential and secure. Using powerful fair and fast algorithms, Softsettle can quickly transform conflicting objectives into fair and efficient solutions.

Soft Settle can be viable platform where decision makers could rather be supported to deal with any type of matters irrespective whether they are complex or simple.
Soft Settle’s products are designed to be able to help with any conflict, no matter how big or small..

The software SS-Equity is powered by sophisticated optimization algorithms at a neutral site that securely manages confidential data without human intervention. SS-Equity quickly becomes the eventual unbiased virtual arbitrator or mediator Suggestions made by SS-Equity are completely unbiased and impartial, based only on information that parties provide. Parties can do everything by themselves without any help or assistance from the part of any lawyers or authorized experts and hence they could control the process by themselves.
The best time to choose SS-Equity is at the beginning and the middle level (termed to be early and middle level interventions) in certain conflict segments, could rather help the affected party from all the drastic consequences he is supposed to undergo. Litigation is adversarial, which means less regard to fair solution. Court decisions might not acceptable to either party, result in disturbance of commercial relationship.
SS-Equity integrated in Soft Settle is a tool that can work for peace and harmony ultimately leads to a harmonious bondage between or among the parties. Everybody is invited and they can experience the vibrant process as an eye witness.

Soft Settle provides invisible and secure neutral site server on the Internet that Soft Settle employs to keep party’s choice of interest and their respective position confidential and thus pursue the effort for attaining fast, fair, efficient and cost effective attributes.

The 24×4, round the clock discharge of services and the convenience of synchronous and asynchronous feature the scheduling of the parties’ participation in the process more facilitative so that the resolution process can be structured with each sessions consisting of three attempts. The recurring attempts would provide the parties more opportunities and confidence and their anticipation of result might never go betrayed.

Court Litigation, ADR, Technology and Access to Justice

SoftSettle Support

COURT LITIGATION
Litigation is very costly and expensive. Every citizen has the right to seek satisfaction for his or her grievances in the courts. The problem is paying the bills. A trial of a complex business case normally takes months; some have gone far for more than a year.

Examples of the fees and expenses required to pay are lawyers’ fees, expert witnesses’ fees and others associated fees. Notably, the pre-action stage of proceedings can often be a very time-consuming and an enormously costly exercise. In addition, the uncertainty of the period of time that a trial might use will raise the expenses and fees time to time.

Other disadvantage of litigation is it is more benefit to wealthier party. Litigation is not a process of solving problems, but a process of winning arguments. Wealthier party is enable and affordable to hire an experienced and good lawyer to engage in the lawsuit. Judge and jury can be easily convinced by a good lawyer whom has strong convincing skill.

Litigation is adversarial, which means less regard to fair solution. Court decisions might not acceptable to either party, result in disturbance of commercial relationship. Adjudication of court results in win-lose scenario and not a mutually acceptable decision.
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ADR
Giving adequate attention to important decisions tends to be very time consuming, especially in multiparty negotiations, mediations in its traditional form. Not all forms of ADR are quick, in fact some forms of ADR require a client to pass through many stages before adjudication.
ADR is not always cheap, and can be as expensive as court action. Drawn-out negotiations involving professionals can be very expensive, both in time as the process used to creep and crawl and unutilized negotiation energy.

TECHNOLOGY
In recent years, the legal sector has seen the introduction of numerous software designed to make legal work more efficient. In some cases, the software is able to automatically analyze court and tribunal cases or even produce “better quality” work than that traditionally done by paralegals. On the flip side, this software is also able to reduce legal costs, and work towards closing the justice gap by helping those who aren’t able to afford a lawyer or qualify for legal aid, access appropriate legal resources.

Online dispute resolution was sup¬posed to take over the legal profession. With the rise of the Internet, ar¬tificial intelligence and other clever bits of technology, lawyers would be able to solve legal disputes with computers, not courtrooms and judges.

ODR promotes a virtual scenario to facilitate the mediator or any presiding officer interacting with the disputing parties. By formulating a technology stimulated ambience, ODR has cleared a way for bringing justice most transparently and thus winning the trust of the people.

The approach to justice will become easier and quick with the aid of technology supported ODR. A key advantage of resolving disputes through the use of cyber-resolution is that it avoids the issue of whether a particular court has jurisdiction over the dispute. Since disputants can bind themselves to resolution through an agreement, jurisdictional issues can be avoided altogether.

The claim of saving court litigation expenses used to be the primary advantage of the traditional dispute resolution. The business segments all around the world is experiencing a tough time as the result of the recession prevailing and dominating in all countries. It has become indispensable for even ordinary individuals to stabilize their financial position at this juncture. Hence to a great extent Online Dispute Resolution has become a blessing to the society so far as this method can be adopted to make the resolution process most cost effective. The online resolution mechanisms eliminate the need for physical travel which used to be long and tedious one to reach particular forum to participate in the alternative dispute resolution process. This level of convenience obviously saves both money and time.

ACCESS TO JUSTICE USING SOFT SETTLE
Considering the technical inputs to simplify the process to accessing to justice, SoftSettle Support has built a platform Soft Settle where technology can interact with disputes with fast and fair criteria being integrated for an efficient mode of case management so as to reduce the cost and bring justice to the parties without any complications, hassles and leaving no room for tensions or stress for the parties what they are forced to experience during the court litigation and ADR

The digital platform Soft Settle helps people deal comprehensively with their legal problem and encourages a mediated settlement rather than recourse to lawyers and courts. Agreements reached through collaboration and respective generous interests of the parties tend to more effective and proposes a harmonious bondage paving way for an accurate judicial reasoning and in every ways rather efficient than decision imposed by judges.

Technology must be utilized to better assist Indians and other Asians get fair and proper access to justice.

Soft Settle is on the mission to make the law accessible – with the Artificial Intelligence igniting the fire hence calls for technological legal tools. Soft Settle revolutionizes the legal assistance technology that suits the needs of ordinary people – and that extends to low-income and disadvantaged Indians and Asians.

Soft Settle – A Platform for Robot Lawyers ignited by Artificial Intelligence

Soft Settle Support

Artificial intelligence is changing the way lawyers think, the way they do business and the way they interact with clients. Artificial intelligence is more than legal technology. It is the next great hope that will revolutionize the legal profession.

Change can be brought on through pushing existing ideas. What makes artificial intelligence stand out is the potential for a paradigm shift in how legal work is done.

AI, sometimes referred to as cognitive computing, refers to computers learning how to complete tasks traditionally done by humans. The focus is on computers looking for patterns in data, carrying out tests to evaluate the data and finding results.

Soft Settle first time in India, and among in other Asian countries has shown the mettle to disclose how Artificial Intelligence combining with Digital Technology can eliminate lengthy, expensive lawyered-up court litigations; the technology is already adapted to reshape and revamp the justice patterns, by making its presence felt in the issues relating to debt, insurance, consumer matter and other different forms of civil and corporate disagreements.

Indians and other Asians are in the process of embracing digital technology – using it for their shopping, communicating, house hunting, work and leisure activities etc.. Simultaneously, it is to borne in mind, the digital revolution can prevent costly and lengthy court action – so it would benefit our justice system and out society as a whole. Hence the digital sparkling would have to reshape the Indian and Asian societies ultimately would offer the opportunity to address fundamental problems in our present legal system – combating the legal menaces like expensive lawyers and slow, confrontational and painful court proceedings.

The digital platform Soft Settle helps people deal comprehensively with their legal problem and encourages a mediated settlement rather than recourse to lawyers and courts. Agreements reached through collaboration and respective generous interests of the parties tend to more effective and proposes a harmonious bondage paving way for an accurate judicial reasoning and in every ways rather efficient than decision imposed by judges.

Technology must be utilized to better assist Indians and other Asians get fair and proper access to justice.

Soft Settle is on the mission to make the law accessible – with the Artificial Intelligence igniting the fire hence calls for technological legal tools. Soft Settle revolutionizes the legal assistance technology that suits the needs of ordinary people – and that extends to low-income and disadvantaged Indians and Asians.

Technical Aspects Behind SS-Equity’s Performance

By
SoftSettle Support

Problems can be resolved quickly and efficiently with machines guiding decisions based on the data provided by user or the company.

Decision making by machines is only likely to grow and also likely to increasingly challenge ODR systems. As algorithms shape more and more aspects of our lives, we will need to design systems that will help citizens to understand how they are being affected and how problems may be resolved. ODR systems will need to be put in place to address algorithm-related problems and prevent them from recurring in the future.

Artificial Intelligence and Law cannot go together so far as the Computers are simply executors of rules while legal field requires interpretation. Hence AI would be normally not acceptable for taking judicial decisions. Hence we have worked on combining AI with the basic elements of Scientific Mediation where negotiations could be facilitated

Artificial Intelligence based on the following, supports Dispute Resolutions in the Soft Settle Support System Platform.

Basic elements considered for the Resolution Procedure:
1. Separating the people from the problem;
2. Focusing upon interests rather than positions;
3. Knowing your BATNA. – Best Alternative to a Negotiated Agreement – The reason you negotiate with someone is to produce better results than would otherwise occur.

Soft Settle comes out with Sophisticated optimization algorithms to generate optimal solutions for complex problems.

Fairness Algorithms – Fair & Prompt Concessions rewarded.

Soft Settle’s algorithms actually reward the negotiators for their attitude in respect of their respective interests, generosity, cooperative inclination, thus resulting in quicker settlements. Rather practical comprehensive collaborative attitude is appreciated.

SoftSettle’s dynamic process is particularly suited for ‘early intervention’, middle level intervention with potential to save significant time and other resources.

Efficiency of Software Stimulated Dispute Resolution

SoftSettle Support

 Everybody used to say there must be something which can execute adequate justice without waiting in the corridors of the Court Complex, complexities of the trial and other procedure, and even the tension

Legal community is going to be encountered with certain challenges as a result of many functions traditionally performed by lawyers will be soon replaced by software systems. The integration of technology into the practice of law has been advantageous for the clients so far the basic legal activities to the effect of dispute resolution would be carried out with ease, flexibility, cost reduction , fast, fair and efficient.

The logic behind supporting the automation of online dispute resolution cannot be decried as the process can make the functionalities more simple and easy so as to facilitate the accessibility to the justice. Faster and efficient process guarantees the transparency too. These potentials are being reflected in the Case Management segment integrated in the interactive portal www.softsettle.com

SoftSettle Support, proponents of software stimulated Dispute Resolution, targets resolving some of the major conflicting areas in the civil and corporate segments. In the first phase SoftSettle Support has come with some revolutionized applications to the effect of resolving Financial Disputes, E-Commerce Disputes and Insurance Claims Conflicts.

SoftSettle Support has evolved research methods to create technologies,that are needed for realizing the promise of effective software support for resolving complex disputes coming under certain categorized areas. SoftSettle Support avoids human intervention to an extent to conduct the dispute resolution procedure and activities on their own. At the same time other significant issue taken into consideration while designing these devices is about the role of human dispute resolution agent or expert neutral in the online resolution system and the job better to be left over to automated (software) solutions. The execution of the justice has entered a revolutionized phase.

The access to justice has become very easy, fast, fair and efficient with the introduction of Artificial intelligence in the area of dispute resolution and www.softsettle.com has been organized with more stability and consistency so as to counter certain challenges likely to be posed by the conflicting situations in different areas.