Posted By Alan Sackrin on February 25, 2016
Unfortunately in Florida, some small businesses do not have an insurance to cover any accidents that might happen on their property (like slip and falls or other personal injuries). However, a large amount of commercial establishments, particularly national chains like Walmart, McDonald’s, or Macy’s, (if they are not self-insured) are likely to have insurance policies with some of the nationally recognized insurance carriers.
Businesses And Insurance Companies Are Experienced
Most businesses with insurance, as well as their insurance companies, have years of experience in dealing with slip and fall claims and other kinds of premises liability claims. It’s a cost of doing business.
What’s the goal of these parties?
Their goal is to minimize how much they have to pay on a claim. Here, both the business and its insurance company act as a team, looking for ways to deny any responsibility for the accident.
What’s their first argument?
Fraud, or other similar reason that exonerates the business. That’s right: the first thing that a slip and fall accident victim may encounter, even while they are still at the scene of the accident, are questions challenging or suggesting the victim is faking or the accident was a planned event.
Fake Insurance Claims
One of the first things that an insurance company will instruct its business customers to do is consider whether or not the victim is faking an injury in order to get some fast cash in an insurance settlement. For several years now, there have been national trends for criminals to fake slip and fall accidents in order to file for the insurance claim money.
The National Insurance Crime Bureau (NICB) tracks these cases, and as far back as 2010, were finding a 57% increase in questionable slip and fall claims, most being filed against commercial policies held by national stores and businesses. These are crimes and if the culprits are caught, they will be charged accordingly.
This doesn’t help the legitimate accident victim, who has been suddenly hurt in a slip and fall accident and is still reeling from the event. Here, even the suggestion of fraudulent behavior is a serious insult to an innocent accident victim who is hurt and in pain due to a fall or other incident at the business’s location.
For many business operations, a slip and fall is assumed to be phony until proven otherwise.
Sadly, these days most insurance adjusters and business managers are looking for fraud in any Florida accident claim, particularly a slip and fall. In fact, they are prepared and trained to find ways to limit their exposure, including accusing the victim of fraud.
Sounds extreme doesn’t it? Not these days. Today, there are even training sessions and written instructions on hand for business management to deal with an accident when it happens.
These are not instructions on how to help someone who is hurt. This are instructions on how to start building a defense within minutes of an injury taking place.
Just check out the written instructions provided by CNA (read them here online) where tasks (called “valuable suggestions for detecting fraud”) include:
- Having a camera ready to take photos of the accident site, with instructions to avoid taking any pictures of the injured person (which suggests that the business should grab its camera to limit liability even before medical help arrives, right?);
- Try and get a statement from the injured person “as soon as possible” (maybe they’ll say something against their own interest while they’re there, in pain; frightened and confused);
- Don’t voice any suspicions (but it’s okay to have them) and make sure to write everything down as soon as you can after you’ve talked to the victim and any witnesses to what happened;
- Look for “red flags” that hint of fraud and call your insurance carrier so the two of you can work together “to determine the next steps.”
Insurance Company Instructions To Its Policy Holders Before An Accident
Not only do insurance companies instruct their customers on how to handle an accident and sniff out potential fraud at the accident scene, but they also educate their policy holders on ways they should act to prevent accidents at their property in the first place.
Now, this is a good thing. Preventative measures to protect people from getting hurt are always a good idea.
So when an insurer like Traveler’s makes suggestions like the following, it’s a great thing for everyone (see their risk control guide here):
Suggested Steps a Business Owner Should Take To Avoid A Slip And Fall At An Entryway
- Keep vestibules protected from blowing wind, rain, and snow
- Have umbrella drying rack or bags
- Have “Shake Umbrella Here” signs posted above absorbent mats
- Install handrails to assist walkers over transition areas
- Have adequate lighting for the entrance
- Make sure the walking surface of the entry is free of debris, cracks, and bulges
- Make sure the entrance has some kind of slip resistant material.
Proving The Business Owner Is At Fault For Your Accident
When it comes to a slip and fall caused by a substance on on the floor, the insurance carrier will ask a personal injury victim a variety of questions try and determine fault. Many times, these questions are tricky and designed to make the victim slip up and say something that makes him or her look bad in their own claim.
It is important to know what you are getting yourself into and ensure you have all of the necessary elements to prove that the business owner’s breach of its legal duty is what caused your injuries. Some ways a business may breach its legal duty is by:
- Failing to maintain the premises in a reasonably safe condition
- By allowing the dangerous condition to exist for an extended period of time;
- Failing to warn the invitees about the dangerous condition.
Furthermore, if a victim is able to prove one or more of the following statements, he or she may be able to prove the business owner was at fault for the slip and fall.
- It knew, or in the exercise of reasonable care should have known, of the accumulation of the dangerous substance on the floor, and
- failed to remedy it;
- The accumulation of the substance occurred with such regularity that business owner should have known of the condition.
A good way of illustrating a breach of these duties is by gathering evidence such as pictures, testimony of witnesses, video surveillance, and copies of the incident report.
What are Some Injuries That Can Result in A Slip and Fall?
When a slip and fall occurs, the victim is unable to control how his or her body falls. Sometimes, the injuries can be minor (such as a pulled muscle or scraped knee) and other times, the injuries can be severe (for instance, herniated discs, injuries to the shoulder, ankle, hand, wrist, etc). The severity of these injuries can depend on a variety of factors, such as the height of the fall and even the age of the person who fell. For example, if an elderly person slips and falls and suffers damage to the hip, this can be detrimental to the person’s well-being, as opposed to if a younger person suffered the same injury, he or she has a better chance of achieving a full recovery.
Getting Your Accident Claim Paid Even If The Business Didn’t Obey Its Insurance Carrier
If you compare the Traveler’s Online Risk Control Guide with the above list of steps a business can take to protect against slip and fall accidents at the business entrance, you’ll see that things aren’t quite the same.
In the Risk Control Guide, there are a series of questions to be answered by business management. It’s a checklist of sorts to make sure that the risk of a slip and fall accident at the business location is minimized.
Again, a good thing. However, what happens if that business owner doesn’t follow these suggestions? What happens if there is an accident at the business entrance?
Can You Use This To Your Advantage When Trying To Settle Your Slip And Fall Claim?
A victim might be able to use a business owner’s failure to follow the recommendations of their insurance company as leverage to force an insurance company to settle a claim. During settlement negotiations, a victim can try and argue that the insurance company set forth in their risk control guide steps the business should have taken to fulfill their obligation to provide a safe environment for their invitees and by failing to follow the steps the business owner is negligent. Essentially, the point is to try to use the insurance companies recommended procedures against them. Meaning, if an insurance company recommends steps to its policy holders (business owners), and the policy holder doesn’t follow them, then how can the insurance company argue that their policy holder isn’t negligent and therefore isn’t obligated to compensate the victim for their injuries?
Be Careful: Insurance Companies Like to Deny Claims
If the insurance carrier can finger point at the accident victim and find a way to label them as fakes or frauds, then the insurer will do so. That means they don’t have to pay.
And if the insurance carrier can finger point at the business owner and find a way to label them non-compliant and out of policy protections, then the insurance company may do so. That, again, means they don’t have to pay.
It’s all about business. These insurance companies are in the business of making profits. They aren’t charities.
For instance, if you look at the online Zurich Risk Management Guide for slip, trip and falls, you will read that Zurich’s internal research shows that 14% of the company’s “overall losses” are attributed to slip, trip and fall accidents. The insurance company’s perspective is that an accident claim that is paid to a slip and fall victim is a loss on its books.
Example Of An Insurance Company Denying Coverage
Consider the above online example of Traveler’s Risk Evaluation Guide for a slip and fall accident at a business entrance. Failing to take its described steps to protect against harm in the form of a slip and fall accident at the entrance to a business may be grounds for the carrier to deny coverage.
That checklist might be used as a basis for that denial. How? The insurance company may argue that if the business didn’t act reasonably in taking steps to protect against the accident, then the policy won’t cover the claim.
What about the accident victim?
When the insurance carrier denies coverage it then considers itself out of the loop. Let the slip and fall victim try and collect their damages from the business’ cash and assets. It’s not the insurance company’s responsibility to compensate the victim.
Fighting for Payment When There’s a Dispute Between the Business and Its Insurance Carrier
When a slip and fall accident victim is hurt at a large store or chain restaurant, there is comfort in knowing that the business itself has ample resources to cover their damage claim even if their carrier denies coverage. However, sometimes that sense of relief may be fleeting because a lot of times the business will drag its heels in settling a claim. They don’t want to pull out their checkbook, not matter how large a company they may be.
If there is a coverage dispute between a business and its insurance company, then the accident victim can feel like a rudderless ship left out in the sea of deniability.
Here, an experienced personal injury lawyer can be of tremendous help. Steps can be taken to force someone to assume responsibility and to cover the victim’s damages, including filing a lawsuit to recover the victim’s lost wages, pain and suffering, medical care costs, physical therapy, doctor visits, and other costs.
Personal Injury Lawyers and Slip and Fall Accident Claims
When you or a loved one has suffered an injury at a business location, then it may well be in your best interests to seek out the guidance and counsel of an experienced Florida personal injury lawyer as soon as possible.
In Florida, fraud has been a problem for many businesses and slip and fall accident victims here may have more of an issue with allegations of exaggerated claims or fake injuries than accident victims in other states. Lawyers can help here especially when a business or their insurance carrier drag their feet in covering an accident claim after a slip and fall because the business owner failed to follow the insurance company’s risk control procedures.
A good piece of advice if you have been harmed by a slip and fall, is to at least speak with an experienced personal injury lawyer before you file a claim to learn about some of the issues that can arise with these claims, including the type of evidence needed to prove a claim and the type and amount of damages you can recover. Most personal injury lawyers, like Alan Sackrin, will offer a free initial consultation (over the phone or in person, whichever you prefer) to answer your questions.
Do you have questions or comments? Then please feel free to send Alan an email or call him now at (954) 458-8655.
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