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Insurance Claims Complaints - A Private Appeals Procedure

NCJ Number
92425
Journal
Law and Society Volume: 9 Issue: 2 Dated: (Winter 1975) Pages: 275-292
Author(s)
H L Ross
Date Published
1975
Length
18 pages
Annotation
The complaint procedure used by citizens to handle many problems with business firms and bureaucracies represents the ultimate determinant of citizens' rights, to the extent that these claims involve sums of money that are small in comparison to the cost of litigation.
Abstract
The use of this procedure is unlikely to change greatly as a result of increasing the access of citizens to the courts and decreasing the costs of this access through such mechanisms as small claims courts, legal aid, and insurance. Study data came from the analysis of 304 complaints handled by one insurance company during 1972 and the first 2 months of 1973. Most of the complaints involved losses of $100 to $200. Problems concerning insurance coverage generally involved clear legal issues, and complaints were nearly all unsuccessful in their appeals. When the underlying problem concerned liability, the bureaucracy of the insurance company probably acted less generously than a jury would have. However, when the underlying problem was damages, the complainants most often won their points, at least in part, in the private forum. The outcomes of these cases appeared to be more liberal than might have been obtained in court, perhaps because of the company's concern with having a happy customer. The analysis of informal negotiations such as the complaint procedure of a bureaucratic organization is crucial to the understanding of the real nature of legal rights: the results which people get when they put forth their claims. Footnotes and eight references are provided.

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