Negotiating Insurance Claims

Negotiation of Disability Claims

Negotiation involves reaching an agreement with the other side. The idea is that the agreement meets the best interests of both sides. Of course, this usually means that both sides have to make compromises. You won’t get everything you want and neither will the other side.

Know Your Bottom Line

Before you begin negotiating, figure out what your bottom line will be. That is the least you will accept in exchange for resolving the legal dispute. Never reveal your bottom line at any stage of the negotiations.

Begin your negotiations by asking for everything to which you believe you are legally entitled.

Present as many negotiable issues as you can and do not reveal their level of importance to you. That way, you can “give up” on an issue that was never really important to you to begin with. The other side will see this as a compromise and will be more willing to compromise in return.

Negotiating Without a Lawyer

If you are negotiating a legal problem without a lawyer, you should both sign an agreement first that says your negotiations are WITHOUT PREJUDICE. That means that whatever you say or write down in the process of negotiations won’t be used by either side if the matter ends up going to court.

If the negotiations fail, there are alternatives available to you other than court.

Mediation Chairs

Mediation of Insurance Denial Claims

Mediation is a voluntary process, to which both parties agree. A mediator is appointed to hear the claim. The mediator is a neutral person assigned to help the two sides reach a solution that works for both. Usually a mediation takes place in a boardroom at a neutral location. The setting is usually casual in order to relax both sides to allow for easier communication.

A mediation is conducted on a “without prejudice’ basis. This means that whatever is said at the mediation cannot be used against you if the matter were to proceed to trial. This rule encourages both parties to speak more freely.

The mediator will manage both parties to ensure that each has an opportunity to speak and listen to all the issues. The mediator may help clarify misunderstandings and make discussion of the issues less stressful.

The mediator does not “decide” or “rule” on any issues and cannot force a settlement.

Mediation only works if both parties are willing to resolve their dispute.

If one party refuses to compromise and refuses to listen then the mediation will fail.

Arbitration of Disability Claims

Arbitration is useful when one side or the other (or both) prefer to have someone neutral decide the matter for them. This usually occurs if one party or both refuses to compromise on any issue.

Arbitration often works well for commercial and business disputes.

Arbitration is more formal than mediation, but less formal than court. You and the other side agree in advance on the rules for the arbitration process (for example, what kind of evidence can be introduced, will witnesses be allowed to testify, how much time will be set aside for each side to present its case, etc).

The arbitrator listens to the evidence you each present and then makes a decision. In many cases, it is agreed beforehand that whatever the arbitrator decides is final and binding. This means you cannot have the decision reviewed or changed and must live with the outcome.

Due to the high costs of trial, the associated delays and the unexpected outcomes, in most cases, settling your case through negotiation, mediation or arbitration is preferable than risking it all and going to court.


Small Claims Court or the Supreme Court of British Columbia – You Decide

When you are faced with a legal problem, try and settle the claim. Remember, settling a claim involves compromise on both sides.

If a compromise cannot be reached, you can go to court and have a judge decide the legal issue.

Generally speaking, there are two levels of courts that deal with legal disputes:

The Provincial Court Small Claims Division and The Supreme Court of British Columbia

There are advantages and disadvantages to both.

The advantages of small claims court include:

  • a relatively short time to wait for a trial (about 8 months);
  • shorter trials (usually half a day);
  • relatively low costs; and
  • a mandatory settlement conference in front of a judge to try to settle the case.

The main disadvantage is that a judge cannot award more than $25,000.

The advantages of the Supreme Court of British Columbia include

    • No monetary limit on what you can claim;
    • Rules that provide for wider access to documents controlled by the other side; and
    • Your right (in most cases) to have the matter heard by a jury

The main disadvantages are:

  • A long wait for a trial date (up to 2 years)
  • Longer trials (usually 3 to 7 days in length)
  • Higher costs

Remember, before you decide WHERE to start a lawsuit, you must know WHEN to start a lawsuit. There are strict time limits and if you miss the time limit, you lose your right to sue. Don’t hesitate to consult a lawyer.