The ruling against Allstate Insurance on how it handled the claim of minor injury in one Arizona case may be new, but the company's business practices have come under the scrutiny of courts and regulators elsewhere for years.
Four years ago, the company agreed to pay a $20,000 fine to settle complaints by the Virginia Corporation Commission that Allstate had policies that resulted in unfair treatment of people with "soft tissue" injuries who had retained an attorney. These claims generally include those where there are no broken bones or other obvious physical evidence of harm.
That came a year after a judge in Connecticut faulted Allstate for having a policy of refusing to offer settlements of claims by their own insureds when it involved only minor property damage. The judge said delaying or denying payment the company was contracted to pay amounted to abuse of the legal process.
In 2001, a Pennsylvania judge concluded that Allstate has an "organized plan" to convince people injured in accidents that they did not need to hire attorneys, a plan the court said was designed to reduce the amount the company had to pay out. That ruling came in a case brought by the Pennsylvania attorney general.
And a year later, a federal judge in the District of Columbia said there is evidence that Allstate required more steps and paperwork to process claims by those who hired attorneys than from those not represented by counsel. The company admitted that the goal of the practice was to reduce the number of people who hire lawyers.
An Allstate spokesman said the company will not comment on its claims-handling policies.
The issue of how insurers handle "soft tissue" claims also has come under the scrutiny of Arizona's Insurance Department.
In a directive issued in 2000, the agency warned all insurance companies that they should not ignore the claims of those who said they suffered soft tissue injuries. That came after a review of complaints submitted to the agency by people whose claims had been denied out of hand.
At the heart of that verdict was the department's conclusion that insurers in Arizona were not fully investigating all claims. Instead, they were simply deciding that, based on the speed of the vehicles involved in the accident, there was no real possibility of injury.
Chuck Cohen, who was state insurance director at that time, said such practices violate state law.
He said insurers have a legal obligation to "conduct a fair and reasonable investigation of each claim, including consideration of all available information." That includes "a genuine effort to determine the nature and extent of the injuries actually sustained" by the person making the claim.
He said that can start with an assessment of the likelihood of injury based on the physical evidence from the collision. Cohen said, though, that is not enough: The insurer must evaluate "all of the reasonably available relevant evidence" to determine what injury occurred.
That includes the statement of the person making the claim, statements of witnesses, police reports and relevant medical records and physician statements.
"If an insurer merely determines that it has an arguable basis to assert that it is unlikely that a claimant could have been injured at all or beyond a certain extent based solely on the relative speed of the collision and the extent of resulting physical damage, the insurer has not completed a fair and reasonable investigation of the claim," Cohen said.
Insurance Department spokeswoman Erin Klug said that directive remains in effect.