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Insurance Claims Complaints: A Private Appeals Procedure

Published online by Cambridge University Press:  01 January 1975

H. Laurence Ross*
Affiliation:
University of Denver
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Two of the major insights of the sociology of law are that legal rights in contemporary society are most often determined by bureaucratic actors and that the results differ systematically from those predictable on the basis of formal law alone (Mayhew, 1966; Ross, 1970; Skolnick, 1966; Whitford, 1968). The decision-maker who determines in practice the extent of legal rights and duties is most often a low-level employee of a bureaucracy—a patrolman, a tax auditor, a building inspector, or an insurance adjuster. He is usually untutored in academic law and possesses discretion because of his isolation from supervision, rather than by design. The decisions in theory may be removed from the bureaucracy and tried in a court of law. Critical attention, however, has recently focused on the fact that most claims based on legal rights are too small to warrant the cost and inconvenience of a formal trial. There has been less attention paid to the fact that bureaucracies typically offer internal means of appealing the decisions of low-level employees. These appeals procedures permit review and modification of initial decisions by higher-level employees, and furnish the claimant with a less expensive and more convenient alternative to the removal of his claim to the courts. Where the claim is small the internal procedure is usually the only avenue of appeal from an adverse decision that is realistically available to the claimant. In these cases, the internal procedure is in fact the ultimate means by which legal rights and duties are determined. This paper reports a study of the functioning and outcomes of one such procedure, the handling of complaints about claims by a typical insurance company, hereafter called Acme.

Type
Research Article
Copyright
Copyright © 1975 The Law and Society Association

References

GELLHORN, Walter (1966) When Americans Complain. Cambridge: Harvard University Press.10.4159/harvard.9780674491694CrossRefGoogle Scholar
KALVEN, Harry Jr., and ZEISEL, Hans (1966) The American Jury. Boston: Little, Brown and Company.Google Scholar
MAYHEW, Leon H. (1968) Law and Equal Opportunity. Cambridge: Harvard University Press.10.4159/harvard.9780674429840CrossRefGoogle Scholar
NEW YORK STATE INSURANCE DEPARTMENT (1973) “Complaint Statistics—1972,” unpublished memorandum.Google Scholar
ROSS, H. Laurence (1970) Settled Out of Court. Chicago: Aldine Publishing Company.Google Scholar
SKOLNICK, Jerome (1966) Justice Without Trial. New York: John Wiley.Google Scholar
STONE, Gary K. (1966) “An Analysis of the Complaint Handling Practices of the State Insurance Departments,” unpublished Ph.D. dissertation, University of Pennsylvania.Google Scholar
WHITFORD, William C. (1968) “Law and the Consumer Transaction: A Case Study of the Automobile Industry,” 1968 Wisconsin Law Review 1004.Google Scholar