Denied – Underpayment – Harassment
This is a very common story. The insurance company declines to pay the claim, or offers less than 40% reimbursement for the house that has been set on fire. The policyholder informs the company about the flat-screen TV she purchased in her family room, but she doesn’t have her receipt because it was destroyed in the fire. Is she going to fight with the insurance company and wait for the damage to be repaired or do she accept a lower settlement so she can continue with her life?
Insurance companies make big profits by helping people to overcome losses and get on with their lives.
What should you do if your insurance company refuses or delays paying a claim?
This question is also relevant if an insurance company only pays a part of a claim, or intentionally undervalues a case.
It is also known as “bad faith” when claims are not settled in a timely manner, or undervalued.
An insurance company must act in the best interests of its client or policyholder in all 50 states. It doesn’t matter if you live in Texas, Maine or elsewhere. An insurance company’s legal obligations remain the same. There may be differences in state laws that govern how and when such matters should be resolved. The basic principle governing the operation of an insurance company remains unchanged.
Bad faith is when an insurance company does not act fairly and honestly towards its policyholders, or is dishonest in any other way, it is considered bad faith.
Bad faith situations can arise in many areas, such as auto insurance, life insurance and disability insurance.
Insurance bad faith can include, but is not limited to:
Paying claims off for an unreasonable amount of time
Refusing coverage
Refusing to pay claims
Inability to investigate a claim in an acceptable manner
Retaining benefits without cause
Insufficient payment of claims
Undervaluing claims
Unfairly refusing settlement or reimbursement
Abuseful behavior towards policyholders and unreasonable claims processes
Unjustified cancellation of an insurance policy
Any person can file a civil suit against an insurance company if they suffer damage from the company’s conduct. These claims can be made against insurance companies for auto, home and business.
The Federal laws known as ERISA (the Employment Retirement Income Security Act) can make it difficult to get health insurance. This means that if your employer provides health insurance, and you are denied a claim, your rights to sue the insurance company could be limited. You should not assume that you are unable to sue. Consult an attorney before you make any claims.
What does it mean?
Insurers employ whole departments of people called “actuaries”. An insurance actuarial can be described as “A n Actuary” who analyzes the potential outcomes of events that could lead to policyholders making claims against their insurance policies. This is it.
Actuaries are responsible for weighing the probability of litigation in the event of a loss, and the likelihood that a policyholder will seek competent legal counsel or pursue a claim. This is called “risk management” and although they don’t make claims decisions, they provide information to insurance companies about the “odds” of the situation.
It may seem like a good economic decision to force a policyholder into litigation. The policyholder will need to spend time trying to get their money if the claim is $50,000. In order to frustrate the policyholder, the claim is delayed or lost. Then, they agree to settle for a lower amount than the actual value. It happens all too often.
However, it is not easy to pay claims. Insurance policies can be complex. Few policyholders take the time to review their policies and determine if there are any exclusions or omissions. Before you file a claim.
However, lawsuits have shown that some of the country’s largest insurance companies have denial valid claims to increase their bottom line. Some companies even paid employees who refused to pay claims and then engaged in fraud to avoid paying claims.
Stall. Delay. Complete more forms. Keep waiting! !
There are many legal cases that show insurance companies delaying claims knowing full well the fact that many policyholders will give up. Some even went so far as to lock away paperwork in safes. Long-term care insurances are the worst offenders for delay tactics, as they often exploit policyholders’ ill health and age.
One regulator stated that “the bottom line is that insurance firms make money when it doesn’t pay claims.” . . They will do whatever it takes to avoid paying because they know that policyholders will soon die if they don’t wait long enough.
Qualified Assistance!
An attorney with experience in claims and insurance bad faith is the best option if you or someone you love is fighting with an insurance company. This is a unique specialty. To assess the level of experience, it is important to ask how many actual bad-faith insurance trials has the attorney participated in. Keep looking if the number is not high.
It’s easy to say you have experience, but it is quite another to show that you have built a career in fighting bad insurance.
