• I Think Certain Words in My Policy Mean Something Different From What My Insurance Company Says They Mean?
• My Insurance Company Tells Me My Claim Is Not Covered Due to a Particular Provision in My Policy. While it Seems to Me That the Provision in Fact Covers the Loss, Isn't the Insurance Company Going to Win? Is it Any Use to Fight It?
• The Insurance Company Appears to Be Simply Dragging its Feet on My Claim?
• My Insurance Company Denies My Claim and Appears to Be Committing Bad Faith?
• They Continue to Deny My Claim and Commit Bad Faith?
• The Insurer Has Recently Told Me over the Phone That My Claim Is Being Denied?
• My Claim Was Denied and My Appeal Was Denied by the Insurance Company?

If I Think Certain Words in My Policy Mean Something Different from What My Insurance Company Says They Mean, How Do We Resolve It?

The law recognizes that insurance policies are complex and that the insurance companies, which obviously have an unequal bargaining position with respect to their insured, write policies. For this reason, the courts have developed certain "rules of construction" for reading insurance policies, which tend to favor the interests of the insured. If there is more than one reasonable way to interpret a certain policy provision, the courts will favor an interpretation that supports coverage under the policy rather than an interpretation that would support denial of coverage. If there is more than one reasonable way to read a coverage exclusion, the courts will tend to favor the narrowest interpretation of the exclusionary language.

My Insurance Company Tells Me My Claim Is Not Covered Due to a Particular Provision in My Policy. While it Seems to Me That the Provision in Fact Covers the Loss, Isn't the Insurance Company Going to Win? Is There Any Use to Fight It?

No and yes: no, the insurer isn't going to automatically win and yes, there frequently is reason to fight it! If a policy provision is subject to more than one interpretation, and your interpretation is a reasonable one, the insurer is usually bound by that interpretation. Also, any ambiguities in a policy are construed in your favor. Don't think that insurance policies can't possibly contain ambiguities simply because they are written by big companies. They do. Further, the insurer cannot in good faith adopt a restrictive view of the policy coverage in an effort to deny a claim if your reasonable expectations are supported by the policy language and facts concerning the claim.

What If the Company Appears to Be Simply Dragging its Feet on My Claim?

Put your complaint in writing and send it to the insurer. Know who the claim adjuster is and correspond with him or her in writing. Ask who the claim adjuster's supervisor is and send him or her a detailed and direct letter (but be polite). Trying to copy the "President of the Company" with your letter probably won't do too much, but copying the "Claim Supervisor" or "Senior Benefit Analyst" on your contacts with the first line claim adjuster might get you a bit more attention. If the "foot dragging" does not appear to stop, you may need to contact a lawyer. But again, do what you can first; send the letter, put it in writing, ask for a written response within a (reasonable) specified time, and be direct and firm, but polite and rational. Your threatening to "sue them for everything they've got" if they don't pay generally does not work.

What If My Insurance Company Denies My Claim and Appears to Be Committing Bad Faith?

If you still feel you are in the right after having reviewed your insurance policy, collected all of the correspondence you have had with your insurance company and other pertinent documentation, write a letter and send it certified mail to the Director of Claims of the Insurance carrier citing the relevant provisions of the policy and demonstrating that the Insurer's denial of claim benefits is unreasonable. At the same time, write the Commissioner of the Department of Insurance in your State and, for whatever it's worth, ask the Department for a review and assistance in the matter.

What If My Insurance Company Still Continues to Deny My Claim and Commits Bad Faith?

Collect your policy and documentation and bring them to a qualified Insurance attorney. Insurance bad faith is a specialized field and it is important to go to an insurance attorney. After a quick consultation and review of the policy, an Insurance attorney should be able to determine whether or not coverage applies to your loss, and whether or not your Insurer has committed bad faith.

The Insurer Has Recently Told Me over the Phone That My Claim Is Being Denied. What Should I Do?

Once again, see the advice given earlier to get it in writing. Immediately request that the denial be put in writing and demand (politely) that the insurer specifically tell you all reasons why the claim is being denied. Most policies provide for an "appeal process" or "administrative review" (by the insurance company itself). While these appeals or reviews are frequently denied, be careful to comply with policy requirements concerning such appeals or requested reviews. Courts frequently reject a subsequent lawsuit where the insured has not "exhausted administrative remedies" (i.e. jumped through the policy hoops concerning the appeal process).

My Claim Was Denied and My Appeal Was Denied by the Insurance Company. What Do I Do Now?

It's probably time to consult an attorney with experience in insurance law and bad faith litigation.

Please feel free to give us a call at (858) 259-7790 or contact us online.