We Can Help You With an Insurance Claim Denial
Insurance is a heavily regulated business, which has resulted in the creation of a vast number of insurance laws. Most of the regulations pertaining to the business of insurance. Some, however, directly affect the fundamental aspect of insurance: that is, what is covered under an insurance policy and what is not.
If you received an insurance claim denial, contact The Law Offices of Loren Scott Etengoff today. Our team of experienced Vancouver insurance lawyers can help you understand and protect your rights.
The Business of Insurance
The basic concept of insurance is to allocate the risk of a loss from the individual to a larger group of people. Each individual pays a premium that goes into a pool from which losses are paid out. Much of the regulation is to ensure these pools are sufficiently funded and well managed to meet the insurance companies’ obligations.
Understanding the Insurance Policy
The peace of mind an insurance policy provides the policyholder can be suddenly shattered when a claim is denied. Although it may seem obvious, what is covered in the policy is only what is contained in the written contract of insurance. If a policyholder files a claim, the insurance company has only two duties:
- The duty to promptly and fairly investigate the claim, and
- Pay the claim if it is valid.
Why an Insurance Claim Denial Happens
In determining the validity of a claim, the law holds the insurance company to a duty of good faith and fair dealing. If a claim is denied, the issue a Vancouver insurance lawyer will investigate is whether the claim should have been paid but was improperly denied.
When an insurance claim is denied without legal cause, this amounts to a breach of contract on the behalf of the insurance company. Thus, the company may also be liable for extra-contractual damages. An insurance claim denial can take place with an array of policies, including:
- Homeowner’s insurance
- Car or truck insurance
- Business insurance
- Health insurance
- Disability insurance
Each of these policies amounts to a contract, which may be breached if your claim is denied. Our Vancouver insurance lawyers can help if the insurance company violated the policy by denying your claim.
Other Acts of Bad Faith by Insurance Companies
The bottom line for many insurance companies is that they make more money by paying out less in claims. Other than an outright denial, this can take the form of unreasonably delaying the payment of benefits, making low ball offers of settlement or failing to settle a claim within the limits of the policy. Vancouver insurance lawyers can cut through all this, and help make the odds better when you are dealing with the insurance company.
Common bad faith tactics include:
- Insurance claim delay
- Delayed payments
- Insurance claim denial
- Insurance claim fraud
- Utilizing contributory or comparative negligence
- Problems with the adjuster
- Misrepresentation of the claim
- Making unfair settlement offers
- Denial based on pre-existing conditions
- Refusal of medical treatment
- Improper subrogation
It can be difficult to determine when an insurance company is behaving in bad faith. If they seem to be contradicting themselves or making promises they don’t keep, then they may be acting unethically. They may fail to properly investigate a claim or fail to give you information that you deserve. It’s important to be aware of the actions of an insurance claims adjuster and the company as you navigate a claim.
Washington State Bad Faith Insurance Law
The State of Washington has the Insurance Fair Conduct Act (IFCA), which sets standards for insurance companies who operate within Washington. The Act encourages insurance companies to handle claims in a fair manner and in good faith. All Washington insurance companies must abide by the IFCA.
IFCA also allows personal injury claimants who have had a claim denied unreasonably to pursue legal action against insurance companies. People can recover damages as a result of the unreasonable denial as well as attorney’s fees and costs of filing the lawsuit. In some cases, this means that a claimant may be able to recover more than their actual damages in a claim.
The Insurance Company Will Take Advantage of You If You Don’t Know Your Rights
When an insurance company denies a claim, they rely on the fact that the claimant may not know their rights. Insurance companies have teams of powerful attorneys who will use legal language to convince a claimant that they don’t deserve compensation. That’s why it’s important to utilize insurance lawyers on your side. You deserve to have someone on your side who is not afraid to stand up to the insurance company and their army of attorneys.
The insurance company has more money than the claimant. In fact, the claimant is often in a bad situation and needs money quickly. For this reason, the insurance company often makes the claimant a lowball offer to make them go away. The initial settlement offer will not be much to the insurance company. But the claimant may see it as a windfall during a time when they are unable to work and have bills piling up. It’s almost always best to refuse this initial offer and force the insurance company to make a reasonable offer. Your claim is worth more than their lowball amounts.
Insurance companies will often use unethical strategies to win a claim. They may hire someone to follow the claimant around and prove that they aren’t injured. They may improperly deny a claim or draw out the timeline until the claimant losses steam. By working with insurance lawyers, you can fight back against these unethical tactics that most insurance companies use.
What Are Bad Faith Actions?
Bath faith insurance companies tend to take similar actions that amount to unfair practice. Common indicators that you should look for to determine if your insurance company is acting in bad faith include:
- Automatic denial of claims. If you have an insurance company that does not investigate claims, but instead automatically denies any claim you submit, then they may be acting in bad faith.
- Taking a long time to payout. If your claim was approved, but the insurance company takes longer than necessary to issue payment, then they may be acting in bad faith.
- Prolonged investigations. Although investigation of an incident can take a long time, the insurance company should be in constant contact with you. If they fail to communicate with you and indicate they are still investigating, they may be acting in bad faith.
- Failure to properly investigate. If an insurance company does not review all of the facts of the case and fails to speak with everyone involved, they may be failing to properly investigate and acting in bad faith.
A Washington jury is tasked with determining whether or not bad faith exists in an insurance case. Sometimes those situations are egregious wrongful acts where the insurance company clearly fails to take appropriate actions. However, other cases are more nuanced. It’s important to work with an attorney who can present evidence to the jury regarding insurance bad faith.
Types of Insurance Companies That May Act in Bad Faith
Any type of insurance company may act inappropriately, including:
- Car Insurance. You may have a first or third party claim that is handled poorly by the insurance company.
- Uninsured/Underinsured Vehicle Coverage. If someone else hits your car and you make a claim with your own insurance company, they may still act in bad faith.
- Disability Insurance. You may be owed lost earnings, but forced to wait on the insurance company to collect evidence of your disability.
- Homeowner’s Insurance. A fire or other incident can result in a significant homeowner’s insurance claim.
- Health Insurance. Most claims are small, but they can add up when a health insurance company acts in bad faith.
Contact a Vancouver Insurance Attorney for Legal Advice
If you are dissatisfied with an insurance company’s response to your claim, or if you are facing an insurance claim denial, it is important to understand your rights. For any questions, call the Law Offices of Loren S. Etengoff today.