When you have insurance, you rely on them and expect them to fulfill their liability for what you pay, right? Well, unfortunately, that doesn’t happen all the time. Most people will need an insurance claim attorney because insurance companies often deny claims.
Here we are going to teach you how insurance companies play their cards in order to give less of what the policyholder expects by applying tactics and techniques that an average person may find reasonable and that puts them in an uncomfortable position.
You will know why an attorney for car insurance claims from The Ward Law Group P.L. can help you if you or a family member gets in this annoying situation where they can face financial burden even though they were supposedly backed up by a policy they paid.
What is Bad-Faith?
Bad faith happens when a policyholder wants to start a claim process in their insurance company but is unfairly treated. That leads them to the claim to be denied. Let’s see some examples of when a bad-faith happens.
Denies a claim
The insurance company denies a valid claim without proper investigation or valid reasons. For example, denying a claim for water damage caused by a burst pipe, stating that it is not covered when the policy includes coverage for water damage, or denying a claim for hail damage to a roof, saying that the policy does not cover “acts of nature.”
It is encouraged for a policyholder to read all the clauses since they may add these lines where they don’t cover something that is a possibility in your case.
Requires the insured to provide unreasonable information
This happens because they know that not all people save such documents as detailed receipts for every item in a home burglary claim, including items purchased years ago, making it difficult for the insured to provide the requested information or demand irrelevant medical records for a property damage claim.
Repeatedly asks for information, prolonging the claims procedure needlessly.
Multiple communications requesting the same information over and over again may delay the unnecessary process. This could include requesting multiple copies of documents that have already been provided.
Fails to submit a fair settlement proposal within a reasonable time once liability has become evident
This usually happens after a car accident where the insured party was not at fault, the insurer fails to make a settlement offer for an extended period of time. Also, there have been cases of slip and fall accidents at a business establishment where liability is clear, and the insurance company delays making a settlement offer for an extended period, causing financial hardship to the injured party.
Forces an insured to file a lawsuit to recover money owed under an insurance policy
The insurer refuses to pay a legitimate claim for property damage caused by a severe storm, forcing the insured to file a lawsuit to receive the rightful compensation.
Fails to confirm or reject a claim promptly
The insurance company does not provide a response or decision on a claim within a reasonable timeframe. This leaves the insured uncertain and without resolution for an extended period, causing unnecessary stress and financial strain.
For all of the potential actions they may do, you will need to have an experienced insurance claim attorney to help you fight against these companies that put profits over policyholders.
Why was my insurance claim denied?
There are many reasons why your insurance claim may have been denied. Insurance companies will use one of the following reasons as an excuse to either pay you less amount or refuse to pay for your losses.
Lack of Coverage:
They love to say this to policyholders: “Sorry, but it seems that your plan does not cover the situation you are dealing with; you are on your own.” It's crucial to review the policy and understand the coverage limits, exclusions, and conditions as this may be a difficult task, but an experienced insurance claim attorney can do it for you.
Certain events or circumstances may be specifically excluded from coverage. For example, a homeowner's insurance policy may exclude coverage for damage caused by floods or earthquakes.
Failure to Meet Policy Requirements:
If the policyholder fails to meet specific requirements stated in the policy, such as timely reporting of the claim, providing necessary documentation, or fulfilling policy conditions, the claim may be denied.
This is why it is sometimes used as a bad-faith action. They may ask you for documents that are not relevant or that they know you may not have, and they don’t tell you that you might need them when you file a claim.
In health or life insurance policies, claims related to pre-existing conditions that were not disclosed or covered under the policy may be denied.
For instance, a health insurance claim related to diabetes treatment or complications may be scrutinized if it was a pre-existing condition at the time of policy issuance, or if a policyholder has a pre-existing heart condition and files a claim for cardiac treatment, the insurance company may assess the claim in light of the pre-existing condition.
Regarding life insurance, if a policyholder has a pre-existing terminal illness at the time of policy purchase, the insurer may deny a claim made due to the illness. Also life insurance claims related to chronic conditions such as advanced-stage kidney disease or chronic obstructive pulmonary disease (COPD) may be affected if they were pre-existing at the time of policy issuance.
Misrepresentation or Fraud:
If the policyholder provides false or misleading information during the application process or when filing a claim, the insurance company may deny the claim based on misrepresentation or fraud.
Of course, they have a lot of people working with them who will make sure all the pieces of information that they receive are accurate and valid.
Failure to Pay Premiums:
If the policyholder fails to pay premiums within the specified grace period, the insurance company may deny the claim due to the lapse in coverage. They state this very clearly at the beginning.
Sometimes there is a miscommunication between the companies and insured people, but yet if they don’t receive the payment, you won’t receive any coverage if you get an incidence in the hours you didn’t pay.
Intentional or Criminal Acts:
Insurance policies typically exclude coverage for intentional or criminal acts committed by the policyholder, such as arson or fraud. In this case, they are right not giving the coverage but it does need a full investigation to come up with that verdict. They can’t just assume you did it for the insurance money.
Types of Insurance Claims We Handle
Indeed, there are a lot of types of insurance out there, and most of them are a need. If you want to drive a motor vehicle, you will need to have insurance that is required by law.
If you want to have your integrity saved when you work on a construction site or in a job that is prone to suffer an accident that may lead you to serious injuries or even death, you may need insurance.
The Ward Law Group is right here to help you with any of the following types of insurance claims.
- Mass Transit
New York Consumer Protection Laws
There are a set of laws and regulations designed to protect consumers from unfair and deceptive practices in the marketplace. In New York, the Consumer Protection Law encompasses various statutes and regulations that aim to safeguard consumers' rights and promote fair business practices.
The primary goal of the Consumer Protection Law is to ensure that consumers are treated fairly and are provided with accurate information, quality products, and reliable services. It covers a wide range of industries and business transactions, including retail sales, advertising, telemarketing, debt collection, and more.
The Consumer Protection Law in New York includes provisions that address:
- False Advertising: Prohibiting deceptive or misleading advertising practices, such as false claims, bait-and-switch tactics, or deceptive pricing.
- Unfair Trade Practices: Prohibiting unfair and deceptive practices in business transactions, including fraud, misrepresentation, or any act that can mislead or harm consumers.
- Product Safety: Establishing safety standards for various consumer products and holding manufacturers and sellers accountable for providing safe products.
- Consumer Contracts: Regulating the terms and conditions of consumer contracts, ensuring that they are fair, transparent, and do not contain unfair provisions that disadvantage consumers.
- Consumer Remedies: Providing avenues for consumers to seek legal remedies, such as the right to file complaints, pursue legal action, or seek compensation for damages caused by unfair or deceptive practices.
An experienced and wise insurance claims attorney will use the consumer protection law on your side to fight any of these companies that are trying to save money and not giving you the compensation they promise and that you paid for with effort for many years.
Contact an Insurance Claim Lawyer Today
At The Ward Law Group P.L., our insurance claim attorneys have been dealing with companies their entire careers. With over 25 years of experience, they understand that business as the palm of their hand.
Many people, including minorities, are vulnerable to these massive companies that use their resources to make the policyholders believe they won’t be able to receive compensation. If you are dealing with an unfair situation, you should contact an insurance claim lawyer at 855-DOLOR-55, and one of our team lawyers will answer any question you may have entirely for free.