Long Nguyen | author
ICHQ | Site Author
Thousands of insurance companies operate in the United States, and almost half of them are property and casualty (P&C) insurance companies. So, it’s not surprising that most of the common insurance claims are property and casualty claims.
Documenting your claim and knowing your rights are usually the two keys to prompt claim resolution. Flo and her insurance adjuster compadres are sympathetic and affable on TV. But in real life, these professionals never take your word for anything and bully policyholders at every opportunity. If the company refuses to pay your claim, an New Orleans bad faith insurance lawyer can force the company to honor its commitments.
These claims usually don’t directly involve property loss. Instead, the parties disagree about the scope of coverage, credit for premium payments, or other nuts and bolts. Disagreements might also arise over sales fraud or deceptive insurance coverage clauses. Since an attorney is a good negotiator and a good litigator, a lawyer often helps insured parties successfully resolve these disputes.
First Party Claims
Almost all insurance claims, be they P&C, health insurance, or anything else, are first-party claims. An insured policy submits a reimbursement or payment claim to a company. Firms have concrete legal obligations in these situations. For example, they must quickly and thoroughly investigate the claim and then pay or deny it based on that investigation. If a company tries to bend the rules, an attorney can stop such action.
Natural Disaster Claims
Most homeowner’s policies cover things like hail, high wind, earthquakes, fire, and most natural disasters. But most policies exclude flood damage. So, insurance adjusters frequently claim that a related flood, instead of something like high winds from a hurricane, caused most of the damage.
Damage caused by fires and other human-made disasters dominates homeowners’ insurance claims. Theft claims are a close second, and dog bites are usually third. The insurance company cannot use depreciation as an excuse to reduce payment. The insurance company must protect the total insured value.
Auto Insurance Claims
Anyone who owns or drives a vehicle is required to carry an insurance policy. While some individuals have state-minimum coverage, others pay additional monthly premiums to insure themselves against their vehicle’s loss of value, accident-related injuries, injuries caused to others, or other types of claims. If you file a first-party coverage claim after a car accident, you expect your insurer will cover your costs promptly. Unfortunately, this is not always the case. Insurers may reject or delay payment of claims, saying the loss is not within the scope of the policy’s coverage. If insurers do not adequately investigate claims and unfairly deny legitimate claims, insured parties may file a claim against them.
Health Insurance Claims
Most Americans belong to an employer-sponsored or employer-subsidized group health plan. Given the sky-high cost of most medical procedures, insurance companies often refuse payment based on obscure reasons. For example, they might label a cutting-edge procedure as “experimental” or claim the patient didn’t dot all the Is and cross all the Ts on a specialist referral. Such technicalities rarely hold up under scrutiny. So, if an insured party has a lawyer, the insurance company often backs down.
Insurance companies deny claims whenever possible. It’s part of their business model. For a confidential consultation with an experienced insurance lawyer, contact Insurance Claim HQ. We have offices in several states.
Can insurance companies rubber-stamp claims as “paid” or “denied?”
No, Insurance companies can’t rubber stamp claims as paid or denied. Insurance companies always have to promptly and thoroughly investigate claims.
What if I disagree with an adjuster’s insurance claim decision?
Most policies have appeal provisions for denied insurance claims. An insurance claim lawyer can help you prepare this appeal.