Insurance companies are in the risk management business. They help their clients manage risk by taking responsibility for keeping costs under control in the event that a claim is made against a policy. In turn, an insurer’s claims adjusters work hard to make sure that claims are valid and not, in the opinion of the adjuster, overbroad or outside the scope of the policy. In some cases, an insurance company takes an aggressive approach, denying claims in hopes that the injured person doesn’t appeal the decision or sue. Fortunately, there are options for people who find themselves in this circumstance.
Insurance companies have a legal obligation to be honest
When someone makes a claim against an insurance policy, the insurer has a legal obligation to conduct an honest assessment of the claim and pay for damages that are covered under the policy. The assessment process needs to be concluded and payments made within a reasonable time. At the same time, insurers also have an obligation to protect their clients, the policyholders, against claims that are invalid, unsupported by the facts, or fraudulent.
An insurer that acts in bad faith can be sued. An insurer acts in bad faith if it tries underhanded methods of delaying or avoiding its obligations under a policy. Imposing huge volumes of paperwork, making a lowball offer, or misleading people about a policy question are all examples of potential bad faith. A claim of bad faith may be brought by the policyholder, such as an at-fault driver in an auto accident who is not getting the coverage that a policy promises, or by a beneficiary of the policy, such as someone who has made a claim against the at-fault driver’s policy.
Between honest dealing and unambiguous bad faith is a large grey zone where a lot of confusion and conflict can arise. An insurer may in good faith believe that the facts of an injury place it outside the scope of a policy. An adjuster may in good faith review the costs associated with an injury and conclude that they are significantly lower than what the injured person has claimed. A lack of bad faith doesn’t mean that the insurance company escapes responsibility, but it does mean that the injured person may need to take more aggressive steps to protect his or her interests.
Contesting denied claims
When a claim is denied or only partly honored, the beneficiary should consult with an attorney to determine next steps. An insurance company is unlikely to put aside a claims denial without a rigorous consideration of the issues underlying the claim. Those issues may be purely legal, such as a conflict over interpretation of policy language. They may be purely factual, such as questions about how an accident occurred or the extent to which the policyholder is at fault. Or they may involve a mixture of legal and factual issues.
The appropriate solution for the problem of a denied claim will depend on the particular policies of the insurer and the nature of the dispute. Some insurers may offer an in-house appeals process to help reduce the risk of litigation. But many insurers will need to be sued to bring them to the negotiating table. Once there, an insurer will have an adversarial position and will need to be countered with strong legal arguments.
GGRM can help you resolve your insurance disputes
For more than 45 years the law firm of Greenman Goldberg Raby Martinez has served clients in the Las Vegas area in personal injury cases. If you are struggling to recover what you are owed in a personal injury claims dispute, contact us today for a free attorney consultation. We may be able to help you reach a better settlement. Call 702-388-4476 or contact us through our website.