We’re all familiar with insurance and the multitude of different insurance claims that can be made, but what happens when an insurance claim is made against you?
Read on for a detailed overview.
Category: Insurance
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When to Hire a Workers Comp Lawyer
If you are injured on the job and require medical attention, you may consider filing a worker’s compensation claim. This process can be complicated (and challenged by your employer), so it’s important to follow professional guidance.
So, when should you hire a workers’ compensation lawyer?
Today, we’re taking a closer look at the matter so you know when to hire a workers comp lawyer.
If you handled a car accident through your insurance, you may be surprised to discover the other driver is attempting to sue for additional damages.
In this article, we will explore a common question we hear – Can someone sue you for a car accident if you have insurance?
Hiring a bad faith insurance lawyer will protect your interests and help ensure your insurance provider fulfills their obligation.
Insurance is a means of protection from financial loss.
When you purchase insurance, you can rest assured your insurance provider will help pay the financial obligations you encounter during an automotive accident, hospital visit, or other events. This obligation is written in the contract you sign.
Sometimes, insurance companies will refuse to pay for costs.
If this happens, you may need to seek the help of a bad faith insurance lawyer. Fast.
Today, we’re going to take a closer look so you know what to do if you find yourself in this situation. Let’s get started …
Should You Hire A Bad Faith Insurance Lawyer?
You want to protect yourself from injury or loss of property, expensive repairs, injuries or losses to others that are linked to you, so you purchase insurance.
Insurance is supposed to take care of any damages that are covered by your policy. That is what you expect and what you pay for. Insurance companies have responsibilities to fulfill the terms of the contract you and they signed.
But what happens if an accident happens and you get hurt, and the insurance company refuses to pay your claim? Or the insurance company refuses to properly defend you from the claims of others? In these cases, the insurance company is acting in bad faith.
Let’s look at some of those insurance company responsibilities and then at some examples of how the companies can act in bad faith.
Insurance Companies Have Responsibilities to Policyholders
Insurance companies have clear duties to policyholders and must fulfill them in good faith.
A few of those responsibilities include the following:
Responsibility to investigate:
An insurance company has the duty to conduct a proper investigation of a policyholder claim and provide its findings and an evaluation in a reasonable amount of time
Responsibility to indemnify:
An insurer has a responsibility to pay a settlement agreement or judgment entered against the policyholder, up to the limit of the policy coverage.
Responsibility to defend:
An insurer must defend the policyholder against a claim, even if parts of the lawsuit are not covered by the policy.
Responsibility to settle reasonably:
Some states and jurisdictions recognize another insurer responsibility, and that is to settle reasonably. The reason is that a lawsuit could expose the policyholder to damages beyond the limits of the policy.
Hiring an attorney would help you determine the views of your jurisdiction concerning bad faith insurance laws, as it may have its own tests for when a law has been violated.
There is legal basis for violations
If an insurance company fails to uphold its end of an insurance contract and acts in bad faith (to protect its profits, for example), it may be committing a breach of contract.
The policyholder pays premiums in return for insurance coverage, defense, and the monetary value of the policy. Failure to honor these duties can be subject to lawsuits.
In some jurisdictions, a violation of these insurance duties can be considered a tort, a civil wrong in which one party causes harm to another. A breach of contract usually results in compensatory damages. A tort may result in both compensatory and punitive damages, a combination that frequently is more than the value of the policy.
There are many types of bad faith practices
Individual states define the types of actions that represent bad faith by insurance companies in their state. The presence of any one of those actions may be grounds to consider action. But there is more to it, and there are other elements to also consider.
A common law claim requires proof that your insurance company’s conduct was unreasonable and that the insurance company knew or recklessly disregarded the fact that its conduct was unreasonable.
A statutory claim only requires proof that the insurance company delayed or denied a benefit to which the policyholder was entitled.
In the case where an insurance company delays the time it takes to investigate a claim before agreeing to pay, in an effort to discourage the policyholder and hoping he will give up the claim, that company can be guilty of a statutory violation.
To prevent this, many states set deadlines for insurance companies to accept or deny claims, ranging from 15 to 60 days.
In the case where an insurance adjuster denies a claim or makes a less-than-adequate assessment, ignoring the estimates of a repair shop or failing to make a personal inspection, may be guilty of failing to conduct a complete investigation,
In the case where an insurance company fails to disclose the existence of coverage or fails to notify you of a claim deadline or doesn’t give you necessary filing papers, the company may be guilty of deceptive practices.
In the case where an insurance offers a very low payment that is much less than the claim is worth or refuses to pay anything for a valid claim can also be guilty of bad faith practices.
If an insurer makes a threat of any kind to you as a policyholder or to third parties who are making a claim, you should contact an attorney or call the California insurance board.
These are some examples of the many kinds of bad faith practices out there. These are the times you should hire a bad faith insurance lawyer. He will know the bad faith laws in California and will guide you through the claims process.
The lawyer will do a detailed examination of your insurance policy and help determine if your insurer’s actions were committed in bad faith. He will also outline the best strategy for maximizing a resolution for you. Often, the settlements are much better when the insurance company knows an attorney is involved.
Hire a lawyer for the best result possible
If you have suffered some loss from a fire, theft, accident or some other major damage, and you have filed a claim, you are expecting a satisfactory outcome.
But if you do not trust your insurance company or are feeling the company is not responding to your claim in a reasonable time, your next step should be to contact an attorney.
A bath faith insurance lawyer will tell you what your rights are. He will help you educate yourself on what can and should happen and what the insurance company is responsible for under the law.
The lawyer will advise you on the details of your policy including the Declarations Page, the Endorsements, and Riders. This information covers the dollar limits on various categories of coverage and lists the extras that are covered.
He will review with you your basic coverage categories, like Dwelling, Contents (Personal Property), and Loss of Use(Additional Living Expenses).
He may discuss alternatives to litigation such as negotiation, mediation or arbitration – areas where legal assistance is still very valuable.
The best way to find a bad faith insurance lawyer in California is to contact a certified attorney referral service who can recommend referrals for Plaintiffs Insurance Coverage or Bad Faith Attorneys. The referral service can give you the potential candidates that are right for you.
Insurance fraud is everywhere. Today, we’re taking a closer look at the common types of insurance fraud so you understand why hiring an insurance fraud attorney in Los Angeles can help protect you from paying for fraudulent claims.
Insurance fraud is everywhere.
It’s in the auto industry, in healthcare, home repairs, in the workplace, and more. It is a major financial burden to society. Costs from insurance fraud, with bogus claims and related costs, amount to billions of dollars every year. Since 2007, fraudulent claims in America have increased each year in almost every category.
Fraud drives up insurance costs for everyone as well as general prices of things like groceries and retail goods when businesses are forced to pass on higher insurance costs. It’s almost becoming a way of life.
Here is a look at some of the more common forms of insurance fraud.
Workers’ Compensation Insurance Fraud
Workers’ compensation insurance protects employees who are hurt on the job, paying for lost wages, medical and other expenses while the worker recovers.A small number of workers take advantage of this benefit and use it for personal profit, committing workers’ compensation fraud.
Acts of fraud include making false statements to get benefits, concealing information to get benefits, inflating costs, lying about how an injury occurred or making an exaggerated claim.
Protecting yourself against false claims for workers’ compensation involves careful documentation and reporting. You should get a written statement from the claimant describing his or her injuries, get witness statements, and document any discrepancies.
Send the information to your insurance provider and note if there might be issues with the worker who is submitting the claim.
General liability Insurance Fraud
General liability is a broad form of insurance similar in some ways to worker’s compensation fraud. It covers premises liability which provides protection to guests on your property (not employees) from things like slips and falls.It also covers products liability and completed operations.
You can help protect yourself from these claims through regular inspections of your property for potential hazards and written records of the dates and times of the inspections. It is also good to be vigilant of safety conditions and any possible obstacles that could result in injury.
Property and Casualty Fraud
Property and casualty insurance fraud can be committed by all kinds of individuals including insurance applicants, third-party claimants, policyholders, and others who provide services to claimants.
Common frauds include planned and prearranged auto theft, arson, burglary, identity theft, theft of motorcycles and marine vessels, staged auto accidents, and as noted above, slips and falls, and workers’ compensation.
There are some ways you can protect yourself from this kind of fraud. Always check bills for accuracy and never sign blank insurance claim forms.
Be cautious of door-to-door insurance sales and any insurance prices that seem too good to be true.
Do not follow the advice of strangers on who to contact for medical or legal advice.
Make sure agents and companies are licensed. You can check with your state insurance department for verification.
Auto Insurance Fraud
There are a number of auto insurance fraud schemes. Here are a few of them.
- Premium embezzlement
You give an insurance agent a down payment on insurance and he keeps it, leaving you without insurance. To verify that the policy was received and in force, ask for a copy of it to be sent to you within a week or so. If you don’t receive it, contact the insurance company directly (not the agent).
- Staged accidents
A car can suddenly pull in front of you and force you to follow too closely. This can be a setup for a staged accident. Scammers will blame you for the accident and may try to settle with you out of pocket or will report it to the police as your fault.
To prevent such a situation, be aware of unusual traffic activity that puts you at a sudden disadvantage. Stay in your lane and follow the rules of the road, especially “right of way” procedures.
- Inflated claims
When people pad their legitimate claims, the costs of insurance go up for everyone. The act is called opportunistic fraud. Insurance companies try to verify the validity of claims, but some fraudulent claims always get through.
When you make an insurance claim, do not claim more damage than there really is because it can be a felony crime.
- Collision repair fraud
If you need an auto repair shop, try to find one with a good reputation based on recommendations from family or friends you trust. You can also get a recommendation of a few potential repair shops from your insurance provider.
A disreputable repair shop will profit unfairly by reporting the cost of new factory parts to the insurance company while using old or subpar parts and materials.
By using a good repair shop, you will not only protect against insurance fraud but ensure you are getting quality parts and service. As for paperwork, make sure you get a written damage report from the repair shop instead of just a written estimate of cost.
- False vehicle thefts
Vehicles are stolen all the time and valid claims are made. But reports of stolen vehicles can also be false. This sometimes happens when someone gets behind in his or her payments and makes a report that the vehicle has been stolen in an attempt to get an insurance payoff.
With similar intentions, crime rings purchase full-coverage policies on vehicles they buy with the intention of later “losing” them. The goal is to use the vehicles for parts or resell them on the black market or trade them for drugs.
Medicare Fraud
In Medicare fraud, con artists try to get your Medicare number or personal information so they can steal your identity. You should guard your Medicare card like you do with your credit cards.
Give your Medicare number only to people you trust should have it. Representatives of Medicare or medical professionals who need your personal information should always ask your permission for your number. Usually, the permission is granted personally or in writing, never over the phone or Internet. Note that there are new Medicare cards coming in 2018.
Home Repair and Insurance Fraud
Home repair and insurance fraud can occur if you are dealing with an unlicensed contractor. Always check the status of the contractor’s license and registration to make sure it is valid and current. For larger projects, the contractor should have both a Construction Supervisor License and a Home Improvement Contractor Registration.
There are some exceptions to this requirement including HVAC installers, landscapers, painters, wall and floor coverings, fencing, above ground pools, driveways and other specialists who operate within a defined realm of expertise.
In any event, for any size project, always ask for a written estimate and detailed costs so you understand the scope of the project and all related costs. Make sure all the appropriate permits are obtained.
Although there are several laws governing all kinds of insurance activities, the best way to protect yourself is with common sense and good record keeping. If you do sense trouble in this field, consult a good insurance attorney to be safe.
