Since you’re here, you may be involved in an insurance dispute.
Perhaps you’ve diligently paid insurance premiums for years. Now you’ve suffered a natural disaster or accident, and your insurance company refuses to pay.
If this describes your case, you need an insurance litigation attorney to help with your insurance dispute. Our Louisiana insurance lawyers represent clients who have been bullied by big insurance companies. We relentlessly work to get our clients maximum insurance settlements.
Here are more points you should know about our firm:
If you need help right away, give us a call. Maybe you need more information before contacting a Louisiana insurance lawyer; we have that too.
Here, you’ll find information about insurance disputes, including the following points:
Keep reading to find out why your insurance company denied your claim and how you can change their mind.
Common Causes of Insurance Disputes
While you may feel frustrated with your insurance company, know that you’re not alone. Insurance companies are in the business of turning a profit, often at customers’ expense. Here are common causes of insurance disputes:
Coverage Limits and Exclusions
Insurance companies may write policies with vague wording that is open to interpretation. Then the company uses their interpretation of your insurance policy to deny your claim. The company may assert that your claim violates the scope or financial limitations of your policy. The insurance company may rely on fine print terms and conditions that are difficult for the policyholder to understand.
Loss Assessments
Do you and your insurance company have differing opinions on the monetary assessment of your loss? An insurance adjuster may undervalue your loss so that the company offers only small financial compensation. We aim to recover the full value of your loss. This potential compensation includes legal and investigative costs, repayment of fines, and lost value to your reputation.
Communication Problems
You may have trouble communicating with your insurance company. Perhaps they deflect your questions, don’t respond to emails, or fail to return calls. Insurance companies are more likely to respond to an insurance litigation attorney. If you have difficulty communicating with your insurance company, our insurance dispute attorneys can take over that challenge.
Reasons an Insurance Company Denies Claims
An insurance company may try to deny your claim on any grounds possible. After all, finding a way to deny your reimbursement helps their bottom line. Insurance companies use corporate lawyers writing fine print contracts that the average policyholder can’t understand. Insurance companies may deny claims for a number of reasons.
Policy Limits
When you select your policy, you agree to certain financial limits. For instance, maybe you insured the replacement value of your home or car. Perhaps you wanted to save money on premiums, so you insured less than the replacement value. In that case, you would not receive adequate compensation to replace your home or car.
In a typical example, if you experience a devastating flood without supplemental flood insurance, your home insurance limitations would apply. Even if you suffered a total loss of your home, policy limits would prevent the insurance company from reimbursing your home’s full value.
State Law Violation
If illegal activity resulted in your loss, the insurance company usually will not pay. For instance, if you were driving while intoxicated and experienced an accident, your auto insurance may not pay. Sadly, suicide falls into this category and invalidates many life insurance policies. If you committed arson on your own home, your fire insurance might not pay. Also, health insurance may not cover treatment related to an illegal drug overdose or injuries incurred while committing a crime.
Not Following Procedures
If you don’t follow the procedures the insurance company requires, they may deny your claim. An insurance company may require you to file a claim within a certain time after an accident or injury. Perhaps you didn’t file a required police report or misrepresented the events that led to the claim. Maybe you didn’t seek medical attention immediately. All of these problems may cause the insurance company to deny your claim.
What Does It Mean When an Insurance Company Acts in Bad Faith?
After you diligently pay insurance premiums, you expect your insurance company to come through for you when needed. Unfortunately, insurance companies don’t always hold up their end of the bargain. Sometimes, insurance companies treat victims unfairly, a practice known as acting in “bad faith.”
Your insurance company is obligated to act in good faith when they investigate, negotiate, and settle claims. However, insurance companies might violate this code of conduct and act in bad faith in many ways.
Unreasonable Delays
An insurance company should act with reasonable haste in settling claims. Sometimes insurance companies delay processing a claim, hoping the claimant will just give up on it. Most states impose time limits on insurance companies, requiring them to respond to claims within 60 days or less. This time frame varies by state. For instance, in Texas, insurance companies have only 15 days to acknowledge a claim. When adjusters and insurance agents cause unnecessary delays, they act in bad faith.
Failure to Investigate
Insurance companies have a duty of good faith and fair dealing. This means that when a policyholder files a claim, an insurance company must promptly investigate the claim. The investigation must be thorough. The insurance company cannot simply dismiss a claim over the phone without investigating it. For instance, an insurance company should investigate reports of a damaged car or roof by quickly sending an inspector.
Deceptive Practices
When an insurance company acts deceptively, it violates its duty of good faith. For instance, the insurance company might fail to notify you of aspects of your policy or a claim deadline. If an insurance company attempts to mislead you about the legal language of your policy, they are acting deceptively. Insurance companies should always communicate truthfully with claimants.
Lowballing or Refusing a Claim
If a policyholder files a claim properly, an insurance company may still try to avoid paying. Sometimes, an insurance company refuses a valid claim entirely. Other times, an insurance company may offer to pay less than the claim is worth. For instance, maybe your house is insured for full value and is leveled by a tornado. In that scenario, the insurance company can’t offer you only half the value of your home.
Don’t fall for the deceptive, bad faith practices of some insurance companies. An insurance dispute attorney works to make insurance companies promptly pay what they owe.
Options When an Insurance Company Denies Your Claim
When your insurance company denies your claim, you can evaluate whether the denial was reasonable. Insurance companies must tell you why they denied your claim. If your insurance company based their denial on a valid clause in your contract, then you may not have recourse.
On the other hand, if your insurance company unfairly denies your claim, you can respond with an appeal or a lawsuit.
Appeal the Denial
You can appeal the denial by requesting that the insurance company conduct a full and fair review. Make sure that you research any deadlines for filing an appeal. Then write a concise letter stating why the denial was wrong.
File a Lawsuit
You can sue the insurance company, accusing them of acting in bad faith. You should hire an experienced insurance litigation attorney to help you with this option. If you win your insurance litigation suit, the insurance company will have to pay you.
You can sue the insurance company for breach of contract. This means that the insurance company did not abide by the terms of the agreement they made with you.
In some states, a bad-faith or breach-of-contract lawsuit allows you to collect attorney fees from the insurance company. Even if the insurance company won’t pay your attorney fees, Louisiana insurance lawyers often work on contingency. This means that your insurance dispute attorney may take a portion of your settlement instead of requiring payment upfront.
Insurance Claim Denials You Can Dispute
A claimant experiences disappointment when an insurance company denies a claim. However, the claimant doesn’t have to just give up on the claim. Insurance companies may deny claims using unethical tactics, and the claimant is free to dispute an unfair denial. You can dispute various reasons given for insurance claim denials.
Misinterpreted Text
The insurance company may have misinterpreted text within the policy, unfairly denying coverage. An experienced insurance dispute attorney can carefully read the policy and argue for a fair interpretation.
Unspecified Injuries
Certain injuries or procedures may not be specifically named in the policy. If an injury or procedure falls in a vague zone of policy language, your Louisiana insurance lawyer can argue for coverage.
Lapse of Coverage
If there was a lapse in coverage during the time your claim arose, you may be able to argue for coverage. In fact, most insurance companies have a grace period that covers insured people for a time after their insurance lapses.
Incorrect or Incomplete Information
Some of the factual reporting used by the insurance company may be incorrect or incomplete. For instance, if the insurance adjuster took incorrect measurements or failed to account for damage, the facts should be reconsidered.
How To Dispute an Insurance Claim: Phases and Considerations
If you think an insurance company has unfairly denied your claim, you may consider disputing the denial. After reading the text of your policy, you should decide whether to move forward with an appeal or lawsuit. Factors you’ll want to consider when making this decision include:
When reviewing these points in your insurance policy contract, it can be helpful to consult an experienced Louisiana insurance lawyer. Insurance companies may intentionally write confusing policies that are difficult to understand. An insurance dispute attorney can help you analyze complex insurance policy terms.
Once you’ve decided to move forward with a dispute, consider what resources you have to devote to the dispute. Fighting an insurance company can take a lot of time, and the financial stakes are high. When deciding whether to go up against an insurance company on your own or hire an attorney, you should consider:
You may decide to dispute the insurance company on your own at first and hire an attorney later if needed. In that case, you may encounter several phases of your dispute process.
Self-Help Negotiations
When you represent yourself against an insurance company, you might save money initially. Because you don’t have attorney fees, you can keep your entire settlement without paying anyone else. However, you may not achieve as high of a settlement on your own. Also, the self-help option is the most demanding of your time.
Alternative Dispute Resolution
Alternative dispute resolution (ADR) holds the middle ground between self-help negotiations and a lawsuit. If you use ADR, you and the insurance company can meet with a third-party mediator or arbitrator. A mediator helps you and the insurance company reach an agreement while an arbitrator holds power to make a decision. Each method of ADR saves the time and expense of a lawsuit while allowing a neutral party to hear your dispute. However, mediators or arbitrators sometimes come from within the insurance industry, so they may be biased against you.
Insurance Litigation
If self-help negotiations and alternative dispute resolution don’t achieve your desired result, you can turn to insurance litigation. Often, insurance companies intimidate claimants with technical language. However, an insurance dispute attorney can interpret this language and argue persuasively for you. An insurance litigation attorney is usually able to achieve a higher settlement amount than is feasible in self-help or alternative dispute resolution. In litigation, your Louisiana insurance lawyer will attempt to negotiate with the insurance company and proceed to a jury trial if necessary.
Need Assistance with Your Denied Insurance Claim Dispute?
If you have experienced problems negotiating a disputed insurance claim, we may be able to help. Our experienced insurance litigation attorneys regularly go up against big insurance companies. We see right through these big companies’ deceptive tactics, and we don’t back down until we get you money. Contact us today for a complimentary case review. If we accept your case, we work on contingency, so you don’t have to worry about a retainer. You can let go of some stress while we work to get you the insurance settlement you deserve.
Jeremiah Johns is a former insurance defense attorney who now represents plaintiffs in bad faith insurance, catastrophic injury cases, and commercial disputes. He has a unique perspective from his experience representing some of the nation’s largest insurance companies.
Jeremiah is licensed to practice law in Texas, Louisiana, Florida, and Georgia (though he is presently inactive in Georgia). He is also admitted to the 5th Circuit Court of Appeals. For his education, Jeremiah earned an LL.M. in Admiralty from Tulane University, a J.D., cum laude, from Syracuse University, and both a B.A. and B.S., magna cum laude, from Georgia State University.
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