Insurance companies go out of the way to advertise how fast, neighborly, generous, kind, understanding, patient and friendly they are. This is certainly true when they are trying to sell you one of their policies. It continues to be true for as long as you make your timely insurance premium payments without asking for anything in return. However, sometimes policyholders are forced to submit a large claim learn there are limits to insurer congeniality.
Having spent over a quarter of a century litigating insurance cases, we have gathered some Survival Tips which you may find useful.
- Take careful notes when you purchase an insurance policy. Write down what you are told by the insurance agent concerning the coverage you are buying. Save these notes and keep them in a file with your policy.
- Insist on reading the completed application form for any insurance for which you are applying. Read all applications, questions and answers yourself rather than allowing them to be read to you by the agent. Make sure that your answers are truthful, thorough and complete. Insurance companies can rescind your policy entirely after you have made a large claim if they find some basis for asserting that you have misrepresented a material fact on the application.
- Insist on seeing a copy of the policy before you purchase it. Ask questions about things like deductibles, exclusions and limitations. Make sure that you understand these key points in the policy you are obtaining. Keep these notes in your insurance file as well.
- Save all promotional material that you are given or shown at the time you purchased the policy.
- When you have a claim, review your insurance policy and notes before speaking with a company claims representative. This is to avoid the possibility of the company using what you have said as a basis for denying the claim.
- Document your loss immediately and completely.
- Keep a “log” concerning your claim. Write down the date, time and facts pertaining to every telephone or written communication with the company representatives. Note the name, title and direct telephone number of each person with whom you have had contact. Keep a record of all statements and representations made to you about your claim by these individuals.
- Learn and understand the rules of interpretation that courts apply to insurance policies. This is crucial to your understanding of the meaning of key provisions in your own policy. For example, the Coverage provisions must be construed broadly, while the Limitations and Exclusions will be interpreted narrowly. Any ambiguity in the policy will be interpreted in favor of the policyholder and against the insurance company. In a liability policy, the duty to defend you is broader and more encompassing that the duty to indemnify you for a loss. There are many other such “rules of construction” which affect whether or not you will be able to compel your insurer to pay for a loss. Learn them.
- Realize that insurance companies are required by law to treat claimants fairly, reasonably, and in good faith in all respects. An insurance company cannot place its financial interests above those of a policyholder.
- Remember that if an insurance company violates its legal duty of good faith and fair dealing, it can be held responsible for paying the costs and attorney’s fees you incur as a result. All damages, which you actually suffer as a consequence of unreasonable insurer conduct, are also recoverable. This means, for example, that if a policyholder loses his or her house or is driven into bankruptcy as a result of the bad faith of an insurance company, that the insurer is responsible for all such losses, not just for the policy benefits.
- Recognize that insurance companies earn money on investments while they are holding onto claims dollars. One major insurance company alone receives over a billion of dollars in valid claims per year. Simply by delaying, a company can earn hundreds of millions of dollars per year. By under-settling claims, the company can obviously reap enormous additional profits. Such conduct also enhances their competitive edge – since so few policyholders challenge this conduct it pays to cheat and forces competing insurers to do likewise.
- Exaggerate any aspect of your claim.
- Accept the insurance company’s expert’s evaluations of your losses without obtaining your own expert’s estimates. The two can vary widely.
- Submit to an “examination under oath” without first obtaining objective advice from an expert.
- Sign an insurance company release or check unless you are certain that the amounts you are receiving are full and correct and that you are not waving or giving up any rights by cashing the check.
- Proceed on a large claim without first learning the legal standards that are applicable to the type of claim in question.
- The above information will not make you an insurance law expert, but will give you a jump-start in the effort to be treated in the manner promised by your company when you purchased your coverage.
We are long-term disability lawyers. It is all we do and we may be able to help.