My insurance company denied my claim, do I have any rights?

Absolutely! If an insurance company refuses to abide by the terms and conditions of the policy in the payment of a legitimate claim, then it has breached the policy and you are entitled to the benefits for which you were denied. In addition for suing for breach of the contract, if the carrier’s denial of the claim was in bad faith you would be entitled to additional damages, including punitive damages if applicable. 

 What is Bad Faith? 

Generally it is a course of conduct of an insurance company evidencing the insurance company’s unreasonable and/or unjustifiable treatment in the handling of an insured’s claim. Your insurance company has a duty of “good faith and fair dealing”. This requires the carrier to: (1) adjust your claim (pay it or deny it) within a reasonably prompt time, (2) cooperate with you regarding your claim by explaining requirements and benefits of the policy to you, (3) timely respond to your inquiries, and (4) tell you in writing precisely why it is denying or reducing your claim (it must refer to the policy provision or rule of law it is relying on). Failure to perform such duties equates to “bad faith”. Basically the carrier must attempt to find a basis to pay the claim rather than invent or find reasons to deny it.  Some the following acts are examples of bad faith; the list is far from exhaustive:

(1) John saved for many years and was finally able to purchase a home. He insured his home with ABC Insurance, and paid good money for a replacement policy. The policy called for replacing the home at the prevailing market cost if destroyed. As a result of a tornado John’s home was completely destroyed. Luckily John and his family were not hurt, but they had to take up residence in a hotel with what little belongings that could gather from the site. Four weeks after the loss ABC hired an appraiser that had a long time business relationship with ABC to determine the replacement cost of John’s home. This appraiser determined the replacement cost at $60,000. Two independent appraisers appraised the cost to replace John’s home at $85,000 and $82,500. Without adequate explanation ABC would not consider the independent bids. ABC told John that he either accept the $60,000 or they would quit paying his motel expenses immediately and he would have to make other arrangements for himself and his family. Due to the economic and emotional stress he was placed under by ABC’s actions John was forced to accept the $60,000. He thought his insurance company treated him unfairly. He was right.

Juries have awarded millions of dollars to people like John.

 (2) David was driving his car through a controlled intersection at 8:30a.m., when Joe ran the red light and collided into him. The police arrived and asked David if he needed to be taken to the hospital, and he responded that he was experiencing pain but he thought he would be alright, but if it got worse he would go to the ER. The officer noted on the report that David “refused treatment”, but when David spoke with him after he received a copy of the report admitted he remembered what David told him but just didn’t write it in the report. The officer also noted in regards to the accident that David had not acted improperly in the operation of his vehicle. David went the hospital at 8:00p.m., complaining of pain in his low back. He was diagnosed with a herniated disc, and started treatment with a neurologist who first attempted conservative care, and when that failed he underwent back surgery. His medical bills were over $20,000, and since Joe only had minimum coverage as is required by Oklahoma law ($10,000), Joe’s insurance company offered the $10,000 limit.  David advised his insurance company that he was making a claim under his underinsured motorist policy, since David had $50,000 in underinsured motorist coverage and Joe was underinsured. David’s insurance company, without speaking with the officer, examining the scene of the accident or the cars involved, told David that they thought he was partially at fault and therefore would discount his claim. Without ever discussing David’s care with any of his treating physicians his insurance company sent him to a doctor that the carrier used on a regular basis to deny claims. This doctor sent the company a report stating that the accident only aggravated a preexisting condition and that the herniated disc would have occurred some time in the future regardless of the accident. David thought that Joe’s insurance company was treating him more fairly than his own. David paid premiums to his company for 10 years and they were treating him like an adversary. David was right, his insurance company failed to perform an adequate investigation. It should not treat him as an adversary and place its interests ahead on his by using captive doctors to support its positions.  A jury, under similar facts, awarded an insured such as David 9.5 million dollar

What should I expect or do when I am dealing with my insurance company after I have made a claim?

The best thing to do is to “put it in writing” or “get it in writing”. You should expect that you are going to be dealing with a professional who handles claims everyday. This person most likely will place the insurance company’s interests ahead of yours – it’s his/her job to save the company money. Therefore, phone calls are ok for quick contacts, but get the adjuster to put his/her position about your claim in writing. In Oklahoma you can even tape a telephone conversation between yourself and the adjuster without telling the adjuster, as long as you don’t record others involved in the conversation that are not aware that it is being recorded. Therefore, if you are having problems with the adjuster when discussing the merits of your claim, it may be a good idea to tape the conversation and always ask the adjuster to “put it in writing”.

There are certain words in my policy that I think mean something very different that what the insurance company is telling me they mean, do I have to accept their definition?

NO.  The law recognizes in most jurisdictions that insurance policies can be somewhat complex. The law also recognizes that most of these polices are “boiler plate”, not giving the insured much bargaining power. The courts have developed certain rules of interpretation for reading insurance policies. If the language is not clear and unambiguous the court will favor an interpretation that supports coverage for the insured rather an interpretation that would deny coverage.

What is the time limit for asserting a bad faith claim?

 Bad faith is a “tort” or “personal injury” type of case versus a breach of contract case. Suit must be filed within two years from the date of an insurance company’s unreasonable conduct. Statute of limitations in these cases can be difficult to determine sometimes, therefore it is important to contact an attorney immediately if you feel like your insurance company is not keeping its part of the bargain.

I think my insurance company treated me unfairly in handling my claim, but I don’t have the money to hire an attorney, and besides is it worth my time and effort to go against a large insurance company?

YES. The reason insurance companies treat their policyholders unfairly is because they think they can get away with it. Juries across the country are letting insurance companies know that they will not tolerate such conduct. Many attorneys, including our firm, take bad faith cases on a contingency fee basis. This means that you do not have to pay the attorney any thing unless he/she is able to recover for you, and then it is a percentage of the total recovery. WE HAVE THE RESOURCES, EXPERIENCE AND DEDICATION TO TAKE ON ANY INSURANCE COMPANY.

 What is my case worth? 

As much as a jury thinks its worth based on the conduct of the insurance company. Verdicts range from thousands to millions of dollars. The jury is to consider the financial losses you incurred as a result of the bad faith conduct, your embarrassment and loss of reputation, and your mental pain and suffering. Under certain circumstances the jury will also consider awarding punitive damages.

Where can I receive more information?