1. An insurer may be acting in bad faith if the insurer delays, discounts or denies payment without a reasonable basis for its delay, discounting, or denial.

2. Failure of insurer to acknowledge and reply promptly upon notification of a covered claim.

3. Failure of Insurer to pay a covered claim as a result of failing to do a proper, prompt, and thorough investigation as to reasonable liability and damages based upon all available information.

4. Failure of insurer to affirm or deny coverage of claims within a reasonable time upon receipt of the claim and/or proofs of loss.

5. Failure to offer or attempt to effectuate prompt, fair, and reasonable evaluation of damages and equitable settlements of claims to insured within a reasonable time where liability is reasonably clear.

6. Insurer attempts to settle a claim for less than the amount to which a reasonable person would have believed was entitled or attempts to substantially diminish a claim requiring an insured to initiate litigation

7. Attempting to settle claims on the basis of an application and/or policy which was altered without notice, knowledge, or consent of the Insured.

8. Making payment(s) for claims without accompanying statement indicating the coverage for which payment(s) are being made.

9. Insurer failure to make known any arbitration award appeals policy in an attempt to settle a claim for less than the arbitration amount awarded.

10. Insurer requiring claimant or physician to submit both a preliminary claim report and formal proof of loss forms which contain substantially the same information.

11. Failure of insurer to promptly settle claims, where liability and coverage is reasonably clear under one portion of the insurance policy in order to influence settlements of coverage for
another portion(s) of the policy.

12. Failure of insurer to promptly provide a reasonable explanation and basis when denying or making a compromise offer of claim settlement.

13. Failure of the insurer, when making a cash payout to settle a first-party auto insured claim, to pay the same amount which the insurer would pay if repairs were made.

14. Requesting over burdensome documentation demands not required by the policy.

15. Reference or focusing on recovering on the uninsured portion
of the loss.

16. Using illegal and fraudulent investigative methods and
Procedures.

17. Using harassing, intrusive, or demeaning investigative methods and procedures which victimize the insured.

18. Failure of an insurer to settle a claim directly, when and where settlement is required, and instead requiring the insured to pursue a claim against another party first before offering a settlement.

19. Failure of Insurer to make full and satisfactory payment of a first-party claim prior to requiring settlement or exhausting the limits of a third-party insurer.

20. Failure of Insurer to unreasonably refuse to waive subrogation thus hindering or preventing a claimant from reaching a settlement with the party at fault.

21. Unjustified contention and/or “lowballing” regarding the value of a loss.

22. Intentionally withhold, misinterpret or misconstrue claims information and/or failure to not inform insured of provisions and covered benefits under the policy pertinent to a claim.

23. Attempts to use indiscriminate measures, references, and/or procedures that diminish or reduce the top line amount or value representing full payment of the claim.

24. Intentional or irresponsible non-disclosure and withholding of information, misinterpretation of file documents, and/or policy provisions, that would be in favor of the claimant.

25. Wrongful threats not to pay claims

26. Utilization and/or development of deceptive insurer schemes or use of outside company services set up or conducted to carry out the same false pretense schemes for the purpose to be able to wrongfully deny or reduce payment of claims.

27. Insurer advise claimant not to hire a lawyer.

28. Treatment of insureds represented by attorneys as insurer adversaries.

29. Treatment of insureds and claimants as adversaries.

30. Significant increase in the amount of premium as a result of making a claim where the insured was not at fault and in conflict with industry standards.

31. Cancellation of a policy as a result of making a claim or result of an accident where the insured was not at fault and in conflict with industry standards.

32. Failure to live up to, conform, or comply with industry standards.

33. Using inaccurate or wrongful information of a factual or legal nature to diminish, deny, or delay payment of a claim.

34. Not being forthcoming with facts regarding coverage to deny, delay, or reduce the amount of the claim.

35. Using extreme undue persecution, wrongful and victimizing tactics and actions, meant to crush, threaten, thwart, intimidate, oppress, in order to scare away and get the claimant not to make or pursue a claim.

36. Failure to convey to insureds settlement offers and demands of adversaries in accident and liability cases.

37. Changing or altering policy coverage without informing or receiving the consent of the insured.

38. Representation by an insurer that an investigation “of fact” is taking place, knowing that no investigation is being done, in order to intentionally stop and dismiss an inquiry by a plaintiff, plaintiff’s attorney, or DOI examiner.

39. Biased investigation of that which is supposed to be neutral and unbiased.

40. Repeated and constant reference and intentional miscommunication and misrepresentation by insurer downplaying the size of a claim to the insured’s attorney.

41. The same claims person of an insurer handling conflicting and both sides of the same or related claims.

42. Deviating from standard procedures called for in an insurer’s claims manuals.

43. Attempting to prevent the court or an insured’s attorney with due exception from securing a copy of an insurer’s claims manual.

44. Abusing and/or misusing the judicial court system in order to delay or settle in good faith payment of a claim where liability to the claim is clear and amount of the claim is reasonable in order to delay insurer’s having to make payment of a claim.

45. Fraudulently misrepresenting and revealing various conflicting financial information that mischaracterizes the true financial information and status of an insurer.

46. Attempting to shift blame and responsibility of investigation to insured and away from the insurer.

47. Insurer refusal to settle a third-party claim against an insured within the limits of the insured’s policy thereby exposing the insured to additional liability.

48. Intentionally misinterpreting or misconstruing the law to the disadvantage of the insured and benefit of the insurer.

49. Deny treatment for a covered health benefit because of its expensive cost and instead misrepresenting and suggesting a less costly procedure in its place to be just as effective when it is not.

50. Unreasonable denial of a covered health benefit because of its high cost.

51. Unreasonable misinterpretation of policy language.

52. Taking undue excessive advantage of the unlimited time when knowing there may be no time limitations established on alleged investigations of such matters or matters of fact.

53. Making health insured patients pay their standard copay when the cost of both the drug and the pharmacy’s fee for dispensing the managed care prescription is lower than the copay amount.

The post 53 Signs Of Bad Faith Insurance Claims Settlement Practices appeared first on D.A. Lamont.

You would think that since you purchased something you would get the value of that service if and when it is needed. But it’s not that easy. No other industry works like this, where you purchase something and have to right to actually get the value. This is why you need a public adjuster on your side.

Review the Reasons for Denial

If and when your insurer denies your claim, they will send you a letter explaining their reasons for why your claim was denied. Be sure to read the letter thoroughly, and read the language in your policy. You need to obtain the full policy coverage language, oftentimes you have to ask your insurance company for the proper documents.

Contact Your Insurer

It’s often frustrating to even get your insurance company on the phone, but you’ll need to in order to collect the proper documentation. The frustrating part is often times when you call, you get someone different on the phone each time. On the flip side, if the insurance company calls you, keep notes of these conversations, but respond in writing. Try to be polite, since the person answering the phone isn’t the one who denied your claim, and you probably are being recorded.

Appeal the Denial

Your insurer should have given you instructions to appeal the denial of your claim. Follow this procedure closely because you can have an appeal denied on a technicality. Prepare your appeal with care, your public adjuster can help you. You will want your public adjuster to review what you’ve written to make sure you’ve included all the information the company wants to see.

Why You Need a Public Adjuster

You have the option to hire a public adjuster to evaluate your claim. This can bolster your argument that your request for assistance was unfairly denied. Public adjusters often offer a free policy evaluation, so if one is offered to you, be sure to take it.

When you are intimidated by the process and the stress this denied claim has caused, it can be difficult to advocate for yourself, even when a substantial claim is at stake. Your personal emotions can get in the way of an amicable solution.

Since public adjusters know how the system works, they can help you prepare an appeal that is less likely to be denied and even speak to the company on your behalf. You can hire a public adjuster at any time during the process, but the sooner the better.

The post Why Insurance Companies Deny Claims and What to do About it. appeared first on D.A. Lamont.

However, arriving at a settlement with your insurance company can be a long and complex process full of investigations and negotiations conducted by an insurance adjuster working for the company. One thing you always have to keep in mind when working with an insurance adjuster to arrive at a settlement figure is that the adjuster ALWAYS wants to pay you as little as he or she possibly can.

Insurance agencies are businesses that are focused only on their bottom line, and they pay little mind to the emotional side of your case. Their goal is almost always to get you to agree to the lowest possible settlement while staying as friendly as possible to you.

In this blog, we have detailed five useful tips to help you ensure that you receive the best possible settlement offer from your insurance company, so that you can collect the compensation that not only you deserve, but that you paid for.

1. Hire a Public Adjuster

The most important thing you can do to ensure you receive a fair settlement offer from an insurance company is hire a public adjuster. Public Adjusters are the experts on your side, who will fight the experts your insurance company has working for them.  Hiring a public adjuster will also help ensure that the insurance company takes your claim more seriously.

The more evidence your public adjuster is able to present to the insurance company with regard to your property damage and the costs of repairing those damages the stronger your case for a high settlement offer. Keep detailed records of all financial costs, and any other evidence that could possibly demonstrate a lowered quality of life.

2. Save all your receipts

If you are seeking insurance settlement compensation be sure to save all receipts in relation to repairing your property. Insurance companies have processes for documenting such receipts, your public adjuster can help you manage and document such receipts. The more organized you are, the easier and quicker it is to collect your repayment.

3. Do not take the first offer

You should rarely if ever, accept the first offer from the insurance company. The settlement determination is a negotiation, and as with any negotiation, the company is not going to come in at the highest offer they willing to give, no matter what they may tell you. Have a minimum figure in your head you are willing to accept and do not accept any less.

4. Make the company justify the offer

Insurance companies will commonly low-ball you with their settlement offer because, as we previously mentioned, their goal is to pay you as little as possible. If the company offers you an unreasonable settlement, ask them to explain exactly how they chose that figure, and what factors played into their decision. You can then respond to each justification and explain why you deserve more than what is being offered, particularly if the justifications are not very strong.

5. Confirm accepted offer in writing

Once you and your public adjuster decide that the figure is high enough to accept the offer from your insurance company, you should confirm the details and your acceptance of the offer in writing so that the insurance company cannot falsely claim that they made no such offer in the future and refuse to pay.

If you have sustained property damage, you deserve the policy you paid for and you are entitled to fair compensation. Do not allow an insurance company to take advantage of you or give you a settlement that is less than you rightfully deserve.

The post Top 5 Tips for Getting the Best Possible Settlement from Your Insurance Company. appeared first on D.A. Lamont.

Many people don’t realize that insurance companies, like banks, earn their profits from investments, which can take on many forms. The profitability of a company depends on how much money they have available to invest. If a company owes X million to all claimants at a given point in time, it can save say 12% (or more) of that per year in investment profits by engaging in delay tactics. Other tactics like low-balling and wrongful claim denials can help insurance companies save even more.

Policyholders are often at the mercy of their insurance company. The company wrote the policy, the company interprets the policy, the company evaluates the claim and the company holds the money.

So the policyholder is really at a substantial disadvantage to the insurer. Fortunately, public adjusters exist for this very reason, to right for the homeowner who needs to deal with insurance companies.

Public adjusters know a thing or two about how to deal with insurance companies, and the tactics they use to deny and stall claims. Below are 7 things your insurance company doesn’t want you to know.

Note: This content was provided by badfaithinsurance.org

1. An insurance company must act in utmost good faith in the interpretation of their policies, and in the investigation and payment of claims.

It is unlawful for an insurer to engage in unreasonable delay; to put their financial interests ahead of the financial interests of the policyholder, or to lowball (underpay) claims. They cannot use deception or trickery in sales or claims handling. They cannot compel an insured to hire an attorney in order to be paid what they are owed. They must be fair to their policyholders. The violation of any of these standards is a violation of the duty of good faith which the law imposes on insurance companies. It exposes the carrier to potentially significant damages.

2. If an insurance company unreasonably denies a claim or breaches its duty of “Good Faith and Fair Dealing,” and you must sure them in order to recover your policy benefits, the insurance company must pay for your legal costs and attorney’s fees.

If the attorney’s fees and other damages were not available, the policyholder could not be made whole and the insurer would be able to under-settle claims merely by arguing that they are offering more to settle that than what the uninsured would net on the actual value of the claims, after payment of their legal fees. If an insurer makes this argument to you in an effort to underpay, thank them in advance for offering to pay your costs and attorney’s fees. That is exactly what they doing by engaging in such conduct.

3. If an insurance agent misrepresents the coverage being provided at the time the agent sells you your policy, the insurance company will have to honor the coverage representations made by their agent.

Insurance agents are really nice. Otherwise, they wouldn’t be able to sell you any policies. The same is true for claims adjusters. Otherwise, they wouldn’t be able to settle any claims. It is important to distinguish these nice individuals from the company itself. The purpose of an insurance company is not to be nice, but to make money for its stockholders. If it makes more money than expected, the stock goes up. If it makes less money than expected, the stock goes down. When the stock goes up, executives are given bonuses. When the stock goes down, they are given headaches. The name of the game in the home office begins with the word “profits.” Don’t ever forget this. When the home office trains agents or claims adjusters they don’t tell them to be sinister. There are no conventions at which agents are taught to misrepresent coverage and adjusters are taught low-balling techniques. What does happen, however, is that agents are told very little about the policies they are selling. They may know something about what is covered, but they know very little about what is not.

If you were to spend the rest of your life talking to insurance agents about policies they are selling, you would probably not, and a single agent who would be able to simply pull out a policy and explain it. The truth is that agents don’t understand policies. They just sell them. Most agents won’t even show you a copy of the policy they are urging you to buy. If you ever see a policy at all, it will probably be sent to you in the mail directly by the insurance company days, or weeks, after you have purchased the insurance. So at the time of sale, you don’t know what you are buying other than what the company or agent promotional or sales pitch conveys to you.

4. If the amount of your insurance coverage is not sufficient to cover your actual loss because the insurance agent recommended that you insure for less than the amount you actually needed, the insurance company may be responsible for paying your entire loss, not just the amount of the policy benefits.

For example, when an individual purchases a business property or homeowner’s insurance, they will often ask the agent what the policy limits should be before the particular property in question. Sometimes, the agent, in attempting to give you the lowest premium bid possible (in order to beat out the competition), will underinsure the property, (e.g. insuring a property for $600,000 that would cost $800,000 to replace) thus lowering the premium quoted. Perhaps the agent rationalizes that the policy contains a “replacement guarantee” anyway. The problem is that replacement coverage is useless unless you actually rebuild the property with “like, kind and quality: of what was destroyed. In the event of catastrophic loss, many policyholders decide to take their insurance payment and buy elsewhere, rather than actually rebuilding. In that case, the underinsured policyholder loses a bundle. Moreover, personal property and business property are usually insured under these policies as a percentage of the face value of the policy, not a percentage of the replacement value of the property. Therefore an underinsured policyholder is uninsured for both the building coverage and the personal or business proper coverage.

This is another good reason to take notes when you buy your policy in the first place and to keep these notes in your insurance file. If the limit which your purchased were recommended by the insurance agent and they are insufficient, you are entitled to be paid for all losses on the basis of what your limits should have been.

5. The insurance company, not the policyholder, has the obligation of providing the applicability of a “limitation” or “exclusion” in the policy.

Insurance policies typically contain a very brief “insuring clause” describing what’s covered. Dozens of paragraphs and thousands of words are then spent listing exclusions, exceptions, and limitations. When a large claim occurs, insurance companies want to be able to write a letter to their policyholder denying coverage by quoting from one or more of the “exclusions.” The bottom line will be that they sure would like to pay your claim, but golly darn, they just can’t. Many insureds will either accept what they are being told or will seek advice from someone in the insurance industry or from a lawyer who doesn’t specialize in this field. As a result, many legitimate claims go either unpaid or severely underpaid.

What you should know is that the insurance company, not you, has the burden of proving that an exclusion or limitation in the policy is (1) clear, (2) conspicuous, and (3) applicable. The shifting of this “burden” concerning exclusions – to the insurers – is contrary to the usual rule of the law that the party making the claim is the one who hears this burden. Because most policyholders are unaware of this rule, insurance companies often avoid paying legitimate claims based on exclusions that, if challenged, the exclusions, to the company.

6. In cases involving your insurance company’s duty to defend, its duty to defend is broader than its duty to indemnify.

The liability portion of every business, homeowner, auto, or similar insurance policy is the portion of the policy that protects you from lawsuits by others. It requires the insurance company to pay your legal defense costs and fees if you are sued. Sometimes an insurance company will say that it doesn’t have to defend you because you have been sued for something that is not specifically covered in the policy. It must also defend you in any situation which potentially seeks covered damages. For example, if a complaint filed against you does not see damages within the scope of your overage but is capable of being amended or modified to include such damages, your insurer must defend. Furthermore, if the insurance company learns of facts from any source which would trigger coverage (not just the complaint itself), it must also defend you. In addition, it must defend where the policyholder has a reasonable expectation that it will do so. If there are multiple causes of action in the complaint against you, let’s say that you were sued in a complaint alleging both negligence, breach of contract, and intentional misconduct, then if the insurance company must defend any of those causes of action, it must defend all of them.

If an insurance company that has a duty to defend in a particular case refuses to do so, then it may well be responsible for all resulting damages, including payment of the amount of any judgment entered against you, or of any settlement (including collusive or fraudulent.)

The post 6 Things Your Insurance Company Doesn’t Want You To Know. appeared first on D.A. Lamont.