You expect your insurance company to provide coverage in the event you make a claim. Unfortunately, however, this may not happen. When insurers unfairly deny claims or disagree over what’s covered, policyholders get left behind. When it does happen, I review the policy, what the insurer said, and whether they match.
I also handle coverage questions before any dispute, on a flat-fee basis, for policyholders and other counsel.
Denied Claims and Coverage Disputes
Insurance companies often deny claims, sometimes for legitimate reasons and sometimes without a reasonable basis. If your insurance company refuses to pay on a claim that your policy should cover, reach out to me. I can review the insurer’s basis for the denial, determine whether its interpretation of the policy was reasonable, and assess whether the insurer complied with claims-handling requirements.
If the denial is unreasonable, I can explore remedies to challenge it. These could include requesting reconsideration, providing additional supporting documentation, filing a complaint with the California Department of Insurance, or filing a lawsuit.
Duty to Defend and Indemnify
Under your insurance policy, your insurer may have a duty to provide and pay for a legal defense for a covered claim or lawsuit. This is known as the duty to defend, and it’s an important but sometimes overlooked benefit of insurance coverage. Your insurer may refuse to provide a defense, but that doesn’t mean its decision is final.
The duty to indemnify is similar but different. Generally, this refers to an insurance company’s obligation to pay a court judgment or settlement for which the policyholder is legally responsible.
Coverage Opinions and Second Opinions
Sometimes the question is what a policy covers, before anyone has denied anything. A coverage opinion is an independent analysis of whether a policy responds to a claimed loss, based on a review of the policy, its endorsements and exclusions, and the facts of the underlying matter. A second opinion serves a related purpose when coverage has already been analyzed, and questions remain. These often arise on a reservation of rights, on the exhaustion of underlying limits, or when a settlement number is being discussed, and the available coverage has not been confirmed.
Coverage Program Analysis
A single policy does not cover every loss. When a claim spans several years or layers of coverage, the program structure matters as much as the language of any one policy. Coverage program analysis addresses how primary, excess, and umbrella layers attach, which policy periods respond, and how a continuous or progressive loss is allocated across them. The analysis can be reduced to a coverage chart and timeline for use in mediation or in court.
Insurance Archaeology and Lost Policies
Coverage can remain relevant long after a policy expires, and the original policies are often lost or incomplete. Insurance archaeology is the process of identifying and reconstructing historical coverage from secondary evidence. California law does not require producing the policy itself, so a missing policy is a problem to be worked through rather than the end of the inquiry. This comes up most often in claims reaching back decades, including institutional abuse, environmental and toxic exposure, asbestos, and construction defect matters.
Complex Issues. Simple Explanations.
Disputes may involve whether the insurer honors these duties and related matters, such as policy limits and the choice of legal counsel. Legal action can compel the insurer to defend and indemnify you in accordance with the terms of your coverage. Contact me to learn more. I meet with clients in English, Armenian, and Russian.