If your insurance company has denied or underpaid your claim or is otherwise disputing coverage, it may be time to retain legal counsel. Although claim denials can be and often are valid, not all of them are. The insurance company could be mistaken or acting in bad faith. You have options for challenging the decision.
Why Insurers Say They Denied a Claim
After your insurance company has denied or underpaid a claim, you should read its decision to understand why. The insurer may give any number of reasons, including:
- The insurance policy excludes the claimed loss
- The policy does not cover a particular type of loss
- The insurer views the value of the loss as less than what the policyholder believes it should be
- The policyholder did not satisfy a required condition
- The policy lapsed, expired, or was not in effect when the loss occurred
- The policyholder engaged in misrepresentation or fraud
Coverage disputes therefore arise over anything from whether the loss is covered at all to how much the insurance company should pay. They can also involve issues with the policyholder’s actions related to the loss or policy.
How an Attorney Can Help
Just because the insurance company has denied your claim or failed to pay what it’s worth doesn’t mean it’s the last word. I can review the insurance company’s decision, compare it to your policy, and assess whether the insurer’s interpretation and application of the policy holds up.
If the denial is not supported by the policy, or the insurer withheld benefits without a reasonable basis, there are various ways to challenge it. These could include appealing the decision to the company, requesting reconsideration, or submitting additional documentation. If the company continues to deny the claim or pay less than its full value, legal action may be necessary. This could include filing a lawsuit. You can also file a complaint with the California Department of Insurance, though a regulatory complaint prompts a review of the insurer’s conduct rather than recovering benefits for you directly.
One caution about timing. Property and other first-party policies often contain their own deadline to sue, separate from the ordinary statute of limitations, and it can be shorter than most policyholders expect. An appeal, a reinspection, or a long negotiation with the insurer can quietly consume that time. If you are already some way into a dispute, it is worth checking early.
Defense-trained. Policyholder-focused.
I can help you with each of these steps. Give me a call or complete my online contact form to get started. I meet with clients in English, Armenian, and Russian.