Property Insurance Claims FAQs
The attorneys at Louis Law Group will select and, in most cases, foot the bill for industry experts specialized in your type of claim to help you, the policyholder, build a formidable case.
From contractors to engineers and even freelance professionals, Louis Law Group hires only seasoned and experienced experts to comprehensively review your insurance claim. The use of professionals as expert witnesses differentiates Louis Law Group from the plethora of other insurance law firms out there.
The attorneys at Louis Law Group will thoroughly assess any claim and help policyholders receive their rightful benefits. Also, our first review of your insurance claim will cost you nothing. We act on behalf of policyholders, and represent them nationwide.
Attorneys at the Louis Law Group often work on a contingency basis. This means that we only get paid if you win your case. Typically, Louis Law Group will have to seek the services of industry professionals, amongst other resources, as the case progresses to help us build the best possible case on your behalf. The seasoned attorneys at Louis Law Group are fully aware that seeking the impartial and expert analyses of such experts can be the difference between a successful and unsuccessful claim. We are thoroughly committed to getting the maximum settlement for all our clients, and will generally advance most cost pre-settlements.
Louis Law Group demands that you provide the following documents, where possible:
For Commercial and Residential property claims:
- A copy of your insurance policy, or copy of a related declaration page alluding to such.
- Denial letter
- All correspondence and documented conversations to and from the insurance company
- Any estimates of items or property to be repaired/replaced
For Healthcare Claims:
- Copy of insurance policy
- Name of insurance carrier
- Any explanation of benefits and/or rejection letters
- All bills related to or received from the hospital or collection companies
- The reason for hospitalization/circumstances surrounding health problem and/or related procedures.
- The interest of the insurance company and policyholder must be in tandem, and the ultimate goal must be mutual.
- They must show willingness to help the policyholder with their claim.
- They must reveal to the insured all the applicable benefits, coverages, and deadlines applicable to the claim, and carry out an impartial and thorough investigation at no cost to the insured.
- They may not refute a claim, whether in part or full, based on impartial, insufficient or unverified information. Where there is a full or partial denial, the insurance carrier must provide a comprehensive written explanation, referencing the facts and policy provisions.
- They must not distort policy provisions or facts.
- They may not make any abysmally low settlement offers.
- An insurer must set realistic standards for the quick evaluation of claims. While evaluating a claim under a replacement cost policy, it is wrong for an insurer to subtract the cost of depreciation from the claim.
- A failure to reasonably and impartially evaluate a claim is not grounds for the insurance company to reject the claim based on a lack of information or reliable information.
- An insurance company may not blatantly overlook evidence that supports coverage. Where there is a denial of a claim, the insurance company must thoroughly explain the reason(s) to the policyholder, while referring to the facts in the insurance policy or any applicable law that gives credence to why the claim was rejected.
- The insurer must not discriminate during the claim settlement based on the claimant’s gender, income, race, religion, origin, disability, sexual orientation or the location of property or person insured.
- An insurer must keep the insured updated about the status and any relevant information or facts about their policy. Also, the insurer should disclose all major facts to the insured without distorting the facts or policy requirements related to the coverage, whether partially or in full.
- An insurance company must acknowledge and act swiftly to address any issue concerning a claim regarding an insurance policy, and must respond and act accordingly to ensure that an investigation into the claim is promptly carried out.
- Where the insured is unsure or not knowledgeable of a claim or benefit in their insurance policy, the insurance company is obligated to reveal these benefits to the insured.
- An insurance company must not operate a claims department like a for-profit business and must keep a record of all claims and related activity.
In the insurance industry, bad faith refers to a situation where contractual obligations to a policyholder aren’t met. Examples of bad faith include intentionally giving wrong information to a policyholder or failing to act in accordance with the typical industry standard.
This would heavily depend on the prevailing law that determines/interprets insurance practices and policies in your locale. The fact that an insured can file a bad-faith lawsuit against an insurance company helps ensures the impartial and prompt payment of benefits and claims when the insurance company has neglected to act. However, an insured must not consider bad faith as a route to getting a guaranteed payment from an insurance company. Generally, bad faith litigation offers a more favourable result when it is backed up by a previous court ruling. Bad faith often originates when an insurance company refuses to pay benefits that are applicable under a policy, or any other unfair behavior by the insurance company.
Whether a refusal to pay benefits escalates to bad faith mainly depends on why the insurer deems it fit to withhold benefits. When the insurer has a good reason not to effect the payment of benefits, this may not be termed a contractual breach or bad faith. Every case of withheld benefits isn’t necessarily bad faith; therefore, it is important that the case be carefully considered before a file for bad faith is made.
You must file a lawsuit against your insurer after a loss during the statute of limitations period. This time will vary based on the details of your policy and the state you reside in. If you would like swift legal redress regarding a claim, you should begin the process as soon as possible if you wish to receive your claim in full.
Usually, a defense counsel will claim fraud if a policyholder purposely refuses to answer a question at EUO. In such a scenario, the insurer can argue that the policyholder is breaching their obligation to cooperate. Most times, the insured may refuse to answer very sensitive or personal questions, but the insurer is allowed to thoroughly probe into specific areas in the course of their examination that may reveal any unclear information (e.g., how much the policyholder actually earns).
The stance of the court is often that the EOU is a contractual duty that must be adhered to before the insured can claim recovery. It is not unusual for the policyholder to be asked to answer questions regarding the actual loss or the circumstances regarding the loss.
Refusing to submit to an EUO is considered a violation of your contractual obligation with your insurer. An examination under oath is different from a deposition, since the former involves an agreement by contract where the policyholder is obligated to give accurate information on request to the insurer. During a deposition, no such demand exists. Therefore, depositions cannot take the place of an EUO.
Usually, property insurance policies will come with an appraisal provision that can be invoked by either the insured or insurer to ascertain the value of a loss. The responsibility of “valuation” is often termed by the court as a duty of the appraisal panel, and “coverage determinations” are determined by the court. The court isn’t explicitly clear on what can be classified as “valuation” (which can be verified through an appraisal) or classified as “coverage determination” (which must be defined by a court). Policyholders who feel that their claim has been partially underpaid or valued commonly opt for an appraisal provision, in a bid to evade the expense and time associated with litigation. However, one of the following answers is often given to the insured by the insurer:
- “An appraisal isn’t necessary for the mode of repair.”
- “Appraisals are not compulsory to ascertain the cause of damage.”
Experiences from prior cases demonstrate the importance of policy interpretation. Policyholders must, therefore, pay attention to the following facts in first-party property claims:
- Minor fact-based changes can potentially and severely alter the result in a coverage evaluation.
- In some cases, property insurance companies may have exclusions that denote cases where an insurer may not be liable to cover a loss “to the interior of any structure or building, or any items inside the structure or building, due to rain…” Here, it is crucial to check whether the policy clearly describes the word “rain”, as this may determine if the loss will be covered or not. The insurer may cover the loss if there are damages to the exterior walls or roof of the building or structure caused by rain.
This sort of policy exclusion/limitation is popularly described as the “wind-driven rain” exclusion. It is highly recommended that the insured is knowledgeable of the basic provision when reporting claims to their insurance company or giving an official statement of the loss
There are numerous aspects to be evaluated during the examination of losses and damages to your property. Were there any prior damages before the loss? Is the insurance policy only liable for losses and not damages? Can there be loss without damage? Was there any previous damage caused by any other factor (wear and tear)?
Usually, the property insurance proof of loss is often included in the formal claim, including:
- The cost
- The parties making a claim under the policy
- Parties with interest
- The cause and date of the loss
- Any proof or document showing the extent of the loss.
This policy typically requests that the policyholder swear that the proof of loss is accurate. It also has to be signed by the insured. The timeframe for submitting a proof of loss will differ based on policy and state. Thus, you should confirm the exact permitted time limit for a proof of loss in your state. In some states and some instances, submitting a proof of loss after the allotted period can become a reason for the insurer to reject an otherwise valid proof of loss.
Once the claim has been filed, the insurer must instruct a licensed insurance adjuster to verify that the property of the insured can be restored to the condition it was in before the damage. As a policyholder, you are expected to peruse the policy and be aware of the demands of the requirements and applicable obligations in the case of a loss.
The Responsibilities of the Insurance Provider
The insurer must:
- Comprehensively and quickly investigate the claim(s) of the policyholder.
- Have an unbiased and fair approach to the policyholder.
- Quickly pay out any claims or benefits regarding any damages.
- Succinctly and comprehensively outline in writing why all or a part of the insurance claim was denied or withheld.