Dealing with Insurance Claim Denials
Insurance companies sometimes refuse to pay claims submitted by its policyholders. When an insurance company does so, this is called “denying” the claim. A claim may be denied, for example, because the company has determined that the loss is not a type that is “covered” by the terms of the insurance policy or that the person who suffered the loss is not an “insured” for purposes of the policy or that a policyholder engaged in some type of misconduct which “voided” the coverage. Occasionally, a claim may be denied in error. In any event, due to the complexity of insurance policies, any resolution of coverage disputes often requires careful analysis of the unique facts and circumstances specific to the denial in light of applicable state law. Time is of the essence. All disputes have a specific period of time for which they must be addressed, either through the State Insurance Commission, or by legal means. If you think your claim has been improperly denied, find out which statutes or time frames apply to ensure that you preserve your rights and claims against your insurer. Tips on what to do if your insurance claim is delayed or denied: Tips for Delay If your claim is unduly delayed, it is possible the insurance adjuster reviewing your claim has is missing information that they need to make a decision. There may also be times when the adjuster is undecided as to whether to pay the claim. In this instance, it is best to cooperate within reason with your insurer. You can provide the missing information which can turn a potential denial into an acceptance. Whenever you call your insurance company, make every effort to be helpful and not confrontational. Do not let them forget about you either! Telephone your insurer regularly — every 2-3 weeks. Be polite, and be persistent. If you do not receive suitable responses or see any progress always ask for a supervisor or manager. Keep detailed notes identifying who you talked to, what you discussed, and make sure you find out what is to occur next. If you still are not seeing timely progress, contact an attorney who can negotiate on your behalf and/or take the necessary steps to put the insurer on notice of a potential bad faith claim lawsuit. Tips for Denial If your claim is denied, make sure you get the denial in writing and insist on a written explanation of the reasons for the denial. Take note of the reason(s) given in the insurance company’s denial letter. Next, read your insurance policy carefully and check the reason for denial against your policy. Look for anything that does not add up or make sense. The denial may be due to an error based on a lack of complete information, an incorrect reading of your policy or misinformation. But it may also be a correct determination by the insurance company. Document every phone call to your insurer by noting the date, time, name of person you spoke with and a detailed summary of the conversation. Follow-up...
Tips for Filing Your Fire Insurance Claim
Insurance carriers are expecting to receive hundreds of thousands of fire claims in the upcoming months due to the recent southern California wildfires. Given the high number of cases that each insurer within the state will have to investigate, the earlier that you file the better. If your home was damaged by the fires and if you have not yet filed a claim with your insurance carrier, there are some simple tips that may make the difference between being compensated completely for your losses or receiving pennies on the dollar. Typically, homeowners’ policies cover wind, fire and lightning damage. If your home was damaged or completely destroyed by smoke or flames, the typical insurance company will pay to have your home rebuilt or to replace the damaged portions. In addition to paying for physical damage to your home, homeowners’ policies pay for damage to other property and structures on the premises, like your garage or tool shed, damage to your furniture, clothes, appliances and other personal possessions. Additional living expenses will likely be covered as well. Tip 1 – Contact Your Carrier Right Away IN WRITING Contact your insurance carrier to begin the process to file your claim as soon as possible. You will likely need to provide your insurance carrier with the following: A description of your loss. Be as detailed as possible, including: photos police reports inventories or itemizations of your destroyed or damaged personal and real property your date of loss the type of loss or damage that you suffered related injuries identity of all witnesses and all parties involved identity of all repairs that you made or that you know are required plans, accounting books, investigation reports or any other documents that the insurer requests Tip 2 – Know Your Deductible Your deductible is the amount that you are required to pay toward your claim before the insurance company begins to pay. Find out from your insurer how much your deductible is; if your losses are less than the deductible, you may want to reconsider filing the claim. Tip 3 – Keep Your Receipts Keep all of you receipts! If you stay at a hotel, eat at a restaurant, buy clothing, or make any other expenditure because of the fire, make sure you get a receipt. All of these items may be reimbursable depending on your coverage. Your insurance company might even cover your housing expenses, depending on your plan. Policies that include “additional living expense coverage” or “loss of use coverage” options will pay for similar housing while repairs are being made to your home or if you have to permanently relocate. Be aware that in most cases, you must request reimbursement for the expenses that you incurred. Tip 4 – Assess Your Damage Keep track of everything that was damaged, and be as accurate as possible. Identify the manufacturer, brand name, model and the place and date of purchase for as many of your losses as possible. Divide your list into categories, items in different locations in your home such as: living room,...
Deal Reached In Carlsbad Flooding Suit
A $250,000 settlement has been reached in the lawsuit brought by the La Costa de Marbella Homeowners Association against the city of Carlsbad over a leaking storm drain that caused earth movement and damage in the complex. This settlement does not resolve the lawsuits regarding the 2005 landslide that destroyed homes in the complex. Patrick E. Catalano is quoted in the article.
The full text of this article can be found here: www.signonsandiego.com/uniontrib/20051008/news_1mc8carls.html
City Begins Shoring Up Landslide Area
This article discusses the beginning of slope stabilization work to repair the damage from the 2005 landslide above La Costa Avenue in Carlsbad. The article goes on to describe delays in beginning the repair work and examines who is responsible for those delays. Patrick E. Catalano is referenced in the article.
The full text of this article can be found here: www.signonsandiego.com/news/northcounty/20051004-9999-1m4slide.html
El Cajon, Water Panel Sued Over Landslide
Homeowners in a Fletcher Hills neighborhood have filed a lawsuit over a landslide that has significantly diminished their property value as well as left one home uninhabitable. Homeowners claim that the city of El Cajon and the Helix Water District are to blame for the landslide due to a lack of maintenance of water and sewer lines as well as fire hydrants in the area. Patrick E. Catalano is referenced in the article.
The full text of this article can be found here: www.signonsandiego.com/news/metro/20050922-9999-2m22ecslide.html
Under Pact, City Would Pay To Raze Ruined Condos
In an agreement that is expected to be signed shortly, the city of Carlsbad has agreed to pay for the demolition and removal of the eight units destroyed in the La Costa de Marbella landslide along with grading of the area after the removal is complete. This agreement will raise the total that the city has pledged towards stabilizing the slope where the landslide occurred to $1.6 million. Patrick E. Catalano is quoted in the article.
The full text of this article can be found here: www.signonsandiego.com/news/northcounty/20050825-9999-1mc25marbel.html
Oceanside Residents Spared Cost Of Lawsuit
The city of Oceanside decided against a rate increase on city resident’s water/sewer bill in order to cover the costs of a lawsuit over a landslide. The landslide damaged homes on Arroyo Avenue and Comanche Street, leaving six uninhabitable. The City is now considering other options including dipping into the water and sewer reserve funds in order to cover litigation costs. Patrick E. Catalano is referenced in the article.
The full text of this article can be found here: www.signonsandiego.com/uniontrib/20050804/news_1mc4oside.html
La Costa Slope Repairs Will Move Forward, Says Official
The repair agreement in the La Costa landslide is back in place after Patrick E. Catalano, new attorney for the homeowners association, charged that the city of Carlsbad broke the previously signed agreement by not beginning repair work fast enough and not sharing repair plans with the La Costa de Marbella Homeowners Association. The reinstated agreement will give access to land owned by the homeowners association to begin slope repair above La Costa Avenue. Patrick E. Catalano is referenced in the article.
The full text of this article can be found here: www.signonsandiego.com/news/northcounty/20050722-9999-1mi22slide.html
Dreams’ Reduced To Dust In Oceanside
Demolition and removal of the landslide-damaged homes on Arroyo Avenue has begun, and the city of Oceanside has committed $68,000 to complete the project. The removal is partly intended to protect the houses below on Comanche Street from any damage that could be sustained due to the houses on Arroyo Sliding further down the hill. Patrick E. Catalano is referenced in the article.
The full text of this article can be found here: www.signonsandiego.com/news/northcounty/20050715-9999-1mc15arroyo.html