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,...
Town Homes’ Owners Owners File Claims Blaming Carlsbad For Damage
The two residents of Sacada Circle are alleging that grading work done by devlopment firm Calso, LLC., with the blessing of the city of Carlsbad, caused a landslide which damaged their homes. The city disputes the fact that a permit to allow grading work was ever issued. Patrick E. Catalano is referenced in the article.
The full text of this article can be found here: www.signonsandiego.com/news/northcounty/20050527-9999-1mi27lacosta.html
Lawsuit Filed Over Condemned Oceanside Homes
The lawsuit filed by the homeowners claims that cracks in city water and sewer pipes caused the landslide while the city maintains that unusually heavy winter rains caused the slope failure. A court order was also obtained to keep city workers from ‘slip lining’ a damaged sewer pipe in order to allow experts for the homeowners to examine the pipe for evidence related to the lawsuit. Patrick E. Catalano is quoted in the article.
The full text of this article can be found here: www.10news.com/news/4536551/detail.html
Oceanside Would Pay Bill For Demolition, Add Property Liens
Under the plan, the city would initially foot the bill for razing the homes ($20,000 – $40,000 per home) and then put a tax lien on each house for the cost of demolition which would be paid when the property is sold. Patrick E. Catalano is quoted in the article.
The full text of this article can be found here: www.signonsandiego.com/news/northcounty/20050512-9999-1mc12arroyo.html
Vandals Hit Condemned Oceanside Homes Sliding Off Foundations
Homeowners say that vandals have been breaking into the structures and removing light fixtures and other objects. They have also voiced concerns that they could be held liable should someone get injured while on the property. Patrick E. Catalano is quoted in the article.
The full text of this article can be found here: www.signonsandiego.com/news/northcounty/20050509-9999-1m9oside.html
$19 Million In Claims Filed Against Oceanside
The claims ask for $750,000 for the value of each home plus $50,000 for loan costs and another $350,000 for emotional distress. The claims blame the city for the landslide due to inappropriate maintenance of water and sewer lines. Patrick E. Catalano is referenced in the article.
The full text of this article can be found here: www.signonsandiego.com/news/northcounty/20050420-9999-1mi20claims.html
Condo Owners Ask $8.1 Million From Carlsbad
The $7.1 million claim made by the homeowners association states that the cause of the slope failure that damaged the complex was the city’s failure to maintain lines that service fire hydrants in the area. It alleges that water from these lines then seeped into the surrounding area, saturating the hill and causing the slope failure. Patrick E. Catalano is quoted in the article.
The full text of this article can be found here: www.signonsandiego.com/news/northcounty/20050419-9999-1m19slide.html
2 Homeowners File Damage Claim Against El Cajon
Each homeowner has filed a $1 million claim with the city. One of the homes has been ‘red tagged’ (meaning it is no longer inhabitable) while the other was damaged severely enough that the owner is no longer living on the premises. Patrick E. Catalano is quoted in the article.
The full text of this article can be found here: www.signonsandiego.com/uniontrib/20050407/news_2m7ecslide.html