Life Insurance / Bad Faith / 1st Party Claims

Insurance / Bad Faith Insurance / 1st Party ClaimsThe type of insurance claim we handle is where an insurance company refuses to pay a claim that one of its own insureds (customers) is making.

This is where the customer makes a claim for benefits. In other words, the customer has a piece of property he believes is covered by an insurance policy, the property gets destroyed or damaged and the insurance company denies the claim for benefits citing any number of reasons. Some of the reasons are typically:

  1. The customer missed a payment
  2. Misrepresentation on the Policy Application
  3. Information was not Timely Updated
  4. Insurance Company Believes the Insured is Committing a Fraud
  5. Many Others

The insurance companies rely on your ignorance of the laws and your rights under the policy of insurance to deny your claim, or make only partial payment, or delay payment of the claim.

There are specific requirements for insurance companies to follow when a claim is made. These requirements are found in the Texas Insurance Code.

The insurance company enters into a contract (bet) with you when you buy an insurance policy. The bet is - you will pay them $$$ monthly, yearly, or some other time frame, and in return they will pay for loses or liabilities that you incur. They are playing the odds and betting you and others like you will not have bets they have to pay on, and in the end they will make a profit. Nothing wrong with that except you need to realize that when you make a claim for benefits the insurance company is essentially losing their bet. They do not like to lose their bets. They (the insurance adjusters) will look hard to find reasons to not pay up. Sometimes their reasons are good...but too often the reasons are not real. Sometimes they fake reasons to keep from paying you. Our office frequently catches someone in the insurance company line of agents or employees falsifying documents to justify their position. Other times, they cite a reason for not paying when they know the reason is not valid, but they rely on you not knowing the reason is not a valid reason.

Reasons to call us:

  • Life Insurance Benefits are being Denied when a Loved One Dies
  • Your Car Damage Claim is Being Denied
  • Your Home Owners Insurance Company is Refusing to Compensate You For Damages
  • Your Short-Term or Long-Term Disability Benefits are Being Denied
  • Liability Coverage You Have Paid for is Being Refused
  • Any Property Damage Claim is Being Denied
  • The Insurance Company is Questioning Your Honesty
  • Coverages Under Mortgage Payments or Car Payments or Credit Cards are Being Ignored

Other problems people have to deal with involve the insurance company delaying payment or making unreasonable requests or demands on you before they will pay. The insurance company does this believing that you will grow tired and weary of the process and just give up.

An insurance company is not limited to a "big company." The insurance company is liable for the actions of it's adjusters and agents.

Adjusters want to impress their supervisors and advance within the company. One way of doing that is by limiting the amount of money paid on a claim. An adjuster will often times ignore the claim, particularly small claims, in the hope you will just go away. Other times, they are swamped with other claims and end up ignoring your claim because it is too complicated. Or they simply do not like dealing with you. Maybe it is personality conflict or the two of you did not hit it off well. Maybe they think you are being less than honest with the claim. Whatever the reason, they have a job to do and the Texas Insurance Code in Section 541.060 sets out some of the things they can be liable for when they do not perform their job properly. As for being slow in the way a claim is handled, that is covered by the Texas Prompt Payment of Claims Act.

As to Agents. Agents are salesmen. The way they get paid is by selling policies. While most agents are very professional in performing their job, some take short cuts in order to get the sale. They will fill out an application incorrectly when you have given then correct information, knowing that if they are truthful, that the policy may not get issued and they will not get their commission. Other times they are simply a bit lazy. Rather than answering your questions about the policy correctly, they will be too general about coverages, leading their customer to believe they have one type of coverage when what they actually have is something else. Misrepresenting a policy is covered by the Texas Insurance Code, specifically Section 541.061. In the worse case scenarios, agents will falsify documents. If a policy an agent writes has a claim made on the policy, then the claim affects the "loss ratio" for the agent and thus negatively affects his profit sharing or bonus at the end of a year.

It is not our intent to paint adjusters or agents as bad people. It is our intent to show they are human and have their own reasons for doing some of the things they do. In this office, we see the bad things that are done by adjusters and agents and are committed to correcting these wrongs.

We will talk to you about Private and Commercial policy issues your insurance company refuses to honor.