If you need to file an insurance claim, you cannot trust the insurer to act in good faith. That is not how these companies work. Every day individuals must deal with an insurance company reducing, delaying, or denying their claims.
If you are in this position and find yourself in a dispute with the insurance company after filing an insurance claim, you may pursue legal action to obtain the money you need. Better yet, with an insurance claims lawyer from the law firm of Dolman Law Group Accident Injury Lawyers, PA, fighting for your rights, you will not have to take on this complicated legal ordeal alone.
Dolman Law Group Accident Injury Lawyers, PA—About Us
At the Dolman Law Group Accident Injury Lawyers, PA, our legal team gets clients results while providing them the exceptional services they need. When you reach out to us, we make it a point to meet one-on-one to review your case. We work directly with you to ensure we handle your claim appropriately while fiercely fighting for the money you deserve.
Because of our dedication to each of our clients, we have helped countless individuals and secured millions of dollars through settlement negotiations and jury verdicts on their behalf. We have also been nationally recognized as “Clients Choice for Personal Injury” by AVVO.
For these reasons, if you suffered harm in an accident and require legal help, contact us today for a free case evaluation. We are not only a Florida law firm but a national one, and we serve clients all over the country, meaning all you have to do is find an office near you and reach out to discuss your case.
How Insurance Claims Work
An insurance claim is the policyholder’s formal request to the insurance company to recover compensation for a covered loss or policy event. Once the insurance company receives this request, they will review it and either validate it or deny it. If the insurer approves it, they will issue payment once the policyholder pays the deductible.
While several situations give rise to an insurance claim, the below claims are some of the most common:
- Auto insurance: If you are involved in a car crash with another motorist, someone steals your car, or a collision or a natural disaster damages your vehicle, you can file an auto insurance claim to recover compensation for these damages.
- Homeowners insurance: If your home a fire, storm, or vandalism damages your home, you may file a homeowners insurance claim to obtain compensation for your losses. However, this insurance typically does not cover every disaster that can destroy your home, like floods and landslides. Rather, you must get separate coverage to protect your home against these risks.
- Health insurance: You make a health insurance claim every time you receive medical care or fill a prescription covered by your insurance.
- Life insurance: If a person dies and has a life insurance policy, their beneficiaries can file a claim with the insurer to receive the policy’s proceeds.
- Workers’ compensation insurance: If you are injured or become sick at work, you can file a workers’ compensation claim to receive medical and wage benefits.
These claims can cover everything from comprehensive medical exams to death benefits. We can review your insurance policy for you and tell you what it covers. If you do not understand why an insurance company will not cover your claim, reach out to our knowledgeable insurance lawyers. We can verify what your policy includes.
The Different Reasons an Insurance Company Denies an Insurance Claim
Most people believe the insurance company wants to help them after an accident, primarily since this is the purpose of having insurance and paying premiums. However, this is not how these companies operate.
Like other businesses, the insurance company wants to make a profit. By offering you less or denying your claim, they make more money. These insurance companies and adjusters will have a stockpile of reasons for denying your claim. Yet, while some of these reasons may be legitimate, many are not.
Consider the following common reasons that the insurance company may deny an insurance claim:
- An error with the claim: Check your policy after an accident to review the rules regarding notifying the insurance company. Some insurance companies have timelines that require you to submit a claim within 24 hours. If you don’t, the insurer will deny the claim.
- An error with the application: Some insurance companies may argue that you made an error when you filled out your insurance claim application and, as a result, will deny your claim.
- A lack of coverage: Depending on the circumstances of the incident, the insurance company may argue that their policy does not cover your claim.
- A bad faith denial: A bad faith denial typically involves the insurance company refusing to pay an insurance claim without a reasonable basis. Instead, they will issue a denial by using confusing policy jargon to hide the fact they do not have a reason to deny your claim. On the other hand, they may have a reasonable basis for denying, but if they fail to properly investigate the claim promptly, it can still be a bad faith denial if they reject the claim.
What Legal Action Can You Take Against the Insurance Company?
If an insurance company does not uphold the terms of your insurance policy, you may take them to court for breach of contract, especially when you have always paid your premiums and properly filed your claim.
In addition, depending on the circumstances of the incident, you may also pursue a bad faith tort lawsuit. For instance, if you discover that the company outright manipulated the terms of its policy to avoid paying you the money you deserve, this could warrant a bad faith suit.
To understand your legal options and determine whether you can bring one of these claims, it is often in your interest to reach out to an experienced insurance attorney. Our skilled insurance lawyers from the Dolman Law Group Accident Injury Lawyers, PA, can review what happened, check the state’s rules regarding your claim, determine your legal options, and go after the financial damages you deserve.
When Can You Sue the Insurance Company for a Denied Claim?
Insurance companies are not only obligated to pay compensation for fair claims submitted by policyholders, but they must also follow the terms specified in the contract, act in good faith of the agreement, and avoid unfair tactics.
As a result, when the insurance company does not meet these standards and denies your claim, you may have a reason to sue the insurance company, especially if they:
- Do not conduct a proper investigation into the claim.
- Delay the investigation.
- Do not approve the claim within the agreed-upon timeframe.
- Do not explain why they denied the claim.
- Refuse or deny to pay the claim where liability is reasonably shown.
For these reasons, if you believe an insurance company denied your claim unfairly, contact an experienced insurance lawyer, such as those at the Dolman Law Group Accident Injury Lawyers, PA. These legal professionals can review your claim, determine if the insurer is liable for unfairly denying it, and help you pursue the compensation you need.
The Damages You Can Recover When You Sue the Insurance Company
If you bring a lawsuit against the insurance company, you may recover compensation. This compensation will often depend on the state rules, your policy, and the facts of the case. You may recover the following types of financial damages:
These damages refer to payment for the actual losses that result from the incident, including:
- Medical bills
- Lost wages
- The loss of the use of a motor vehicle or the home
- Property damages
- The loss of job opportunities
- The costs of the suit and lawyer fees
- Money for all the losses resulting from unpaid insurance benefits
These damages refer to payment for the subjective losses that result from the incident and the insurance company’s conduct, including:
- Emotional anguish
- Pain and suffering
You may also pursue punitive damages depending on the facts of the case. While the above damages make the victim whole after an incident, punitive damages penalize the wrongful party for their egregious actions and prevent other parties or entities from doing the same. Consequently, these damages are not awarded in each case but are limited based on the state and court regulations.
Protecting Your Legal Claim When Suing the Insurance Company
After an insurance company denies your claim, the situation may feel overwhelming and stressful, especially as you determine your next steps. However, if you pursue legal action against the insurance company, remember that the process of holding the insurance company accountable is not easy, and you must prepare when taking on these companies. That is why you should:
Document All Communication
When you communicate with the insurance company, keep a copy of all correspondence, whether by email or phone. Just ensure this information is detailed. For instance, if you are taking a call with the insurance company, stay calm, write down the date, time, and name of the representative you speak to, and include everything you discuss.
Keep Track of Expenses
You want to keep a detailed record of all your expenses, including your lost wages, attorney fees, property repairs, and medical bills. However, make sure you also keep a copy of all the receipts associated with these costs.
You will also want pictures from the incident, including photos of the damage to your property and yourself immediately after the accident.
Reach out to an Experienced Insurance Attorney
Taking on insurance companies requires strong legal skills and knowledge of how insurance companies work. For these reasons, reach out to an experienced insurance attorney who has previously handled these claims.
When you meet with these lawyers, discuss everything that happened, and provide them with all the evidence you collected, including receipts, photos, and correspondence with the insurance company. Your attorney can use this evidence to prepare a strong legal case and go after the justice and compensation you deserve after the insurance company has denied your claim.
Plus, because most of these lawyers work on a contingency fee basis, you will not have to pay out of pocket for your attorney. Instead, these lawyers will only receive a percentage of the benefits they recover from your insurance provider, which means they will not get compensated if you do not get paid.
Contact a Insurance Claims Attorney Today
Dealing with the insurance company can be a challenging ordeal. Thankfully, you do not have to do it on your own.
1. Should You Accept the First Settlement That the Insurance Company Offers?
It might seem like great news if you received a settlement offer from the insurance company following an incident. However, before you accept this amount, consider a few things.
For one, insurance companies typically offer a settlement shortly after an accident in hopes that the victim’s vulnerable state will prevent them from looking into this offer further. However, this offer is generally meager and barely covers the victim’s current costs, let alone future expenses. Worse yet, if victims accept this amount, they cannot go back to the insurance company and ask for more money down the road.
Before you take any settlement from the insurance company, ensure you review it with an experienced insurance attorney, like those at the Dolman Law Group Accident Injury Lawyers, PA. These lawyers can analyze the settlement offer and verify if it is fair to you and your situation. If it isn’t, they can head back to the insurance company and negotiate for more money.
2. What Happens If You Sue the Insurance Company and Lose Your Case?
Typically, the answer to this question will depend on the state’s laws and the fee agreement you entered into with your attorney. While, in general, each party will have to pay their legal fees, sometimes the losing party will have to pay certain expenses for the other side. Thankfully, most contingency fee agreements will help protect individuals from owing money to an attorney if they lose in the courtroom.
Yet, to determine what losing the lawsuit would mean for you, discuss your situation with an experienced insurance attorney. These lawyers can not only go over your concerns but also figure out your legal options and help you go after the results you want.
3. What Is the Likelihood That Your Legal Case Will Settle Before Trial?
In general, over 90 percent of all lawsuits settle before trial. Consequently, it is likely that if you decide to pursue a legal suit against the insurance company, your case will resolve through mediation or negotiations before it goes in front of a judge.
Your attorney can better explain your chances of settling your case after reviewing certain facts, such as the specific details of your case, the insurance company’s wrongful actions, and the costs and expenses that resulted from the incident.
4. How Long Do You Have to Pursue a Lawsuit Following an Insurance Claims Dispute?
Another issue affecting insurance claim disputes is the time limitation to pursue legal action. The statute of limitations is a regulation that dictates how long individuals have to pursue a lawsuit following an alleged offense. If victims do not file their claim within the allotted time, they likely cannot obtain compensation for the harm and losses they endured.
While statutes of limitations rules depend on the state where the incident occurred, individuals generally have a few years to file a lawsuit against the insurance company following the incident.
However, these factors can also affect this timeline:
- The type of insurance dispute you have
- Whether the insurance dispute qualifies as an expectation to the state’s statute of limitations regulations
- The individual state case laws
To ensure you can file your suit before this time runs out, immediately reach out to an experienced insurance lawyer, like those at the Dolman Law Group Accident Injury Lawyers, PA. These attorneys can not only determine the maximum time you have to file your case but will prepare and file your legal documents before time expires.
While you may have years to file your case, it may not be wise to wait that long. Typically, the longer you delay bringing a legal suit, the higher the chance of evidence disappearing, witnesses no longer being able to testify, and memories of the incident fading—factors that can hurt your chance of getting the money you deserve.
5. How Long Will It Take for an Insurance Claim To Resolve?
Settling an insurance claim depends on several factors, as does the timeline. While each timeline is unique, these cases can frequently take months to years to resolve, depending on the insurance company’s willingness to work with you and whether you decide to pursue a lawsuit to recover the money you need.
No matter how long your specific case takes, when you work with the Dolman Law Group, know that our legal team will work hard on your behalf to fight for the best possible outcome. While we will try to secure your compensation quickly, pushing the insurer to settle too fast may not get you the maximum damages you deserve.
Our lawyers will work to handle your case properly and effectively, balancing the timing with vigorous legal representation. We fight to pursue all the monetary damages you deserve.
6. How Do You Sue the Insurance Company for Negligence?
Negligence is a standard legal theory that allows victims to seek financial compensation for the losses and harm they endured following an incident. However, before you can bring legal action based on negligence, you must prove certain elements, including:
A Duty of Care Existed
Negligence claims require a duty of care. This requirement means the defendant owed a duty of care to the plaintiff.
In the context of insurance companies, insurers and their agents have a duty of care to their policyholders, which requires them to use good judgment, reasonable care, and diligence when providing their customers with certain policies that are well-suited to their desires and needs.
Someone Breached their Duty of Care
It is not enough to show that the defendant owed a duty of care. Rather, the plaintiff must also show that the defendant breached this duty.
To sue the insurance company for negligence, you must show how the company breached its duty to you. For example, through misleading comments or omitting critical information about your policy.
Causation and Damages
Finally, to bring a successful negligence claim, you must show causation and damages. Causation typically refers to the relationship between a cause and effect: the damage to the plaintiff would not have occurred but for the defendant’s actions. Yet, while causation is often direct, it can also be through proximate cause. Proximate cause occurs when the defendant could have foreseen the harm of their actions, and if the harm results, those actions are the proximate cause of the resulting damages.
As you can see, proving negligence is complicated. For these reasons, work with an experienced insurance attorney. Your lawyer can find evidence to prove the insurer’s negligence and bring a valid claim while you focus on the more important things, like yourself, your family, and getting back on your feet.
7. If the Insurance Company Refuses to Return Your Calls, What Does This Mean For the Case?
Unfortunately, the insurance company is not required to communicate with you. As a result, if you file an insurance claim and cannot reach them during the process, they likely want you to give up on your claim and settle for as little as possible.
Thankfully, when you work with a knowledgeable insurance lawyer at the Dolman Law Group, you do not have to deal with these unfair practices alone. Instead, these lawyers can handle the insurance companies for you and hold them accountable for what they owe you.
8. If You Repaired the Damage To Your Property, Can the Insurance Company Deny Your Claim?
Depending on the circumstances, maybe. For example, if you sustain damage to your home and make repairs before the insurance company inspects the property, they may use this as an argument to deny your claim.
Following an incident, reach out to the insurance company and file a claim before making any repairs. Contact an experienced insurance attorney to review your policy, explain your rights, and help you go after the money you need.
9. What Are Your Options if the Insurance Company Disputes the Contractor’s Estimate of the Damages?
As mentioned previously, the insurance company’s goal is to minimize the amount of money they pay you. This goal means they will do anything to deny or reduce your claim to keep premiums in their shareholders’ pockets, even disputing the contractor’s estimate of the damages you suffered.
When you contact an experienced insurance attorney with experience representing policyholders against insurance companies, they will know how to pursue the compensation you are entitled to, even if the insurance company claims they do not have to pay you.
10. When Should You Call an Insurance Claims Attorney When Disputing the Insurance Company?
Reach out to an experienced insurance attorney immediately when dealing with an insurance dispute. The faster you provide your legal team with details of the situation, the better chance they have of securing the evidence needed to obtain the strongest possible outcome. Because there are stringent timelines when making these claims, the faster you reach out to a lawyer, the better chance you have of ensuring you file your claim on time.
In addition, when you work with skilled lawyers like those from Dolman Law Group Accident Injury Lawyers, PA, you can have peace of mind knowing that these lawyers will do everything to help you, including:
- Examining your policy to figure out your coverage and the payments your insurance company is required to make
- Conducting a thorough investigation into the incident, the previous inspections, and audits to secure evidence to settle your claim dispute
- Handling all settlement discussions with the insurer
- Heading to trial if the insurance company is unwilling to provide you with a just offer and fighting for maximum damages