Insurance providers are legally required to act in good faith when handling your accident claim, but unfortunately, we know this does not always happen. Most accident victims simply want a smooth process to receive their fair compensation after a traumatic event – not a stressful and extended standoff with an insurance adjuster. However, your just payout stands in the way of the insurance company’s maximum profit. That is where the problems start, and there are some pretty duplicitous tactics that these companies use to protect their profit. An insurance company lawyer can help.
While hiring a personal injury lawyer might seem optional, a study conducted by the Insurance Research Council indicates that an insurance company is more likely to pay, and to award a higher payment to a victim represented by an attorney than one who is not.
In Texas, which is a 60/30/25 state, it is even more helpful to have an attorney by your side, as a lawsuit may be your only recourse for full compensation of your losses if these low limits are exceeded by motor vehicle accident expenses. When an accident happens, and the insurance claim is either denied or the amount paid out does not cover all damages, the financial burden left with the policyholder can be severe.
How Does My Insurance Company Assess My Claim After the Accident?
Insurance companies normally have insurance adjusters who work in tandem with the company’s lawyers to assess a claim amount. The claims adjuster will conduct an investigation, gathering relevant records, photographs, and statements from witnesses and experts. They will question you and other parties involved in the accident.
Using this information and process, they will establish a report of the cause, the damages, and make determinations about the payout of the claim. Inaccurate statements, false or misleading evidence, or incorrect figures should be identified and eliminated from the process so that determinations are made on accurate facts and outcomes. If you accept fault, if discrepancies are discovered, or if the investigation unearths relevant factors, your insurance company will use their findings as grounds to lower or outright deny your claim amount.
Engaging an expert personal injury lawyer to represent you through this process so that you are working with excellent advice, a trusted advocate, and a skilled negotiator is ideal.
On What Grounds Can I Sue My Insurance Provider?
Facing medical expenses after an accident or suffering property damage an auto accident is stressful and difficult, but it becomes even more challenging, and frankly infuriating, when your insurer fails to meet their responsibilities to serve you in the claim process. After an accident, the insurance company should impartially investigate and efficiently settle claims based on the findings. If they are not acting in accordance with these responsibilities, they may be liable in court for acting in bad faith.
In Texas, insurance companies are held by law to provide a range of duties and responsibilities to their policyholders. In the most basic sense, instances where insurance companies knowingly place their insured customer at a significant disadvantage in the claims process can be considered bad faith action. When pursuing legal retribution after suffering bad faith insurance actions, the plaintiff has a responsibility to demonstrate that the insurance company’s conduct was unreasonable. It is essential when arguing breach of contract to show evidence of the insurance company’s failure to adhere to the terms and conditions of the agreed policy.
Examples of Bad Faith
Unreasonable delays and deceptive practices are two of the most common types of bad faith actions that we see our clients having to contend with. Unreasonable delays include cases where the insurer drags out the claim processes in the hope that the policyholder will give up on the case. They will wait as long as possible between steps in the process, give slow return communication, and loiter in their determinations. In Texas, an insurance company has 15 days to accept or deny the insurance claim. An insurance company engages in an example of deceptive practices when they fail to reveal the existence of certain coverages to avoid paying you. Similarly, they may fail to provide you with the necessary documents required to file your claim, despite a looming deadline.
Other Types of Bad Faith Per the Texas Insurance Code (Chapter 541):
- Misrepresenting the policy language or the law
- Failure to compensate for a valid claim
- Failure to provide an explanation of a claim denial
- Failure to carry out a comprehensive investigation
- Failing to affirm or deny the claim within the legal time period
- Undervaluing or delaying adjustment of claims
- Canceling coverage or changing coverage terms after a claim is made
- Failure to communicate with their policyholder
- Failure to assign qualified employees to manage your claim
- Requesting excessive information to explicitly delay processing
- Alleging fraud or criminality of policyholder without cause
- Issuing threatening statements
What to Do After an Insurance Claim Denial
Insurance companies are profit-motivated, so they train their adjusters to search for every loophole and every opportunity to manipulate facts during the claims process so they can avoid paying you. If your insurer denies your claim, you have the right to receive their reason for denial in writing. Request this documentation for your records. If you disagree with the denial and believe your claim is valid, consult an experienced personal injury attorney that focuses on denied claims. Your attorney can review your claim, establish whether you have sufficient grounds to dispute the denial and advise you of your range of options, including appealing the denial and/or pursuing legal action.
Claim Dispute Resolution Methods
There are several ways to resolve disputes with an insurance company. Not all are applicable to every situation, so it is best to consult with an attorney for advice and assistance on your specific options and your best path of recourse. Some methods your attorney may utilize to resolve your claim dispute include:
Negotiation – Your personal injury attorney can put pressure on your insurer to reopen your case and negotiate a fair settlement.
Arbitration – Insurance companies often include a provision in their contracts allowing for arbitration on policy disputes as an alternative to a lawsuit. In an arbitration process, a neutral person (usually a third-party arbitrator) mediates negotiations and seeks to resolve the dispute.
Small Claims Court – Your attorney may recommend pursuing corrective action through small claims court if your claim is less than $10,000. This can be a more efficient method of resolving these claims for smaller amounts, while still including the court system in order to arrive at a finalized resolution.
Filing a Lawsuit – In the event that none of the above methods are workable or successful options, your attorney will file a lawsuit against your insurer as a last resort. This is the lengthiest and riskiest option for recourse, but there are certainly times where such action is demanded, and the resulting verdicts can be life-changing.
Texas law limits your time to file a claim.
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