Expert Insurance Bad Faith Lawyers
You might assume that when you purchase an insurance policy from a seemingly reputable insurance company that they will promptly pay claims when submitted. Not always! When an insurance company fails to pay a covered claim, fails to settle a case within policy limits exposing the insured to personal liability, or unreasonably delays the payment of a covered claim, the insurer is acting in bad faith.
Insurance is big business. Insurance companies take in hundreds of billions of dollars in premiums every year. They make money by investing those proceeds. The longer they retain the money, the more they make on their investments. Thus, from a purely financial standpoint, the insurer has an incentive to delay the payment of claims.
However, when an insurance company fails to meet its contractual obligations, the financial consequences can be devastating. Business’ and individuals rely upon having the use of their assets and they purchase insurance to protect against risks to their assets. When an insurance company fails to pay a covered claim, or delays the payment of such a claim, businesses’ can fail, people lose their jobs, individuals can be subjected to personal liability, and the well being of families is jeopardized. An experienced insurance claims attorney can help.
The law provides a remedy under a doctrine known as insurance bad faith law. Under Pennsylvania law, an insurer who fails to pay a covered claim or unreasonably delays the payment of a covered claim can be held responsible not only for the amount of the claim but for punitive damages as well. Both the law and judges and juries who enforce the law look dimly on insurance companies who fail to meet their obligations to an insured. Simply stated, you can’t take premiums and then fail to pay claims.
Insurance Bad Faith attorney Howard Silverman, a member of the Multi-Million Dollar Advocates Forum, has handled many insurance bad faith cases, and has obtained substantial financial recoveries for his clients. If you’ve been mistreated by your insurance company, contact an experienced insurance bad faith lawyer at the Philadelphia law firm of Kane & Silverman.
Some Insurance Bad Faith cases we’ve handled include:
- fire insurance
- health coverage
- general liability
- no fault insurance
- vexatious refusal
- insufficiently high coverage
- policy exclusions
- material misrepresentation
- accident insurance
- automobile coverage
- coverage denial
Types of Insurance Bad Faith
Perhaps the most common typf of insurance bad faith deals with motor vehicles including cars, trucks, buses, trolleys, and motorcycles amongst others. While it is state mandated in Pennsylvania that every driver has auto insurance, it is meant to help individuals who are involved in auto accidents cover certain associated costs. In Pennsylvania, drivers must have a minimum insurance of $15,000 for bodily injury for one person, $30,000 per accident and $5,000 for property damage.
About 50% of all states have adopted no-fault liability alws which make all persons involved in an auto accident responsible for his or her own damages (with certain exceptions of course). The remaining states have adopted at-fault liability laws, which require the party responsible for the auto accident to pay damages for all parties involved.
According to Cancer Facts and Figures 2009, a study released by the American Cancer Society, men have slightly less than a one in two lifetime risk of developing cancer, while woman have a little more than one in three. There are an estimated 10 million people in the United States that have cancer insurance policies, which are generally sold through employee benefit plans and promise to provide cash benefits for cancer-related medical expenses, which include:
- preventative care
There are a number of examples of bad faith cancer insurance practices committed by insurance companies throughout the Unite States. An insurer can deny a claim for no reason, delay a claim for an extended prior of time, inadequately investigate a claim or misrepresent the meaning of the language of your policy.
There are generally two types of Disability Insurance policies offered to people in the United States. Long Term Disability or Group Policy is governed by the Employee Retirement Income Security Act of 1974. Individual Disability Income Policy is governed by the Pennsylvania Bad Faith Statute. In both types, Disability Insurance Companies are obligated to conduct a full, fair, thorough, and objective investigation of your claim.
This investigation includes both the medical component of the claim as well as the occupational component. If you have been affected by any of the following, you may have a Disability Insurance bad faith claim:
- failure to act in a timely manor
- failure to investigate claim properly
- attempting to settle a claim for unreasonable rate
- delaying investigation
- advising claimant not to obtain attorney services
- misleading claimant
A health insurance company is like any other company in the world, in business to make money. So it comes as no surprise that there is an inherent discrepancy between company profits and what an insured believed he or she deserves in return. The legal experts at Kane and Silverman have experience with health insurance bad faith lawsuits including unreasonably delaying a claim, offering a low claim settlement, private health care fraud, misrepresenting insurance contract, and claiming policyholder omitted facts on application.
There are any number of ways a health insurance company may be acting in bad faith towards a policyholder. We are experienced with the the following:
- insurer delaying, discount or denies payment with no basis
- insurer requiring claimant or physician to submit duplicate paperwork
- insurer failing to reply in prompt fashion
- insurer failing to conduct proper investigation
- insurer attempt to settle claim on basis of application that has been altered
- insurer using fraudulent investigative methods
- insurer requesting overburdening documentation
- insurer issuing wrongful threats to not pay claim
Another common form of insurance bad faith involves homeowners insurance claims. If you are a homeowner or property owner and damage occurs that is covered by your insurance policy, the smart thing to do is make a claim. The process itself involves contacting your agent, filing a claim form, and allowing an adjuster to assess the damage. While most homeowner insurance and property insurance claims are handled in a timely manner there are those that result in insurance bad faith lawsuits.
Bad faith insurance law is governed by both Pennsylvania state and United States federal laws, which ensure that insurance companies have the legal duty to act in good faith and fair dealing with its policy holders and any and all insurance claims. These may include any act of God such as flooding, tornadoes, earthquakes, hurricanes, twisters, and fires, as well as various other claims such as arson and robbery. Below are the different types of homeowner and property owner policies:
- HO1 – Basic Form Homeowner Policy
- HO2 – Broad Form Homeowner Policy
- HO3 – Special Form Homeowner Policy
- HO4 – Renter’s Insurance
- HO5 – Premier Homeowner Policy
- HO6 – Condominium Policy
- HO8 – Older Houses
There are two primary types of life insurance policies to choose from and while most people view this type of insurance as a way to provide for death and funeral costs, it can also be viewed as an effective financial tool. In a term life insurance policy, you make periodic payments to the life insurance company for a specified period of time and if you die during the term, your life insurance company pays the previously agreed upon total to your beneficiary. If you do not die, your beneficiary receives nothing.
In a cash value life insurance policy, which is also known as ordinary, whole, and universal life insurance, you again make periodic payments but as opposed to a set term, this policy spans your whole life. So, regardless of when you die, your beneficiary will receive a previously agreed upon total. In both term life and cash value policies an insurance company may look for an excuse to deny the claim because again, an insurance company like any other company is in business to make a profit.
According to the Pennsylvania Worker’s Compensation Act, all employers, which include non-profit organizations, must issue full-time workers, part-time workers, and seasonal employees (not contractors) workers compensation insurance. If you are injured while on the job you may be entitled to compensation for the following:
- medical care
- payment for loss of limb or use of
- lost wages
- payment for severe disfigurement
- death benefits
Virtually all injuries caused by a work-related accident are covered by the Pennsylvania Worker’s Compensation Act. The only injuries that may not be included are intentionally self-inflicted injuries, injuries caused by intoxication or illegal drub use, injuries that occur when a co-worker attacks you for personal reasons, injuries that occur when an non-employed person attacks you for non job related reasons, and injuries caused by breaking the law.
Time plays a big part in filing a claim. Illnesses that occur from exposure to certain materials such as asbestos or benzenes are covered under the Worker’s Compensation Act. Such exposures can lead to lifetime disability or even death. Under the Worker’s Compensation Act, work-loss benefit and medical benefits may be covered. Death benefits are usually paid to the dependent survivors if the death occurred from a work related injury or illness. Having to deal with a trauma such as a work related injury that leaves a person disabled is devastating. Having someone to fight for that worker’s rights can make the adjustment to everyday life somewhat easier so that the worker can focus on becoming well again.
Frequently Asked Questions
- How long do I have to decide whether or not I want to file a bad faith claim?
Usually, you have two years from the date of the insurance company’s unreasonable conduct.
- What can I recover if I sue my insurance company?
You may be eligible to recover the benefits of the policy for the claim in addition to consequential losses and damages you suffered as a result of the denied claim (including legal fees).
- Can my insurance company deny my claim?
Yes, just as long as the insured has not lived up to the insurance contract, when the claim is not covered by the policy, or fraud is involved.
- What should I do if my insurance company is denying coverage?
You should seek legal advice immediately and be sure to keep a detailed log of any and all communications with your insurance company.
- What are common examples of bad faith conduct?
- Unreasonable denial or termination of an insurance claim that should have been paid
- Unreasonable delay in making payments to the policyholder
- Unreasonable failure to defend a policyholder who has been sued under a policy containing a liability provision
- Unreasonably attempting to under-settle or lowball the payment of a claim..