PROBLEMS WITH YOUR INSURANCE COMPANY?

The insurance business can be confusing. Usually, someone local – the insurance agent – sells you insurance. The agent actually sells you an insurance policy underwritten by one of the insurance company’s the agent sells for. The agent may or may not see the actual insurance policy, which is a contract, before selling it to you. You, the insured, almost never see the insurance policy before you purchase the policy. In fact, you rarely see the insurance policy that you paid a premium for, and which defines all of your rights and obligations under the contract, until several weeks or months later.

Confused? Well, the confusion level increases if and when you file a claim. Typically, a claim is filed with the insurance agent, the local person who sold you the policy. That person has little, if any, say in whether your claim will be honored. The agent submits the claim to the insurance company that issued you the policy. A “claims representative” with the insurance company, who is usually not a local person, investigates the claim and makes a decision as to whether coverage will be provided.

The decision of whether coverage will be provided for your claim depends on the terms, conditions, exclusions and limitations contained in the insurance policy as compared to the facts and circumstances resulting in the claim being filed. The decision process and the resulting determination as to whether the claim will be covered may require legal analysis; that is, the contract must be carefully evaluated.

If you have had a claim denied by an insurance company, you have the right to challenge that decision. Consultation with a lawyer may be necessary to know your rights and the insurance company’s duties under the insurance policy.

Thompson, Dunlap & Heydinger, Ltd.’s attorneys are experienced and skilled in representing individuals and businesses regarding insurance coverage disputes and claims.