Insurance: Unfair Insurance Claim Practices

We’ve all heard about people having problems with an insurance company. It is a fact of life that disagreements happen between insurance companies and their claimants.  You might be an injured person, trying to get relief from someone else’s insurance company. Or, you might have a claim on your own insurance; like your own homeowner’s insurance. You might have a disability insurance claim, either from your own policy on one your employer provided. 

Disagreements are one thing, but unfair or “bad faith’ insurance practices are another. Regardless of whether your claim is covered, the way that an insurance company handles your claim is important. It is important to you – and under the law. If you feel your insurance company is unfairly or wrongly denying or delaying your claim, you might have an unfair claims practices or “bad faith” insurance claim, and Thomas Waitt Pleasant might be able to help you get what you deserve.

What to Look For

If you think your insurance company is doing any of the following, you may have protection from your insurance company under North Carolina law:

• The insurance company has misrepresented policy provisions/coverage;
• The insurance company has not promptly communicated with you
• The insurance company has not properly investigated your claim;
• The insurance company has not promptly told you whether your claim will be paid;
• The insurance company has tried to get you to settle your claim for far less than it is worth;
• The insurance company has tried to settle your claim on the basis of an application which was altered without your knowledge or consent;
• The insurance company has made claims payments to you without explaining the coverage under which the payments are being made, in writing;
• The insurance company has told you it has a policy of appealing from arbitration awards in favor of insurance claimants, thereby trying to compel you to accept less than the amount you were awarded in arbitration;
• The insurance company has delayed or is delaying the investigation or payment of your claim by requiring you to submit basically the same information more than once; or
• The insurance company has denied your claim, but has not provided an explanation for the denial.

The insurance company in your case might clearly be engaging in any number of these unfair claims practices. However, you might not know for sure what the insurance company is up to behind the scenes, and whether, for example, a delay or denial of your claim is being caused by this kind of behavior. But an attorney with experience and/or contacts in the insurance industry might know or be able to find out. You want an attorney who has the resources to find out as much as possible about how your insurance company operates, what might be motivating it, and how all that affects handling your claim. For example, understanding an insurance company’s internal processes and culture can help your attorney make stronger arguments under these laws by showing a “pattern” or “practice” of bad behavior.

There is Protection Under the Law

Unfortunately, our justice system has uncovered some really bad behavior on the part of some insurance companies over the years.  Understanding this can help you be wary when purchasing insurance and it might also help you understand why your claim is not going well now. If you are having a problem with your insurance company, you need an attorney who understands this, and the protections out there for you. North Carolina law (N.C. Gen. Stat. § 58-63-15 et seq.) prohibits “unfair methods of competition and unfair and deceptive acts or practices in the business of insurance.” If your insurance company has done anything in the list above, you may have a claim for “bad faith” or “unfair claims practices.” This might be true even if the insurance company has now finally paid the claim, but only after a long and unjustified delay.

Why Is The Insurance Company Refusing to Pay Your Valid Claim?

Insurance is big business. Practically everyone has insurance of some kind, and the law even requires automobile insurance. Hundreds of thousands of people file insurance claims every year. Think about it: every reduced or unpaid claim is money the insurance company keeps. If most people don’t fight for what they’re owed when the insurance company delays or denies their claims, it makes financial sense for the insurance company to behave this way and see what it can get away with. The unfortunate result is that everyday people may lose – many of whom are facing financial struggles due to short-term disability, long-term disability, property damage, auto coverage, an accident, a health claim, long-term care, an accident, property damage, or general liability problems

Thomas Waitt Pleasant: Responsive Legal Help When You Need It Most

I am a plaintiff’s attorney, representing people who are forced to fight their insurance companies. You may have no choice but to take your insurer to court. When you hire me, I’ll strive to ensure that your disability benefits are paid, or that you are compensated for medical bills, lost wages, injuries, and property damage – whatever the case may be. Denying or intentionally delaying payment for a covered loss isn’t just a nasty thing to do, it’s downright illegal.

You don’t necessarily have to give up and take what’s been offered. You don’t necessarily have to accept the delays in your claim. You don’t have to continue the fruitless, frustrating cycle of phone calls and letter writing. You have a right to receive what you paid for. The Law Offices of Thomas Waitt Pleasant, PLLC can help you get what you’re rightfully owed.

You’ll need all the help you can get to prove that your insurance company disregarded the duties imposed on it by the laws described above, including its duty to investigating and/or pay your claim. Please contact me today. If you’d like a review of your case, contact my office. In most insurance matters, the consultation is free, so there’s no down side, and no obligation. I will work with you to determine whether the insurance company in your case has been unfair or acted in “bad faith.” Call or email The Law Offices of Thomas Waitt Pleasant, PLLC, today.

Library for Insurance: Unfair Insurance Claim Practices:

• AAJ's Top Ten Worst Insurers List (Allstate, State Farm, Unum, Liberty Mutual, Farmers on list) [PDF]   
  Description: AAJ's recently released report containing the top 10 worst insurance companies in America. This is a must read for consumers. If you think choosing your insurance company carefully is not important, think again. If you face having to make a claim against one of these insurance companies, you might be in for a surprise. Hopefully, you will consider this when purchasing insurance, before you need an insurance lawyer to help you with your insurance claim.
• Dateline Story: The Paper Chase (Regarding Allegedly Unfair Insurance Claims Practices in Disability Insurance Claims)   
  Description: Dateline investigates State Farm Insurance Company and its little-known practice of "paper review." In a paper review, State Farm employees review a patient's medical records rather than actually examining the patient. The Dateline crew discovered that some State Farm employees use this practice to manipulate the system. For example, the crew found that some employees "secretly orchestrated the supposedly independent medical results, helping author reports and dictating changes to medical opinions that led to lower recommended payments for medical claims."
• Homeowner Claims: Increase Your Payout   
  Description: CNNMoney.com article outlining how property insurance companies handle property insurance claims. This article might help one see, anticipate and/or understand unfair insurance claims practices or insurance bad faith in the event of a property insurance claim (house fire claim, property theft claim, etc.), or worse, if you are actually having an insurance dispute.
• UnumProvident "Representation" Letter [PDF]   
  Description: This letter details some of the relationships between UnumProvident, a large disability insurance company, with other disability insurance companies. This can be important, because UnumProvident could be behind the scene in handling your disability claim. If you have an unfair claims practice claim or insurance bad faith claim, this could be critical information in determining who should be sued, if an unfair insurance claims practices or insurance bad faith lawsuit must be filed.
• Disability Claim Denied! (Business Week Article on Disability Insurer's Unfair Insurance Claims Practices / Bad Faith)   
  Description: This December 22, 2003 online Business Week Article addresses concerns that were arising about disability insurance company UnumProvident. This article discusses UnumProvident's "roster of rejections."
• United Policyholders Information on UnumProvident's Disability Insurance Practices and Unfair Insurance Claims Practices / Bad Faith Lawsuits   
  Description: This article, at www.unitedpolicyholders.org, states that "[f]rom publicly available federal court records, it appears that Unum, Unumprovident, Provident Life, and Paul Revere companies have been named in at least 4,575 civil actions concerning insurance from 2000 to the present. This may understate the total number of federal court filings, because an insurance coverage action might also be described as contract or some other category of action, and also because not all federal courts participate in the PACER system from which this information was drawn." Click on this link to view this and other information about UnumProvident, bad faith and unfair insurance claims practices, and disability insurance claims generally.

Frequent Questions for Insurance: Unfair Insurance Claim Practices:

• My insurance company has offered an unfair settlement. What can I do?
• I am not sure as to the extent of my coverage, have not read my policy and not sure if my claim is covered. Does this mean I cannot file my claim?
• What if my insurance company says that my claim is not covered due to the specific provision?

The Law Offices of Thomas Waitt Pleasant, PLLC
427 Franklin Street
Fayetteville, NC 28301

Toll Free: 888-HELP-156
Phone: (910) 323-3250