by ty_ger88 » Fri Sep 14, 2007 02:20 pm
Many a times you may be unhappy with your insurance company for not paying you your dues or for delaying your payments or for any other reason. Your insurance company does not always have the upper hand. There are laws to protect you if you have a dishonest insurer.
When can you sue your insurance company?
You can sue your insurance company on grounds of:
If your insurer tries to trick you by not paying up a legitimate claim you can put up a civil suit against the company for having acted in bad faith. A company shows bad faith when it unreasonably denies a legitimate claim. This may mean that:
You can sue your insurance company for the full amount of benefits that has been denied to you as well as for any economic loss or emotional distress that you may have had to suffer as a result of the refusal. If your insurance company has been dishonest you may also get punitive damages. This is a means to make the insurance company behave more responsibly in future correspondences.
It is good to keep all paper works organized so that you can find them as soon as you need them. You may think of an old receipt as unimportant but it might hold great importance when you have a case standing against your insurer for bad faith or breach of contract.
- Bad faith and
- Breach of contract
If your insurer tries to trick you by not paying up a legitimate claim you can put up a civil suit against the company for having acted in bad faith. A company shows bad faith when it unreasonably denies a legitimate claim. This may mean that:
- The company has failed to carry out proper investigations
- Undue delay in processing a claim
- Disregarding the rights of the policyholder
- Inadequate compensation provided against claim filed
You can sue your insurance company for the full amount of benefits that has been denied to you as well as for any economic loss or emotional distress that you may have had to suffer as a result of the refusal. If your insurance company has been dishonest you may also get punitive damages. This is a means to make the insurance company behave more responsibly in future correspondences.
It is good to keep all paper works organized so that you can find them as soon as you need them. You may think of an old receipt as unimportant but it might hold great importance when you have a case standing against your insurer for bad faith or breach of contract.
Related Readings
- Suing your insurance company
- Can you sue your insurance company?
- Suing car insurance company
- How to sue car insurance company?
- Suing insurance company for bad faith
- Truck driver suing insurance company
- Suing for liability claims
- Sue for breach of contract
- Can you sue for liability claims?
I'm confused, please help. Here's my story and question. I'll try to make it short. My car was hit about a month ago. I was not in the car. It was parked on the side street. The driver of the truck that hit me left a note with all of his information. Now, it has been almost a month, and his insurance is not doing much. At first, they promised to have the damage estimated, but then nothing was sent to the car shop where my car located. I ended up going through my own insurance company. The problem is before I went with my insurance company, I had rented a car and had discussed this with the other insurance company. They said they would reimburse me all the fees. Now, they're not answering my calls. They keep on telling me that the agent is busy and will get back to me. It has been 4 days since I faxed in my car rental bill. What can I do? Can I sue them? Would you tell me how to sue an insurance company? The bill was paid for by my credit card, and I don't want to owe interests on it. Please help. Thanks.
Posted: Wed Jul 20, 2011 02:04 pm Post Subject:
No fault has to do with auto insurance. What do your injuries have to do with auto insurance?
my ins. co. has delayed surgery for severe torn rotater cuff for 5 mos. just had surgery and what should of been 2 hr. surgery took 4 hrs
OK, so it took longer than you expected. But you received the surgery you required. I sincerely hope the procedure works for you and you experience the pain relief and freedom of movement in the joint you were seeking.
What is the reason they refuse the MRI scans of your knees? They have to tell you. There is an appeals process within the insurance company/HMO/PPO that governs medically necessary treatments and procedures. You have to exhaust that remedy before you can even begin to think of suing the insurance company.
On top of that, your contract may have an "arbitration" clause that requires you to request arbitration and prevents your matter from being heard in the courts initially.
Get out your insurance contract and read what your rights are, what your responsibilities are, and what the insurer's rights and responsibilities are. Follow the rules, file the appeal with the medical review panel, and then see what happens.
If you can't find your contract, then call the insurance company and ask for another copy. They'll send it to you. Or ask to speak to their patient advocate (or, ombudsman) for assistance. There are plenty of resources available to you. Use them!
Posted: Tue Aug 09, 2011 02:15 pm Post Subject: Insurance Adjuster Dragging Feet.
Upstairs tub overflowed (June 23), and flooded upstairs causing extensive damage there and downstairs where the ceiling crashed into our master bedroom. Damage to walls, electrical, wood floors, etc.
Servpro comes out 2 days later to dry everything up, and take our rugs to clean and dry. Adjuster comes out 2 WEEKS later. Briefly and stoically assesses and says that she'll send out her estimate for repairs the next Monday (3 days later). 2 WEEKS later I get an estimated that is about 3-4k lower than my contractors estimate. I send her his estimated immediately after I get hers.
Still no reply from her (2 more WEEKS and counting). It has been about a month and a half with this damage in the house. I have complained to her boss, and he was nice... alas, still no movement on this. I did receive a check from her in the original amount (I have not deposited it, nor have I had any work done on the house). I would like to have the work done... Is this a case where I should/could sue?
Posted: Tue Aug 09, 2011 02:59 pm Post Subject:
I like the article, very informative n also the discussion.
Posted: Thu Aug 11, 2011 11:06 am Post Subject:
Is this a case where I should/could sue?
This is America. You can sue anyone for anything.
Is it time to sue? NO. It does not appear that you haven't exhausted your efforts to obtain a proper resolution of your claim. Are you calling the claims department EVERY DAY, asking to speak to the highest level supervisor you can reach LIVE? It looks like you maybe made one phone call. Have you mentioned the words UNFAIR CLAIMS PRACTICES yet? Unlikely.
Have you sent the insurance company's check back to them with a letter indicating the only check you will deposit is the one that covers the full cost of the repairs, as covered by your policy?
Have you filed a complaint with your state's Dept of Insurance yet?
You cannot just sit around and wait, doing nothing on your own, and then say, "OK, now it's time to sue." Besides, most states have laws that state you cannot sue your insurance company until at least 60 days after PROOF OF LOSS has been submitted. You have not done that, you have only submitted one estimate of the cost to repair.
Posted: Mon Aug 15, 2011 01:51 pm Post Subject: delayed medical treatments pip
on 1-31-2011 I was in accident with a non owner of vehicle that was a basic policy with no bodily injury or property damage coverage, unfortunately my medical on my policy was 15,000 my injuries are severe enough that I am now disabled haven"t worked since accident it took 6 mos. to get surgery on my shoulder and still need knee operation it seems my ins. co. has delayed every procedure except for less necessary treatments, like chiropractor and pain management now I'm told that I will have tom pay doctors for everything over 15,000 I know from just the bills I have on hand the amount will be well over 200,000 I did have under insured motorist coverage so it seems that by time I am done with medical I will owe all of it even if I win the 100,000 and not get anything for loss of income let alone pain and suffering this is totally unfair can I sue my ins. co. in NJ for causing the long delay even though I had m.r.i. early to show real damage
Posted: Thu Aug 18, 2011 07:31 pm Post Subject: Shoud I sue.
Hi, when I first got my insurance I paid an installment of last month and first month through a broker/agent. It has not been 12 months yet and I am very unhappy with the insurance so I am leaving them but they won't reimburse me for the $160 I paid for the last month. I called the insurance and the operator declared that they only recieved the installment for the first month basically suggesting that the my agent took the money for the last month. Can I sue for that. Also he put full insurance/collision insurance on my car which is a salvage without doing a proper check of the car. What should I do.
Posted: Tue Sep 13, 2011 08:52 pm Post Subject: Recoverable Depreciation
We recieved a check for so much for damage to our roof in a hail storm in June 2010. We waited to cash the check until Aug 2011 since we knew that we would not be doing our roof until the end of summer 2011. We were told to call the insurance company after the work was completed to recieve the remaining amount of the recoverable depreciation. When I called I was told by a manager of claims department that works with their law team that since the work was not completed within 180 of payment that we would not be recieving the recoverable depreciation. That was his final word. We called our agent and said that this is not the case and that what was said was untrue. We are in the middle of trying to get the rest of the claim money in order to pay the insurance company, but in the mean time does this sound like bad faith?
Posted: Wed Sep 14, 2011 12:52 am Post Subject:
We called our agent and said that this is not the case and that what was said was untrue
First off, your agent is not an officer of the insurance company, so he has no authority to tell you anything that is not in your contract. He may or may not be accurate. The final word is found in your homeowner's insurance contract, which most likely has a 180-day provision concerning replacement cost vs. actual cash value.
That is, in order to receive the greater of replacement cost, repairs must be (substantially) complete within 180 days of the original loss unless the insurer grants an extension due to exceptional circumstances (such as inclement/seasonal weather preventing construction activity, or an unexpected delay in building plan or permit approvals).
You must read your contract to know what your privileges are. Waiting 14 months to cash a check? I would have expected that check to have become "stale" after 180 days, too.
Posted: Mon Sep 19, 2011 11:03 pm Post Subject: Insurance have terminated benefits after 30 years of paying
Evaluated by IME, IME findings there are no medical needs from the accident: denied everything that was being paid: new adjuster started battling every claim to be paid or reimbursement: now attorney's will not take case because they can not recover big dollars. I want to file a claim myself for what is due in reimbursements and future medical bills
Posted: Tue Sep 20, 2011 05:22 am Post Subject:
You are not in an enviable position. An IME's determination is often pretty solid, depending on who it was that sent you there. If it was the opposing party's insurance company, well . . . .
What you will have to do is gather all your receipts together, add them up, including proof of loss of wages, if any, or other related expenses, and sue the party that caused your total damages. You don't sue any insurance company -- no insurance company caused your damages.
If the total amount of your claim is below the small-claims threshold for your state (usually somewhere between $5000 and $7500), you can sue the other party in small-claims court, where he/she will represent himself/herself, and the judge will decide who the winner/loser is. You will be unlikely to obtain any "general damages" (pain and suffering) in small claims court, but you can always ask for them in the amount of your claim. If you win the case, the insurance company that denied your claim will have to pay the award. (Then you might be able to sue the same insurance company for its "unfair claims practices" -- forcing you to file suit to collect the same amount you should have been paid to begin with.)
If your claim is for more than the limit and you want to go for that higher total, you will have to sue in superior court (they call it supreme court in NY state) -- or get the other party to agree to binding arbitration (which would be a whole lot less expensive and less trouble, but the outcome is up to the arbitrator, who is not necessarily bound by any legal precepts). Generally, but not absolutely, a binding arbitration finding is ironclad, and not subject to appeal by either party.
You can represent yourself, but the other party's insurance company will defend them with little regard for the cost, since they will file a cross-complaint against you for their costs, which might be awarded if you lose. (Same would hold true if you went to court). A judge in a courtroom might have little sympathy for a plaintiff representing himself "in pro per" (you will be expected to know the law, be able to cite relevant case law on demand, know the rules of court, and cannot rely on ignorance to help you out of a jam -- your initial petition, if defective in any way, could result in your case being thrown out of court -- and all that money for filing fees, legal advice, or representation down the drain). An arbitrator would probably be a bit less intimidating, but would still make you put on a proper case (at least having to know the law and be able to cite case law).
If you don't want to represent yourself, and the amount is not "big enough" to attract attention from attorneys who would be willing to take 30%-40% of your award, then you may have to simply pay an attorney $200-$400 per hour to represent you, and plan on seeing the meter run freely. Oh, and don't expect too much in exchange for that. Like winning your case.
On top of that, if any of your medical expenses have been paid for by your own health insurance, you will have to reimburse them for that expense if you win your case, since your health insurance is not intended to pay "third-party claims" (damages caused by someone other than yourself). It;s a concept called subrogation (kind of like double-jeopardy in reverse, you cannot collect twice for the same loss . . . once from your insurance company, and later from the at-fault party).
Best of luck. You can email me for more specific, but not legal, guidance.
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