We all rely on insurance. We pay our premiums. We would like to assume that if we are unlucky and have a loss, our insurance company will do the right thing and cover our claim. That can be a dangerous assumption.

Insurance companies hire insurance adjusters and attorneys whose focus is on saving money for the insurance company. Paying your claim costs money. They would rather find an excuse not to pay your claim.

“I ripped off a lot of people and I feel bad about that….My goal at the time was to save [the insurance company] money, not settle claims for what the case was worth.” An adjuster for a major insurance company as quoted in the Wall Street Journal.

If you believe your claim has been wrongly denied a claim by your own insurance company, do not give up. You have rights.

Under the law, insurance companies have duties. They must

  • explain insurance coverage in a way you can understand;[1]
  • fully and fairly investigate your claim, and do so within the time frames set out in insurance claims-handling regulations;[2]
  • not misrepresent pertinent facts or policy provisions;[3]
  • not use low-ball tactics to force you, their policy holder, to sue them just to get the benefits you paid for with premiums and are entitled to;[4]
  • not engage in any action that puts its profits above your protection.[5]

Even if the insurance company points to language that excludes coverage, do not give up hope without legal consultation. If an insurance company misleads you to believe you have coverage, or otherwise acts in bad faith, the insurance company might have to cover your claim, even if they would otherwise would not have to under precise language of the insurance policy.[6]

If your insurance company acts in bad faith you may be entitled to treble damages and attorney fees.[7]

Do not be intimidated by the David-and-Goliath scenario. Do not assume your insurance company has the final word. You have important rights as a policy holder. Get a free case evaluation promptly.

 

[1] WAC 284-30-350(1) (“No insurer shall fail to disclose to first party claimants all pertinent benefits, coverages or other provisions of an insurance policy or insurance contract under which a claim is presented.”); Anderson v. State Farm Mut. Ins. Co., 101 Wn. App. 323, 330, 2 P.3d 1029 (2000).

[2] WAC 284-30-330(4) (an insurer may not deny a claim without conducting a reasonable investigation); Coventry Assocs. v. Am. States Ins. Co., 136 Wn.2d 269, 279–80, 961 P.2d 933 (1998).

[3] WAC 284-30-330(1) (an insurer may not misrepresent pertinent facts or policy provisions).

[4] WAC 284-30-330(7) (an insurer may not compel a first-party claimant to initiate or submit to litigation, arbitration, or appraisal to recover amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered in such actions or proceedings).

[5] Tank v. State Farm Fire & Cas. Co., 105 Wn.2d 381, 715 P.2d 1133 (1986).

[6] Safeco v Butler, 118 Wn.2d 383, 823 P.2d 499 (1992); Besel v. Viking, 146 Wn.2d 730, 49 P.3d 887 (2002).

[7] RCW 48.30.015; RCW 19.86.010 et. seq.