YOU HAVE A RIGHT TO A FAIR CLAIMS SETTLEMENT

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The following is a list of some general examples of what may be unfair claims settlement practices:

1. Attempting to settle a claim based on an application which the company changed without the insured’s knowledge or permission.

The simplest example of this is when an insurance company changes the date of application. However, it could be any information on the application that might be altered.

2. Failing to act promptly after receiving information concerning an insurance claim.

Insurance company has an obligation to act reasonably and promptly when they receive notice of a claim. The insurance company cannot ignore or intentionally delay responding to communications.

3. Delaying a claim investigation by requiring unnecessary reports or documents which contain substantially the same information.

As an insured you have a duty and obligation to reasonably cooperate. Reasonable cooperation does not require you to fill out unnecessary repetitive documents.

4. When applicable, failing to pay a claim quickly, fairly, and equitably.

The insurance company has an obligation to make payment when liability is reasonably clear.

5. Failing to promptly settle claims where liability is reasonably clear under one portion of the policy to influence settlements under any portion of the insurance policy coverage.

The insurance company cannot unreasonably refuse to pay a portion of the claim in order to force you to settle the entire claim. Should the insurance company provide you with a release, you should contact an attorney so that you understand what rights you may be giving up.

6. Failing to promptly and clearly explain the policy or law of either denying a claim or offering a compromise settlement.

If you get a denial letter for your claim, the letter should reasonably quote the policy language that applies.

7. Attempting to persuade insured not to invoke and use the Arbitration/Reference process. Arbitration and Reference are alternatives to litigation and the insurance company should not threaten or intimidate you concerning any arbitration and/or reference provision of your insurance policy. Should you feel that the insurance company is trying to pressure you into litigation you should consult an attorney concerning your rights, duties and obligations.

8. Misrepresenting significant facts.

Insurance companies sometimes deny claims based on an alleged misrepresentation of significant facts by the policyholder. There is a difference between a mistake and an intentional deception, which is not always recognized by the insurance company.

9. Misinterpretation of the policy.

Insurance companies sometimes deny claims on their misinterpretation and failure to properly interpret the language of the policy.

 

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