Dealing with insurance companies after an injury is a difficult hassle. While this might still be the fastest way to get compensation – as opposed to going all the way to trial – it is a challenging system. Cases may even end up in court anyway if the insurance company is uncooperative. This is especially true when they try to misrepresent the insurance policy.
Insurance companies often misrepresent insurance policies by misstating or denying what the policy covers, who the policy covers, and how much the policy covers. This can happen in a few different ways, many of which can be resolved by taking the case to court.
For help with your case, call the Dallas bad faith insurance lawyers at The Queenan Law Firm today at (817) 476-1797.
Misrepresentations About Insurance Policy Coverage
Insurance companies often try to shut down coverage by saying that your accident isn’t covered under the terms of the policy. This misrepresentation usually happens regarding who is covered, what accidents are covered, what damages are covered, and what amounts are covered.
Who is Covered?
Insurance comes in two types, usually dictated by which system the state uses:
- At-fault policies (e.g., liability coverage) pay for the damages the policyholder causes others. This means when you file, you file with the at-fault driver’s policy.
- No-fault policies (e.g., personal injury protection – PIP) pay for the damages the policyholder suffers, regardless of who caused them. This means when you file, you file with your own policy.
Insurance companies sometimes try to take advantage of this confusion and tell you that your claim isn’t covered under the policy you are trying to file under. Making sure you file with the right party’s insurance is the first step in avoiding these issues.
Optional Coverages
However, even with at-fault insurance, you may have coverages on your policy that can help pay for your damages while we file a third-party claim against the at-fault driver, further confusing this issue.
Denying Policy Exists
Sometimes insurance companies lie and say that the insurance policy doesn’t exist or is not active, in which case we need to turn to the documents you might have to prove what the policy says and that it does, in fact, exist.
Denying Premiums Were Paid
Often insurance companies deny that the policy is paid and up to date. If this were true, then it might not be active; but we can use your bills and payment receipts to prove it is up to date.
Coverage for Household Members
Especially when it comes to uninsured/underinsured motorist coverage (UM/UIM), many states allow “stacking” coverage. This means that when you file a claim against an at-fault driver, but they don’t have enough to cover you, you can use your underinsured motorist policy and a UM/UIM policy for a spouse or other household member to cover even more.
In some states, the rules on stacking are not quite clear, so insurance companies tend to say it can’t happen, even though it happens all the time.
Types of Coverage
Even if your policy has multiple types of coverage, they might only look at one type at a time and deny that other expenses are covered. It may be tricky to explain to the insurance company you are trying to use multiple areas of coverage.
For example, if you have PIP coverage, it can pay for medical care and lost wages, but not vehicle damage. You would have to make it clear you are also trying to use your collision coverage – another optional coverage – before they will pay for vehicle damage.
Types of Accidents
Insurance companies may deny coverage for complex accidents, DUI crashes, or other accidents by saying that they were “intentional.” Insurance policies usually do not cover intentional crashes, but it is very rare that this actually applies; most accidents should be covered, including DUIs and reckless driving crashes.
Denying Fault
Perhaps the most common way insurance companies deny coverage is by denying fault. If their driver isn’t at fault, they don’t have to pay for damages through the liability policy, so they may misrepresent or misinterpret the facts in their favor.
If they do not flat-out deny fault, they may phrase it that there is not enough information to determine fault, but that has the same effect of denying coverage.
Partial Fault
If the insurance company claims you are partially at fault, they may try to reduce how much they pay. However, this should not apply to no-fault insurance, or cases where the facts do not actually point to partial fault.
Denying Coverage Amounts
Insurance companies have tricky ways of reading policies and interpreting facts in an attempt to reduce how much they pay. This can involve things like reading a percentage cap or policy limit into the wrong area of coverage or trying to block coverage for certain areas of damages (e.g., pain and suffering) altogether.
Can You Sue Insurance Companies?
Depending on the situation and the reason for denial, you may have a case against the insurance company.
When Using the Defendant’s Insurance Policy
If you are the victim and you are filing a claim with the at-fault driver’s policy, then you usually do not sue the insurance company. Instead, when they refuse to pay out full compensation, you can sue the defendant.
The insurance company is contractually obligated under the defendant’s policy to defend the claim in court and pay the covered damages, up to policy limits. So when you win your lawsuit, the insurance company pays.
When Using Your Insurance
If you are using your own insurance, you can sue them for two potential causes of action:
- Breach of contract for failing to fulfill the terms of the policy agreement.
- Insurance bad faith for not even making a good faith effort to pay the policy.
Winning an insurance bad faith claim can result in additional damages in many states, but it requires proof of serious wrongdoing on the insurance company’s fault. Always work with an insurance bad faith lawyer to track this kind of evidence and present it in court.
FAQs for Dealing with Insurance After an Accident
Should You Talk to the Insurance Company Before Calling a Lawyer?
No! Always call a lawyer first, and allow our attorneys to file and negotiate the claim for you.
Can You Appeal Denials Through the Insurance Company?
Yes, but you often should not bother using their appeals processes. Instead, have our lawyers contact them and their lawyers directly to negotiate a fair settlement.
If they refuse to pay you, we can take them to court instead of fighting on their terms through their appeals systems.
Do I Need a Lawyer?
You can technically represent yourself, but you should not. Insurance companies have experienced representatives, claims adjusters, and lawyers, whose jobs involve shutting down and reducing claims as much as they can. Our lawyers have the opposite job: getting your damages paid at their maximum value.
Call Our Insurance Bad Faith Lawyers Today
If you are having trouble getting damages after an accident, call our insurance bad faith and car accident attorneys to get the damages you need. Call The Queenan Law Firm at (817) 476-1797.