FREQUENTLY ASKED QUESTIONS About Insurance Claims
How much does it cost to retain Pazos Law Group?
Nothing. No upfront fees. If we prevail in your case against your insurance
company, the law requires them to pay for your legal fees. No upfront
fees, no out-of-pocket expenses.
What are the guidelines the insurance company must follow on my insurance claim?
Insurance company must treat its policyholder’s interests with equal
regard as it does its own interests. This is not an adversarial process;
- Insurance company should assist the policyholder with the claim;
- Insurance company must disclose to its insured all benefits, coverages
and time limits that may apply to the claim;
- Insurance company must conduct a full, fair and prompt investigation of
the claim at its own expense;
- Insurance company must fully, fairly and promptly evaluate and adjust the claim;
- Insurance company may not deny a claim or any part of a claim based upon
insufficient information, speculation or biased information;
- If full or partial denial, insurance company must give written explanation,
pointing to the facts and policy provisions;
- Insurance company must not misrepresent facts or policy provisions;
- Insurance company may not make unreasonably low settlement offers;
- An insurer must adopt and implement reasonable standards for the prompt
evaluation of claims;
- In evaluating a claim under a replacement cost policy it is not proper
for an insurer to deduct depreciation from the value of the claim;
- Failure to fairly and reasonably investigate a claim does not permit the
company to deny the claim due to lack of information or one-sided information;
- An insurance company may not ignore evidence which supports coverage.
- If denial, must promptly give policyholder a reasonable explanation of
the basis in the insurance policy in relation to the facts, policy provisions
or applicable law upon which it relies for denial of claim;
- If offer is a compromise amount, must provide a reasonable explanation
of the basis of that amount in the insurance policy in relation to the
facts and law;
- Cannot discriminate in the claim settlement practices based on the claimant’s
race, gender, income, religion, sexual orientation, national origin, or
physical disability or the territory of the property or person insured;
- Cannot attempt to settle a claim for an unreasonably low amount;
- An insurer must communicate with its insured to keep it appraised of the
status of its claim;
- It is improper for an insurer to tie in any manner claim personnel compensation
to claim decisions or payments to its insureds;
- An insurer has a duty to disclose all significant facts to its insured;
- An insurance company must not misrepresent facts or policy provisions relating
to coverage of an insurance policy;
- An insurance company must not fail to acknowledge and act promptly upon
communications regarding a claim arising under an insurance policy;
- An insurance company must adopt and implement reasonable standards for
prompt investigation of claims;
- An insurance company must not refuse to pay a claim without a reasonable
investigation of all of the available information and an explanation of
the basis for denial;
- When insureds don’t recognize they are entitled to benefits in a
policy, an insurance company’s obligation is to point out those
policy benefits to them;
- An insurance company cannot deny a claim or refuse partial payment on a
claim without first conducting a full, a fair, a thorough investigation
of the facts and circumstances;
- An insurance company may not use the claims department as a profit center; and
- The insurance company must keep a total claims file that reflects all activity on a fie.
Is it too late to file a lawsuit on my insurance claim?
The statute of limitations is the time you have to file a lawsuit against
your carrier after a loss. This varies from policy to policy. Act promptly
and make sure you don’t delay if you want to be properly paid for
What is bad faith?
Bad faith can be described as intended deception. In terms of insurance,
this can be ill fulfillment of contractual obligations, to the policyholder.
Administering misleading information and breaching basic industry standards
are just some examples of an insurance company displaying bad faith.
What are my responsibilities as a policyholder after a loss?
- Provide your insurer with prompt notice of your insurance claim.
- Provide your insurance company with any and all evidence and documentation
- Mitigate your damages by taking any necessary and practical steps to protect