A determination by your insurance company that you are not covered is not the final word, but only the beginning of a process for you to obtain the insurance coverage which you purchased. Upon further investigation, facts may come to light which may cause the insurance company to re-evaluate its position and provide coverage.
Also, if suit is necessary, the courts may find that you are covered by your insurance policy when your insurer says you are not covered.
The realities of insurance
Whether you are a business that purchased a commercial general liability insurance policy or an individual who purchases a homeowner's policy or a life insurance policy, "peace of mind" was probably a big selling point made by the selling insurance agent. In return for payment of money to the insurance company today, the insurance provider promises that it will be there for you in the future should you suffer a loss.
Unfortunately, many find that after having consistently paid their premiums, an insurance provider denies their claim when they call upon their insurance company for the coverage promised in the insurance policy. In many cases, the one who determines and advises you that your insurance policy does not provide coverage is not an attorney, but a claims adjuster without knowledge of Louisiana insurance law.
Should your insurance company deny you coverage, you should seek the advice of an attorney familiar with the interpretation of insurance policy language.
When doing so, you are obtaining the opinion of a person trained in insurance law and not employed by the insurance company. If your attorney's opinion is that you are entitled to coverage, the denial of your claim is the beginning of your claim's process, not the end.
Why insurers and the insured always seem to be at odds
As an insurance company is a business, and a goal of a business is to make a profit, it is understandable that an insurance company has a bias towards denying insurance coverage. However, this bias may not be the only reason for an insurance company denying coverage to its insured.
At the time that you prepare and submit your claim to your insurance company, you may not know all of the facts and the insurance adjuster may not know all of the facts particular to your situation. In this situation, an attorney can review the insurance provisions, discover the relevant facts that trigger coverage and transmit these facts to the insurance adjuster for a re-determination of coverage.
When problems with claims persist
If the adjuster continues to deny coverage in the face of the newly presented facts, your attorney will be able to further pursue and protect your interests by filing suit against the insurance company. In this suit, your attorney will ask the court to declare that you have coverage under your policy.
In some situations it is not the lack of knowledge of certain facts which cause the insurance adjuster to deny coverage, but the policy language as the policy language relevant to your claim may have acquired a legal meaning which is not apparent to the layman or the insurance adjuster upon reading of the policy. Again, your attorney will be able to explain to the insurance adjuster the legal meaning and ramifications of the policy language and how that meaning entitles you to coverage.
Should the adjuster continue to deny coverage in the face of such law, your attorney will be able to further pursue your interest by filing suit against the insurance company asking the court to determine that you are covered by your policy.
The above situations may be best explained by real life examples:
Family #1 - Accidental Death Claim
In a claim for accidental life insurance policy proceeds, an insurance company denied the claims of a parent for the death of their child, when that child died after losing control of a car he was driving. Scientific examination of blood samples showed trace amounts of a prescriptive medicine, a medicine which was not prescribed to the child.
Also, if suit is necessary, the courts may find that you are covered by your insurance policy when your insurer says you are not covered.
The realities of insurance
Whether you are a business that purchased a commercial general liability insurance policy or an individual who purchases a homeowner's policy or a life insurance policy, "peace of mind" was probably a big selling point made by the selling insurance agent. In return for payment of money to the insurance company today, the insurance provider promises that it will be there for you in the future should you suffer a loss.
Unfortunately, many find that after having consistently paid their premiums, an insurance provider denies their claim when they call upon their insurance company for the coverage promised in the insurance policy. In many cases, the one who determines and advises you that your insurance policy does not provide coverage is not an attorney, but a claims adjuster without knowledge of Louisiana insurance law.
Should your insurance company deny you coverage, you should seek the advice of an attorney familiar with the interpretation of insurance policy language.
When doing so, you are obtaining the opinion of a person trained in insurance law and not employed by the insurance company. If your attorney's opinion is that you are entitled to coverage, the denial of your claim is the beginning of your claim's process, not the end.
Why insurers and the insured always seem to be at odds
As an insurance company is a business, and a goal of a business is to make a profit, it is understandable that an insurance company has a bias towards denying insurance coverage. However, this bias may not be the only reason for an insurance company denying coverage to its insured.
At the time that you prepare and submit your claim to your insurance company, you may not know all of the facts and the insurance adjuster may not know all of the facts particular to your situation. In this situation, an attorney can review the insurance provisions, discover the relevant facts that trigger coverage and transmit these facts to the insurance adjuster for a re-determination of coverage.
When problems with claims persist
If the adjuster continues to deny coverage in the face of the newly presented facts, your attorney will be able to further pursue and protect your interests by filing suit against the insurance company. In this suit, your attorney will ask the court to declare that you have coverage under your policy.
In some situations it is not the lack of knowledge of certain facts which cause the insurance adjuster to deny coverage, but the policy language as the policy language relevant to your claim may have acquired a legal meaning which is not apparent to the layman or the insurance adjuster upon reading of the policy. Again, your attorney will be able to explain to the insurance adjuster the legal meaning and ramifications of the policy language and how that meaning entitles you to coverage.
Should the adjuster continue to deny coverage in the face of such law, your attorney will be able to further pursue your interest by filing suit against the insurance company asking the court to determine that you are covered by your policy.
The above situations may be best explained by real life examples:
Family #1 - Accidental Death Claim
In a claim for accidental life insurance policy proceeds, an insurance company denied the claims of a parent for the death of their child, when that child died after losing control of a car he was driving. Scientific examination of blood samples showed trace amounts of a prescriptive medicine, a medicine which was not prescribed to the child.
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