Missouri Insurance Lawyer Blog

Roy Rogers once said an insurance policy is one page that tells you what insurance you have and 50 pages that tell you why it does not apply in your particular situation. The 50 pages that take coverage away are called exclusions.
Exclusions are the insurance companies way of narrowing the risk they have accepted under the contract. For example if you have a policy of insurance on your car, but the situation that arises falls within an exclusion you bear the risk of loss and not the insurance company. In a recent post entitled Don't Believe The Hype You Are Not Friends, I made the point that all you get from insurance is the written contract. The nice sales pitch and fuzzy promises on TV give way to the hard realities of what's written in the insurance contract when its time for a claim.
If the insurance company denies your claim, it is usually because of exclusion. By way of example consider a common exclusion in a personal auto insurance policy, the business exclusion, which takes coverage away if your vehicle is used in a business instead of personal use. Even if you have your car insured for liability and you are in a crash and hurt someone you won't have any coverage if you were using a personal auto on business. Fortunately exclusions in the policy must be phrased in clear, plain and unambiguous language. If the insurance company claims that exclusion applies it is their burden to prove that it applies. So to protect yourself read your policy carefully to see what is covered before you need to make a claim.

It's amazing how many times I have clients injured in a car crash tell me that that thought they had "full coverage." In Missouri there are minimum state requirements for insurance coverage, but these minimums are very far from full coverage. When your only instruction to an agent or insurance company is that you want full coverage you are leaving your financial protection to chance. Missouri law requires that auto policies have liability insurance coverage of $25,000 per person and $50,000 per accident, and the same limits for uninsured auto coverage. There is no legal requirement to have underinsured motorist coverage, medical payments coverage, accidental death, or extended benefits coverage.
Underinsured coverage offers protection from drivers who injure you but do not have enough coverage to cover your injuries. Medical payments coverage pays for medical bills you incur as a result of being injured by a vehicle related incident, if you are killed this coverage pays all or part of the face amount of the benefit depending on the policy. Accidental death provides additional coverage should you die in an auto related incident. Extended benefits coverage pays lost wages if you are off work from an auto related incident.
If you want full coverage you would purchase all of this coverage to insure that you are truly protected. You also need to purchase insurance limits that make sense for you given your financial circumstances. I suggest that your minimum limits should be no less than $100,000 for liability insurance, uninsured motorist, and underinsured motorist. $10,000 in medical payments coverage and accidental death is adequate if you have adequate health insurance and life insurance. If you have significant assets or income then you should purchase higher limits to protect yourself and your family.

The South Florida Business Journal (8/27) reported, "Florida's insurance commissioner on Wednesday issued a final cease and desist order to three companies found to be engaged in the unauthorized sale of insurance products." The companies, Peck & Peck, Depawix Health Resources, and Green Cross Managed Health Systems, were found to have marketed "group and individual health insurance plans to small businesses and individuals, both directly and through licensed and unlicensed insurance agents, under the guise of selling an employment opportunity with Depawix." The cease and desist order said, "Green Cross calls itself a managed health system that purportedly provides health insurance to Florida consumers by placing them in part-time jobs with Depawix as a tester of the Green Cross process of medical care." The order also stated that employees were "paid a certain amount of money each month, much of which is kept by Depawix to pay for insurance coverage."
As reported in recent blogs here on the Injury and Insurance Blog, Missouri and Illinois have also recently taken pro policyholder positions by preventing an insurance company who did not follow fair claims practices. While this is good, there is still much work to do, and Insurance Commissions must do a better job of stopping unfair insurance company practices involving sales and claims.

Insurance Commissioner Steve Poizner of Californiar said he'll fight the sale of a portion of the State Compensation Insurance Fund for $1 billion." In the story original reported by the AP, Poizner stated that the State Compensation Insurance Fund "is the insurer of last resort for employers to provide compensation to workers who get injured on the job. Selling a portion of the business or taking money from its assets violates the state's constitution, Poizner said. He warned the sale would drive up insurance premiums for construction firms, farms and other small businesses."

The insurance company will have a contractual right to control the defense, but no right to prevent the insured from retaining their own counsel. Therefore, it is the wise policy holder who receives a reservation of rights letter, that immediately hires personal counsel to handle not only the issues emanating from the reservation of rights letter, but to keep tabs on and participate in the defense being put on by the insurance company.

The reservation of rights letter also implicates the relationship between the insurer and its' policyholder with respect to the cooperation clause. Insurance companies expect that their insured will abide by the cooperation clause in the policy which mandates that policyholders provide information and comply with reasonable requests of the insurance company in order to evaluate the claim and provide a defense. Once a policyholder receives a reservation of rights letter, the policy holder may not be sure how to proceed or what is required under the cooperation clause. Fortunately, well established contract principles instruct that the policyholder's obligations under the cooperation clause are conditioned upon the insurance company's performance of its own contractual obligations. Therefore, where an insurance company interest diverge from the interest of a policyholder, the policy holder's duty to cooperate logically only runs to the defense of the claim which could terminate liability for both the insured and the insurance company. Such duty to cooperate should not run to the insurance company and the issues raised concerning insurance coverage.

The conflict can be heightened further if the insurance company completes its investigation and decides to rely on its reservation of rights and file litigation against its insured to declare that there is no insurance coverage. Fortunately, Missouri policy holders have the right to reject the insurance company's reservation of rights. This is a valuable right, because it forces the insurance company to choose whether they wish to fight the battle with their own insured, or if they will honor their contract, defend the case and fight liability and damages against the person suing their insured. This right serves policy holders by preventing insurance companies from putting off performance they have contractually obligated to perform, and subjecting the insured to a conflict of interest in which the insured is obligated to cooperate with someone who is looking to dump them and avoid their contractual responsibilities.

It is clearly important that an insurance policy holder understand the full ramifications of denying reservation of rights. If a policy holder denies a reservation of rights, the policy holder has the obligation to simply reject and proceed on their own or they could offer the insurance company the opportunity to continue its performance if the insurance company will withdraw the conditions leading to the reservation. Although individual policy holder situations vary, the choice to reject the reservation of rights is often the soundest choice for policy holders faced with a reservation. This is particularly true if the policy holder or their counsel has acted to appropriately limit claims brought by the plaintiff through the use of an alternative settlement arrangement. If, of course, settlement is not a viable alternative with the plaintiff, then the rejection of the reservation of rights would leave the policy holder with the obligation to defend itself as best it could and then sue for recovery of its costs and any indemnify from its insurer. However, because of the perceived conflict of interest that a policy holder may feel, an adequately financed policy holder may still choose this opinion as the best choice rather than by defended by an insurance company who is ultimately seeking to break its obligations.

Where settlement with the plaintiff is possible, such may be achieved by using a covenant not to sue or by complying with the provisions of Missouri Revised Statute Section 537.065 which allow the contracting parties to limit the collection of their suit to specified assets. Depending upon the nature of the allegations in the petition, the strength of the liability, and the extent and nature of damages suffered by the suing party, such restriction assets may include the policy or the policy in other specified assets. Other specified assets should be included if there is a potential for a bad faith claim for failure to settle a bad faith claim against the insurance company arising out of their handling of the claim or litigation. Nonetheless, a straight rejection or a rejection with an offer to allow continuing performance to an insurance company may provide just the remedy a policy holder needs to a reservation of rights letter.

Where the best interests of a policy holder are served by outright rejection of the reservations they should do so unequivocally and then proceed to defend the suit themselves or enter an appropriate settlement arrangement with the plaintiff to fully protect their own interests.

Where the policyholder is willing to accept the performance of the insurer if the insurer withdraws the reservation of rights, then the policyholder should make the insurer aware of this fact and give the insurance company a deadline within which to meet the demand. Failure of the insurer to meet the demand will result in a rejection of the reservation. It is also advisable that a policyholder who indicates a future willingness to accept performance should inform the company that if such performance is not undertaken by the insurance company within the time period, that a settlement or other arrangement with the claimant will be forthcoming and it's likely that the insurance company will be sued for breach of coverage, garnishment or bad faith as may be applicable to the particular fact situation involved. Such direct threats often motivate an insurance company to rethink their position, particularly if the liability is defendable, or their coverage position is weak.

Despite the distress associated with receiving a reservation of rights letter, policy holders can come out ahead when they receive reservation of rights letters. The key is taking control of the situation by hiring independent counsel, in appropriate situations rejecting the reservation of rights, taking control of the defense, preventing and where appropriate entering settlement agreements that protect the policy holders interests and shifting the conflict from a policy holder facing lawsuits from both the injured party, and its insurance company to absolving itself of both lawsuits and allowing the injured party and the insurance company to become the combatants. This process allows the policy holder who purchased the insurance coverage to obtain their ultimate desired goal when they purchased the insurance, to protect their assets and transfer risks, while at the same time allowing both the aggrieved party and the insurer to fight the battle of coverage at a later date.

Chris Faiella is a personal injury in Missouri with the law firm of Tatlow, Gump & Faiella, www.tgflaw.com

An insurance policy is a contract and therefore subject to general principals of contract law. Missouri law allows a contract to be reformed when by reason of fraud or mutual mistake the written contract does not express the actual agreement of the parties to the contract. Mills v. Camerson Mut. Ins. Co., 764 S.W. 2d 244, 249 (Mo. App. 1984). In cases of mistake the mistake must be mutual, but that does not mean the parties have to agree that the mistake was a mistake of both parties as long as the evidence shows that both parties were in fact operating under a misapprehension of fact or law, or bot. See State Farm Mut. Ins. Co. v. McGuire, 905 S.W. 2d 150 (Mo. App. W.D. 1995).
In essence what this legal doctrine allows is a showing that there was an joint objective or purpose arrived upon by agreement between the parties, but that the expression of that agreement in the written contract is flawed. The proof required for reformation is clear, cogent and convincing evidence. However, where the litigants present conflicting evidence about the actual agreement, a Missouri court is free to sort out the conflicts which only need be supported by competent and substantial evidence. CMI Food Services v. Hatridge Leasing, 890 S.W. 2d 420 (Mo. App. W.D. 1995).

There are a variety of ways that this theory can help policyholders who have been left out in the cold without coverage. The theory can help not only where the policyholder and company make a mutual mistake but also where a mistake occurs between an agent and an insurance company, because legally the policyholders mistake is being a party to the erroneous policy. If you are in a situation where you thought you had insurance coverage and your insurance policy does not reflect your understanding of the agreement at the time the agreement was made, don't give up. The insurance company is not the final word on justice.

When your premium is due insurance companies expect you to timely pay your premium.  If you don't they will stop providing coverage.  What happens then when they owe you money for a claim?  A common experience among claimants is that insurance company's drag their feet when it comes to claim payments.  If this has happened to you there are some useful things you should know about.
In Missouri, if you are making a claim on your own policy, the insurance company has to comply with regulations that require a timely response, a decision on your claim and an explanation of your claim. If the insurance company says it needs more time to gather facts they must regularly update you with the status of their investigation. To learn more go the Missouri Department of Insurance web site.

This is a two part blog covering some things Missouri policyholders involved in a personal injury claim and who receive reservation of rights letters from their liability insurance company should understand. There is some good news, a reservation of rights letter means the insurance company is offering to pay your defense costs, but the bad news is that the insurance company is reserving its rights to deny coverage and sue you the policyholder or insured to obtain back the defense costs expended. Insurance companies often send reservation of rights letters to their policyholders because their broad duty to defend is implicated by the filing of a petition against their insured. Because the duty to defend is broader than the duty to indemnify there is a possibility the insurance company may be contractually obligated to pay for the defense even if it is not eventually required to pay for any liability alleged. In addition by asserting a reservation of rights letter, a company can undertake a defense and investigation of the claim and coverage at the same time and preserve its rights to disaffirm coverage without precluding itself from asserting defenses to the coverage at a later date, and managing their exposure to bad faith claims. Generally speaking to avoid waiving defenses, the letter will identify every possible coverage defense. Depending upon the individual facts, the doctrine of estoppel and/or waiver may prevent an insurance company from later asserting a defense that it failed to include in its reservation of rights letter. Unfortunately, reservation of rights letters are favorable for insurance companies, are fraught with danger for the policyholder. The mere issuance of reservation of rights letter indicates that there is a conflict of interest between the policyholder and the insurance company. This conflict of interest alone would advise that a policyholder should hire an independent attorney to represent them and not rely on the attorney appointed by the insurance company to provide a defense. Attorneys hired by insurance companies are often financially dependent upon the insurance company and that they receive much of their work from the company. While appointed defense counsel may diligently represent your interest in the alleged lawsuit, it is difficult to believe that that counsel can ignore their own financial interest, and give independent advice on your dispute with the insurance company. Most defense insurance counsel will defend the allegations in the lawsuit, but advise that you should hire personal counsel on the coverage issues. Unfortunately, there is often interplay between the allegations of liability and the triggers for coverage which are in dispute between the policyholder and the insurance company which lead to conflict of interest issues with insurance defense counsel. Bottom line, you should hire an independant lawyer to protect yourself. In part II, we will discuss the right of control, the duty to cooperate and the right to reject the reservation of rights. Chris Faiella is a personal injury lawyer in Missouri with the law firm of Tatlow, Gump & Faiella.

In my earlier post, Policyholders, Don't Believ the Hype, You Are Not Friends I suggested that policyholders hold onto the promotional material used to sell the policy they purchase.  Insurance policyholder attorneys know from experience that the ads, and promises of the sale don't meet the reality of the insurance policy contract.  Recently I read a really excellent post, March Madness Makes It "Official": State Farm Embraces the Reasonable Expectations Doctrine and Rejects Linguistic Literalism by Jeffery Stemple. This blog addresses a recent series of ads by State Farm called the "Something's Missing" series.  These ads will, as Stemple suggests, help policyholders obtain the benefits they thought they had purchased.

Recent events with AIG and the rampant wrongdoing of the worlds largest insurance company has caused me or re-read this report on the practices of insurance companies. PatternOfGreed is posted so you may read it for yourself.

Missouri recently passed a new law which purports to provide better access and more protection to life insurance purchasers.  House Bill 577, which will become law this August makes several changes to the insurance law, but in reality offers little for consumers of life insurance.  The only protection is that an insurance company may not deny an applicant for past or future lawful foreign travel unless based upon sound actual or reasonable experience. 

The strongest protection from abusive life insurance denials in Missouri continues to be common law actions, and first party actions for Vexatious Refusal. Unfortunately these remedies while successful in obtaining payment lack the punch to stop abusive practices in the first place.

People purchase life insurance policies as a way to help their loved ones after they pass away.  A life insurance policy can provide surviving beneficiaries with financial stability after a family member dies.  In the process of selling the policy, Life insurance companies consider a variety of factors including medical history, height and weight, whether you use tobacco or drink and if your job presents particular occupational hazards.  These factors are used to determine insurability and premium (price) on the life insurance policy for a particular person.

People believe that if life insurance is obtained and the premiums paid, that upon death, collecting the life insurance will be easy.  Unfortunately, that is not always what happens. 

Life insurance companies review each claim carefully before paying the benefits.  Insurance companies will want the certified death certificate, and a claim form as part of the claims process.  One of the most common reasons for denial is that there was a "material misrepresentation" on the life insurance application.  Of course the applicant is now dead, so any proof they could offer is gone.  The insurance company may claim that the misrepresentation occurred in the original application for insurance or in a later amendment to the application.  In almost every such case the insurance company will obtain medical records of the deceased and may have the application, records and other facts reviewed by medical specialists.

In such situations the beneficiaries will find that instead of financial security they have a fight on their hands with an insurance company that is motivated to keep its dollars.  While a family can sue for breach of contract, this only recovers the benefits and not expenses and attorneys fees.  Missouri's Vexatious Refusal Statutes Section 375.296 and 375.420 provide for attorneys fees, but have laughable penalties that provide no financial incentive for Missouri insurance companies to not try their luck at the denial game.  Missouri needs true first party bad faith so that insurance companies that unfairly and purposefully deny claims can be held accountable for their actions.  Only when poor treatment of Missouri insurance policyholders is more expensive than fair treatment will abusive practices stop.

A.I.G. to Sell Auto Insurance Unit to Zurich Financial - NYTimes.com.

The Missouri Court of Appeals recently rejected the appeal of an insurance company which sought to escape their duty to defend and indemnify a 15 year old unlicensed driver.  The case arose out of a one car accident which resulted in personal injuries to the passenger. 

The insurance company claimed an exclusionary provision precluded coverage for "any person" operating a vehicle without a reasonable belief that the person is entitled to do so.  The term "any person" was not defined in the policy.  Relying on the doctrine of ambiguity the trial court found the term to be ambiguous when reading the policy as a whole.  On appeal the Missouri Eastern District agreed finding that the policy term could be read by a lay person as either referring to any defined insured or a global term referring to anyone other than a defined insured.  The court upheld the trial court's decision which arose procedurally from cross motion for summary judgment. The case is Miller's Classified Ins. Co. v. Aimee French, et al, Missouri Court of Appeals, E.D. Appeal No. ED82306. 

Universal Casualty Company has been fined by the Illinois Department of Insurance. The Insurance Networking News reports that the fines were related to Universal Casualty's failing to adopt procedures for the efficient, and prompt investigation and settlement of consumers' claims.  The full story, Illinois Dept. of Insurance Fines Universal CasualtyUniversale notes that the insurer does business in Missouri as well as other States.  The Missouri Department of Insurance took action against the insurer in June by banning the writing of all new business. 

According to the Missouri Insurance Director's order, the company violated Missouri insurance laws by:

• Failing to respond to or properly investigate claims filed by policyholders within a timely manner;


• Failing to respond to inquiries from the Department of Insurance, which is investigating consumer complaints;


• Improperly denying claims; and


• Offering unreasonably low dollar amounts for claims.

It's good to see that the Missouri Department of Insurance and other regulators are taking insurance consumer protection seriously.  Consumer's shortcomings are what bad faith conduct is all about.  Responsible insurance companies treat their policyholders fairly and don't use these tactics to hurt their customers.

American Family Mutual Insurance Company has lost its appeal to the 8th Circuit in a bad faith and breach of contract case after accusing its insured of burning down his own home.  Arson is a felony and the accusations resulted in not only economic loss but serious emotional and physical distress of the insured.  The Court of Appeals upheld the district court verdict which resulted in a compensatory damage award of $49,564.96 and $1,150,000.00 in punitive damages. 

The court upheld a jury instruction that allowed the jury to consider violations of Prohibited Practices in Insurance Business Act as evidence of bad faith.  The court also upheld the punitive damages award based upon American Family's "tortious conduct" of labeling their insured an arsonist based on insufficient grounds. The court found that that conduct "evinced an indifference to or disregard of" the insured's financial, emotional and physical well-being.  Notably the insured presented evidence that American Family, without first conducting an adequate investigation, sent documents to the State Insurance Commissioner and the Property Loss Insurance Register that the insured's claim was denied for arson and fraud.  The evidence presented was that such a report would have a devastating effect on the insured's ability to obtain other insurance and thereby hurt his family business.  

Insurance companies cannot deny claims without a valid basis, or without conducting a prompt, fair and full investigation.  In Missouri, the tort of bad faith known as vexatious refusal to pay can be brought to obtain the benefits the insured is owed and to recover punitive damages and attorneys' fees.

Timely notice of a claim or loss is a requirement under almost every insurance policy.  Unfortunately, policy holders sometimes fail to notice their insurance company of a claim or loss, timely.  Do not wait to give notice to your insurance company because doing so may allow the insurance company to deny coverage based upon late notice.  

In Missouri, an insurance company must show late notice and prejudicial effect as a result of the late notice.  Late notice alone cannot result in disclaimed coverage, however it is difficult to tell what events may arise in between the time of the claim or loss and the delay in notice that may occur that could result in actual prejudice to the insurance company.  Since evidence, witnesses, and circumstances change, it is impossible to adequately protect yourself fully if you do not give timely notice to your insurance company. 

When providing notice, it is fine to contact the company by phone; however, it is strongly suggest that you follow up the notice in writing. Some policies have very general notice requirements and any notice to the company will suffice. However, some notice provisions require that notice be sent to a specific address.  The general recommendation to follow is that phone notice should be given shortly after the event, followed by written notice to the company as well as the broker or agent.

If you use an insurance agent to obtain your insurance policy then that insurance agent has certain responsibilities that are imposed by law. In Missouri when an insurance agent undertakes to procure insurance for a party, with a view to earning a commission, he becomes the party's agent and owes a duty to the party to act with reasonable care, skill and diligence. If an agent is unable to obtain the insurance you sought, he has a duty to timely notify you.   The failure to procure the appropriate coverage or the failure to timely notify you will render an agent liable damages.  

If your agent has broken these rules you may sue for money damages for the breach of the agreement to obtain the insurance requested or for negligent breach of the agent's duty. In addition, an independent insurance agent and his client may have a fiduciary relationship.  A fiduciary duty between principal (you) and agent (insurance agent) requires the exercise of utmost fidelity and good faith.  In Missouri the existence of a fiduciary relationship obligates the agent to make a complete and full disclosure of all material facts concerning the transaction which might affect the principal's decision regarding the subject of the relationship. In Missouri it is a breach of fiduciary duty for an agent to occupy a position antagonistic to his principal.

If your agent failed to obtain the policy or coverage you requested, or failed to notify you and you have suffered an uncovered loss or are being sued but have no insurance to cover your liability you may be able to pursue your insurance agent for his wrong doing.

Insurance companies deny coverage for any number of reasons. However, the fact that you have received a denial of your insurance your claim should not be the end of your fight.  Insurance companies are often wrong in their assertions of no coverage, and there are several legal rules which may help your case. One of the most powerful rules that can help people fighting an insurance company on coverage is the doctrine of ambiguity. Simply put if the language of the insurance policy is ambiguous it must be construed by a court in favor of the insured (the policy holder or beneficiary) rather than in the favor of the insurance company.  The reasoning behind this rule arises from the fact that insurance companies use form contracts that they write and issue, so if a dispute is over their failure to make the contract clear then they are the ones who should bear that burden.

As a result of this rule many lawsuits over coverage focus on whether or not an ambiguity exists in the policy.  Generally speaking a policy is ambiguous if there is doubt about its meaning, duplicity or uncertainty about the language as applied to the facts of the case.  This rule has also been expressed as a contract that promises something in one section and then takes it away in another.  While the explanation of what an ambiguity appears simple, in application an ambiguity may be quite complex.  It is also possible that an ambiguity may arise from a document other than the actual contract language such as the application for coverage.  The important thing to remember is that when your coverage claim is denied you do not have to accept the insurance company's position.  There are legal rules that help policy holders, which may apply in your particular circumstances.  Consultation with an attorney regarding your particular situation may turn a denial into a recovery.

If you need assistance contact Chris Faiella, with the law firm of Tatlow, Gump & Faiella at 1-800-264-3455 for a free, consultation.  Chris will help you determine your options and advise you as to the course of action that will best suit your individual situation.

Insurance companies often say one thing then do another. Most of the time, an insurance policy means what it says however, there are numerous reasons why you may be entitled to collect from an insurance policy despite what the company or the policy represents to you at the time you make a claim. As a result you should make sure that you know your legal rights and do not rely solely on the insurance company for your interpretation of the policy. It is critically important that you are aware that sometimes the policy language itself may not control. For instance if the language is confusing, vague or ambiguous your claim may be covered.

Consider also that sometimes part of the policy may be illegal under the law of your state. For example a personal automobile policy which includes uninsured motorist coverage for the policy holder. In many states, most every policy sold of this type, contains an anti-stacking clause which prevents a policy holder who owns more than one vehicle from stacking or collecting the policy limits for each uninsured motorist coverage. However, in many states the insured can stack uninsured motorist coverage. Therefore if you had four vehicles each with uninsured motorist coverage of $25,000.00 and you are injured by an uninsured motorist instead of being able to collect $25,000.00 you could collect up to $100,000.00 despite the anti-stacking clause. Relying on the insurance company to tell you what's covered is not the smart move. So even if you have read your policy it is critically important for you to understand your rights. Simply reading the policy will not protect all of your rights and it is important that you inform yourself of those rights if you are making a claim under an insurance policy.

.  Chris Faiella, a partner with the law firm of Tatlow, Gump & Faiella, LLC has helped clients fight insurance companies after they have been told a policy of a person who injured them was canceled and in cases where their own insurance company claimed a policy lapsed.  Our firm has been successful in securing recoveries for clients in these situations. If there was not proper notification of the cancellation of a policy by the insurance company then you may have a claim even if the company claims there is no insurance coverage.  

Speak with an Attorney

 Call toll free 1-800-264-3455 to speak with a Chris Faiella of the Law firm of Tatlow, Gump & Faiella, LLC about your Insurance Coverage claim when the Insurance Company did not provide proper notification of cancelation or lapse.

Policyholders, the insurance contract is not an exciting thing to read, but it should be read.  I have found that many insurance agents, claims adjusters, underwriters, and attorneys don't understand insurance policy language. So why should you read the policy if even some professionals have difficulty? Well, the simple answer is the more you know, the better you can protect yourself.

While you will probably not understand all of the policy let's discuss some basic things you should check.  Every policy differs but all of them have some common elements, the declarations, the insuring agreement, definitions, policy coverage, exclusions and conditions.  Review the declarations page. The declarations page is in effect a summary of the coverage, and the specifically negotiated terms.  The declarations page will give you the term of the policy, the premium, the general types of coverage the policy contains, and the financial limits of the coverage.  You should check that each of these meet what you understood them to be when you decided to purchase the policy. If they do not you should contact your insurance company or agent to correct the problem immediately.

The remaining sections of the policy are often difficult for people without insurance experience or legal training to understand, but it is worth reviewing the policy so you are generally aware of the coverage, definitions, and terms.  If you see something that causes you concern, contact your company or agent.

When you have completed your review put the policy, along with your copy of the application, and informational brochures you received in a safe place.  If you need the insurance down the road and there is a dispute between you and your insurance company, you will have all the information you need in one place.

If you have a claim dispute with your company the contract is the first place to go to understand the obligations of each party. 

Chris Faiella, a partner with the law firm of Tatlow, Gump & Faiella, LLC has helped clients fight insurance companies after they have been told a policy of a person who injured them was canceled and in cases where their own insurance company claimed a policy lapsed.  Our firm has been successful in securing recoveries for clients in these situations. If there was not proper notification of the cancellation of a policy by the insurance company then you may have a claim even if the company claims there is no insurance coverage. 

 

Speak with an Attorney

 Call toll free 1-800-264-3455 to speak with a Chris Faiella of the Law firm of Tatlow, Gump & Faiella, LLC about your Insurance Coverage claim when the Insurance Company did not provide proper notification of cancelation or lapse.

Nationwide tells you they are on your side, State Farm, is like your good neighbor and Allstate has you in good hands, but reality check, they are not.  The truth is that insurance companies are businesses that sell financial protection against risk.  What you get for your dollars is a promise of payment under the terms of the policy at some date in the future.  The bottom line, you have a contract and nothing else. 

When you purchase or renew insurance you should do at least three things: have an understanding of the coverage available, check the insurance company's financial strength, and check the claims history of the company. 

To get an understanding of the coverage you can refer to literature the company provides, which should give you an honest plain English version of what the coverage is for and what it covers.  You should keep this material from the company you buy or renew your policy with.  If the coverage in the policy and the ads don't match what the contract says, this evidence may help you recover despite what the policy says. 

You can check out insurance company's financial strength, and claims histories at the department of insurance in the State where you live. Most departments keep track and allow public access to complaints that are found to be valid.  Any insurance company can have some complaints, but if there are numerous complaints look for another insurance company. 

Keep in mind that if you end up making a claim on your own policy you and your insurance company are adversaries.  The insurance company's obligations and yours are defined by the contract. Don't buy coverage because of an ad, buy it because it meets your needs, the company is financially strong, and has a good track record of fair treatment when paying claims.