Missouri Insurance Lawyer Blog

Insurance policies are complicated legal contracts between you, the policy holder, and the insurance company. Very often, when a policy holder makes a claim for damages they believe should be covered by their insurance policy, the insurance company will deny the claim citing a reason unknown or often misunderstood by the policy holder.
On December 27, 2011, the Missouri Court of Appeals, Eastern Division, decided an insurance case based on the disputed definition of "owned" and "resident". The case, Manner v. Schiermeier, et. al, and American Family Mutual Insurance Company and American Standard Insurance Company, Case No. ED96143, was a claim against the insurance companies for underinsured motorists coverage on four separate automobile insurance policies because of serious injuries suffered in a motorcycle collision.

The coverage on at least one of the insurance policies depended upon whether the injured Plaintiff "owned" the motorcycle which he was driving as that word was used in the policy. For purposes of the insurance policy, the Court of Appeals determined that even though the certificate of title was not yet in the Plaintiff's name, the undisputed facts demonstrated that the plaintiff held the motorcycle as his own possession, had paid for it, either in whole or in part; drove it; and was in the process of having title transferred to him; and had separately paid for liability and underinsured motorist insurance. Therefore the Court determined that the Plaintiff did indeed "own" the motorcycle for purposes of insurance coverage.

Continue reading "WHETHER OR NOT YOU RECOVER BENEFITS FROM YOUR AUTOMOBILE INSURANCE POLICY MAY DEPEND UPON THE DEFINITION OF A SINGLE WORD IN THAT POLICY" »

Many Missourians have experienced devastating losses as a result of the storms that have ravaged the southern portion of the state in recent weeks. Thousands of people will be filing insurance claims and we want to help make sure those claims are handled properly by explaining a few situations that could happen with your insurance claims. Here are just a few things to take into consideration:

1. Many insurance companies use a property damage estimating software program called Xactimate. Prices in the program are updated on a quarterly basis. When a large storm strikes it is not uncommon for labor and materials prices in the area of the storm to increase, sometimes rapidly. As a result the prices in the Xactimate program may be outdated at the time of the storm because of the sudden increase in prices. Check with your insurer who uses this or similar programs to determine if they have updated their prices to reflect the increase in the prices immediately following the storm. If not, ask that they do so; otherwise your repair estimate may not accurately reflect the exact cost of repairs.

2. Standard homeowner policies provide that you are entitled to the full replacement cost for the repairs to your home. However, the insurer is only required to pay you the actual cash value of your repairs until you replace or repair your property, and then when that is done you can collect the difference between the replacement cost and the actual cash value. This difference is called the hold back. The hold back is determined by subtracting depreciation from the replacement cost estimate for your repairs. Therefore, if your repairs are estimated at $10,000 for replacement cost value, and the insurer determines that $1,000 depreciation should be subtracted from the replacement cost repair estimate, the insurer will then pay you initially only $9,000 (less your deductible). The $9,000 payment is called the actual cash value payment. Depreciation is determined by considering several factors, such as the wear and tear, age and obsolescence of the item being repaired or replaced. Insurers use a variety of schedules to determine what should be depreciated and for how much. Ask your insurance adjuster how they arrived at the depreciation rate for each item depreciated and what the depreciation rate is based upon to make sure that the appropriate depreciation rate is being applied. Make sure the adjuster is aware of the age of items to be repaired or replaced so that the proper depreciation rate can be applied. For example, the expected age of interior paint may be ten years. If you painted the inside of your house only two years ago, then the depreciation rate that should be applied to the paint job should only be 20%. If the insurer charges a higher rate you should question their depreciation reduction. Also, several items should not be subject to depreciation, such as pure labor items (i.e., remove and replace light fixture to paint room, etc.) or other items (i.e., profit, overhead, and sales tax, etc.) because these items are not subject to wear, tear and obsolescence. Read the insurer's estimate carefully to make sure that such items are not being depreciated.

3. For large losses (anything over $10,000) always get your own estimate from a local licensed general contractor who will commit to doing the work for the amount of his estimate. It is preferable that your contractor prepare an estimate on the same kind of estimating program that the insurer uses so that the two estimates can be easily compared. If there are differences between the insurer's estimate and your contractor's estimate have your contractor meet with the insurer's representative at the house to discuss the differences and have the insurer's representative explain why there are differences. Regardless, once the insurer determines what the repairs are, the insurer must pay you that amount, even though there may still be a disagreement between you and the insurer over any additional amounts that can be owed.

4. If there is a dispute between you and the insurer over the amount of the repairs consider taking advantage of the appraisal provision in the policy which is there to resolve disputes over the amount of the loss. In appraisal, you select a qualified appraiser that you pay, the insurer selects their own appraiser, which they pay, and the two appraisers select an umpire, and you and the insurance company share the cost of the umpire. The appraisal panel then determines the amount of the loss which the insurer must pay. Appraisal has some advantages, in that it can be quicker and less expensive than litigation where there is a dispute over the amount of the loss. Nonetheless, you should be careful in selecting your appraiser, and you should consider getting advice from qualified and experienced attorney on your selection as well as to how best proceed with the appraisal.

Many people are worried that their insurance company will not renew them if they make a claim. In today's market there are numerous other choices if your insurance company denies your claim. However, if you have been refused a renewal by your company and you wish to stay with the company you do not have to accept their decision.

Insurance companies usually refuse to renew policies because of claims against the policy or when they have dropped the line of insurance as a product line. If you have no claims on your policy and you believe your insurance company unfairly refused to renew your policy because of false claims information, you should contact your insurance commissioners consumer service division. If your carrier refuses to renew your policy even after working with the commissioners consumer service division and you are having a difficult time finding coverage elsewhere you may wish to contact an attorney to discuss your legal rights.

For more information on insurance in Missouri, visit the MO Department of Insurance website.

Every contract has an implied covenant or promise of good faith and fair dealing. Insurance policies are merely contracts between the insurance company and the person who purchased the insurance and people who qualify for insurance benefits under the terms of the contract. Thus, every insurance policy in the United States has a promise imposed by law upon an insurance company to act fairly towards its policy holder and the beneficiaries in the performance of the contract. This is true whether or not such a clause is specifically include in the policy, because courts will read such covenant into the policy as a matter of contract law.
Insurance carriers must therefore meet the objective reasonable expectations of the policy holders and insurers must give equal consideration to the financial interest of its insurer as it does its own interest. Thus, when an insurance company does not have to put its interests behind that of its insured, it cannot protect itself while abandoning its policy holder.

In cases, commonly referred to as bad faith cases, the essential question is whether or not the insurance carrier met its duty of good faith and fair dealing in the situation presented by the performance of its contract obligations. Examples of bad faith include delaying payments, paying less than what is owned, denying benefits or coverage, or failing to settle claims within the policy limits. The insurance companies also have obligations imposed upon them including the duty to promptly investigate all claims, and where appropriate to defend their insured under the terms of the policy. Bad faith action insurance companies policies, practices, and customs will be at issue to show how the insurance company acted, to show its motive, intent, plan and knowledge concerning the particular facts of the case. It is not necessary to show that a insurer acted intentionally to cause harm. Bad faith is a state of mind and may be evidenced by both acts and circumstances on the part of the insurer, but amounts to more than a mistake.
Specific facts that may indicate bad faith on the part of the insurer include demand that the insurer contribute to the settlement, ignoring settlement advice, not disclosing policy limits to a claimant, failing to foresee probable excess verdicts, taking and employing hard line settlement tactics, and properly investigating a claim and properly evaluation a claim, failing to litigate a claim, failing to provide a proper defense, failing to consider settlement, ignoring setting advice, failing to communicate with the insured about the case, or failing to advice the insured about the potential of excess judgments, failing to advise the insured about the policy coverage, failing to advise the insured about existence of settlement offers, acting on behalf of one insured to the detriment of another insured.

It is clear that when people buy an insurance policy that they are seeking protection from the risks insured. If the insurer fails to satisfy their obligations to the policy holder, the policy holder will face the financial risks for which they had purchased protection, as well as the emotional distress as a result of the breach of the policy agreement. Policy holders and beneficiaries are obviously in a vulnerable position when they must rely on their insurance carrier to protect their interest, particularly if the insurance company does not share information, or take appropriate actions to protect the insured's interests, because an insurance company generally has superior knowledge concerning the facts and law, and in all cases where the insured is the wrongdoer, the insurance company is in control of the defense. Therefore, bad faith lawsuits promote not only compensation by injured policy holders and beneficiaries, but provide deterrence from insurance companies acting oppressively towards their customers.

The Missouri Department of Insurance regulates and monitors the health of state licensed insurance companies through the analysis of financial statements that insurance companies are required to file as well as on site examinations. Other states have there own departments of insurance which perform the same function for insurance companies in those States.
If a company is found to be in poor financial condition, the Department of Insurance can take various actions to try to save the company, and protect the policy holders. Unfortunately, just like bank failures the unthinkable really does happen and insurance companies fail. Fortunately, in the vast majority of cases in the property and casualty insurance industry, most claims are covered through the insurance guarantee fund.
The insurance guarantee fund system was created by lawmakers and the insurance industry more than 40 years ago and is designed to protect consumers to deal with association losses when insurance companies fail. The guarantee fund system in Missouri will pay the amount of coverage under the policy or $300,000.00, whichever is less. These caps are fixed by Missouri state law, and the guarantee fund plays no role in setting the coverage caps.
If you have suffered a personal injury or a loved one has suffered wrongful death and you have made a claim against the responsible party, and that party's insurance company has become insolvent you have a claim against the guarantee fund. Depending upon the residence of the insurer, your claim against the guarantee fund may be in the State of Missouri or in another state. If you have a claim against your own insurance company and they are insolvent, you have a claim against the guarantee fund as well. More information can be found at the Missouri Insurance State Guarantee Fund.

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

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.

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.

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.

Insurance companies must follow specific requirements when they cancel a policy of insurance. If the company fails to follow these requirements then the policy is not canceled.  One rule that applies in almost all cases is that the notice must not anticipate the failure to pay a premium.  In other words the company cannot comply with State Law notice requirements by simply telling an insured in the policy that if you don't pay the policy lapses, a notice must be sent.  However, insurance companies sometimes send notification to a wrong address, to the wrong person or not at all. 

Is the insurance company of someone who injured you telling you there is no coverage because the policy lapsed or was cancelled?  Are you are being told by your insurance company that your coverage lapsed or was cancelled? If you did not receive notice it is possible that the insurance company did not follow all of the rules when they "cancelled" the insurance.  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.

If you don’t want to arbitrate don’t simply accept what your insurance company tells you about your rights.  For instance, James Smith applied for benefits under a policy of insurance he was entitled to receive.  The policy said that any dispute will go to arbitration.  It also said that arbitration was binding and let the insurance company pick the arbitrator.  An arbitrator is like a judge and is the person who will decide whether or not the claim is valid.

 In Mr. Smith’s case the insurance company disputed the claims and when Mr. Smith filed suit to pursue his claim in state court the insurance company filed a federal lawsuit under a law called the Federal Arbitration Act trying to force Mr. Smith into arbitration in front of their handpicked arbitrator.  Mr. Smith lived in a state which had an anti-arbitration provision in their state law.  Under the United States Constitution, supremacy clause, federal law is superior to and supersedes state laws which conflict with federal law.  However, Congress passed the McCarran-Ferguson Act which makes state law which regulates the business of insurance controlling over federal laws like the Federal Arbitration Act.

Mr. Smith lived in a state that had an anti-arbitration provision when it came to insurance law. Although the policy said he had to arbitrate a Federal Court decided that state law trumped the Federal Arbitration Act and Mr. Smith was entitled to his day in court.  As a result the insurance company would have to face a jury to explain why Mr. Smith should not receive the benefits of the insurance policy that he had purchased.  The case settled for a large amount of money shortly thereafter.  While arbitration may be appropriate in some cases, and even mandatory in some states it is not mandatory in every state.  An insurance company may be from another state but if they sold a policy in your state you should check your legal rights before being forced into arbitration by an insurance company.