Insurance defense is legal representation that specializes in cases relating to insurance. Insurance defense attorneys may work for law firms that offer insurance companies legal help or may work as staff attorneys for the insurance company itself. Due to the pervasive nature of insurance, there can be a plethora of litigation with multiple layers of policy to discern. Insurance includes workers’ compensation, automobiles, homes, and healthcare, all of which can lead to litigation over the veracity of claims and the fulfillment of policies. The insurance industry is also heavily regulated, which requires legal expertise that remains abreast of changes and amendments that affect the handling of the policies that insurance companies offer and process. How profitable an insurance company depends on the types of policies it writes, the amount of premiums it earns from underwriting activities, and the amount of benefits it pays out from claims made against its policies. Rather than take all claims at face value, insurance companies investigate the veracity of claims, and doing this requires personnel with legal expertise. Insurance defense may involve a broad spectrum of legal issues relating to insurance policies and claims. Attorneys examine whether the claim being made is something covered in the terms of the insurance contract. For example, a flood damage claim made by a homeowner who has a homeowner’s policy without flood coverage would be challenged. Attorneys also seek to uncover cases of insurance fraud and false claims, including workers’ compensation claims in which employees may not be injured to the extent that they have claimed. Insurance companies will also use insurance defense attorneys to defend policyholders from claims made against them. For example, insurance defense attorneys may represent an auto policyholder in the case that another driver is suing the policyholder for damages.
The insurer may still wind up paying some damages, but the presence of a skilled legal team may lead to more favorable settlement terms. Attorneys are also used by insurers to determine whether the types of contracts and business practices that the insurance company is involved in complying with regulations. Because state law primarily governs insurance regulations, insurers may find that what is considered legal in one state may not be considered legal in another. For example, insurance grace periods may vary from state to state, so insurers must be certain that they do not cease coverage on delinquent contracts before they are allowed to.
Insurance Law
In order to understand insurance law, it is useful to understand insurance first. Insurance is a contract in which one party (the “insured”) pays money (called a premium) and the other party promises to reimburse the first for certain types of losses (illness, property damage, or death) if they occur. Insurance law falls into three major categories. First, the insurance company will hire lawyers to represent the insured in case she is sued for something related to her insurance contract. These are known as “insurance defense attorneys.” For example, an automobile insurance company will hire an attorney to represent an insured driver when she gets sued for causing another driver’s injuries. The second category of insurance law helps insured people determine when an insurance company must pay a claim. Third, insurance companies typically hire attorneys to make sure the company complies with all applicable laws and regulations, which can vary by state. There are many types of insurance. The government runs some kinds of insurance, like Social Security disability, worker’s compensation, and unemployment insurance. However, the term “insurance law” usually refers to the law surrounding private insurance. The most common types of private insurance are health insurance, automobile liability insurance, homeowner’s insurance, life insurance, title insurance, and malpractice insurance.
Terms to Know
• Policy: The contract which outlines what the insurance company will pay in case of loss.
• Benefit: The money or services an insurance company provides in case of loss.
• Insured: The person who receives the insurance benefit. However, in the case of life insurance, the “insured” is the person whose life is insured, and the person who receives the benefit is called the “beneficiary.””
• Premium: The money the insured pays the insurance company.
• Claim: A request for benefits when loss occurs.
• Coverage: The types of losses which the insurance company will reimburse.
• Insurance Agent: A person who is licensed to sell insurance in a particular state.
Insurance defense attorneys are often local attorneys that have contracted with insurance companies in order to find work. Some of these offices work exclusively with insurance companies, so individuals are usually unable to hire these attorneys on their own. However, some insurance companies allow their insured to pick their own attorney, which may allow those individuals to hire otherwise unavailable insurance defense attorneys. Most insurance defense attorneys work to zealously represent the insured. However, the insured does not pay the attorney out of pocket, and many clients have concerns that the attorney is actually working in the best interest of the insurance company. If an insurance defense attorney represents you, be sure you understand everything that happens in your case, and do not be afraid to ask questions. Since there are so many different types of insurance, and insurance touches so many aspects of life, most lawyers are familiar with some aspect of insurance law. Personal injury and medical malpractice attorneys routinely deal with medical insurance companies, similarly, auto accident attorneys routinely work with auto insurance companies. Real estate attorneys often recommend that their clients purchase title insurance, and are very familiar with homeowners’ insurance policies. Probate attorneys must frequently distribute life insurance proceeds and estate planners often recommend different types of life insurance arrangements Insurance law includes a wide range of issues relating to insurance policies and claims.
Essentially, an insurance defense attorney deals with three categories: ensuring policyholders are protected if they are sued, helping people determine when insurance must pay a claim, and making sure insurance companies are complying with applicable regulations. An insurance defense attorney can represent insurers and their policyholders in all aspects of the claims process, including:
• Automobile third party liability
• Uninsured and underinsured motorist claims
• First-party wage and medical coverage
• Property and homeowners claims
• Premises liability
• Products liability
• Professional liability
• Employment Law
• Construction
• Medical malpractice
• Municipal Law
• Legal malpractice
• Insurance coverage
• Bad faith
Working with Policyholders
Sometimes insurance policyholders are sued; for example, if they are alleged to have caused a car accident that injured another driver or caused damage to property, the other driver or their insurance company may seek compensation. In this case, the insurance company might hire an insurance defense attorney to represent the policyholder during litigation. With the assistance of an experienced attorney, the policyholder can often expect to pay less towards damages. An insurance defense attorney can successfully negotiate more favorable settlement terms, which ultimately keeps the insurance company’s client happy and protected from excessive financial loss.
Working with Insurance Companies
Insurance companies often hire an attorney to protect their business interests. For example, they may consult an insurance defense attorney when creating or modifying their available policies to ensure they align with local regulations. State law is generally the governing force behind insurance regulations, so a national insurance company needs an attorney who knows the laws of the state in which they’re operating intimately and can advise the company how to ensure their practices are lawful in that state. The insurance company may also retain an attorney if they are accused of wrongfully denying a policyholder’s claim. Their attorneys will evaluate claims in regard to the applicable policy information and local laws to determine whether the claim is valid.
How to File an Insurance Claim
Each state has laws that govern the process, so contact your state department of insurance if you have questions or feel you are not being dealt with fairly. Take these steps to file an auto insurance claim:
• Call your agent, whether you are at fault or not.
• Follow the directions your agent gives you to provide all documentation related to the accident and file your claim. You may need a police report.
• Keep copies of all your documentation and bills related to the accident. Jot down detailed notes following conversations about the accident. You need to know who you spoke with and what they said, at what date and time, and how to contact the person.
• Find out from your agent: Time limitations for filing your claims and submitting bills, Time limitations for resolving claim disputes, when you can expect the insurance company to contact you., whether you need estimates for the damages, whether your policy covers a rental car while your car is being repaired and how much it covers.
When to File an Insurance Claim
It’s also important to remember that when you file a claim, there’s a chance your insurance company will raise your premium rates. Yes, even if the other driver was at fault or you can’t control the weather. There’s even a chance they might cancel your policy under certain circumstances.
Here are some specific scenarios when you should strongly consider filing a claim:
• When someone is injured: If you’re in a car accident and you, the other driver or a passenger in either car gets hurt, that’s an automatic reason to file a claim.
• When it’s not clear who is at fault: Sometimes there’s some confusion about who’s to blame for an accident. In that case, you’ll let the insurance companies for both parties figure it out.
• When you suffer a “total loss” or can’t afford to pay for the damages.
Call the Police if Necessary
If a crime was committed, someone was hurt in an accident, or there is significant damage, don’t just stand there. Call 911 and get help! And while you don’t necessarily need a police report to make an insurance claim, it definitely doesn’t hurt to have one. A police report will paint a picture of what exactly happened in an accident or at a crime scene, and include information that’ll make the insurance claim process much easier.
Document Everything and Exchange Information
Now it’s time to document what you can from the scene of the accident and gather information from all the parties involved. Think of it as a scavenger hunt. Make sure you get the following:
• Name, address and phone number of the other driver(s) and a photo of their driver’s license, if possible
• Insurance policy numbers
• Year, make, model and license plate numbers of all the vehicles involved
• Photos of the accident from all sides and angles
• Detailed notes from any conversations you had with the people involved with the accident
If you’re hurt and need medical attention, you’ll also want to hang on to any physician reports, medical bills and other documentation you receive for treatment of your accident-related injuries.
Contact Your Insurance Company
Once you and everyone involved in the accident are safe, get in touch with an agent from your insurance company and ask what else you’ll need to file your claim. Your agent knows the ins and outs of the claims process and will be able to give you the direction you need.
What to Expect After Filing an Insurance Claim
After you file your claim, the insurance company may send an insurance adjuster to investigate the accident and the damage done. During the investigation, the insurance adjuster will take a look at all the facts to get to the bottom of what happened. After they determine the cause of the accident, the adjuster will make a recommendation for how much the insurance company should pay for the loss. If you’re dealing with another insurance company’s adjuster, remember their goal is to spend as little money as possible. That’s why it’s critically important to thoroughly document the accident and be completely honest about your injuries and all parts of the accident just in case they try to downplay your losses.
Like many small business owners, you may make errors when filing insurance claims. Such mistakes are easy to make but can have serious consequences. Here are common mistakes made by business owners and the reasons you should avoid them.
Failing to Read Your Policy
To adequately protect your business from losses you need to understand what your insurance policy does and doesn’t cover. You won’t know what risks are covered if you don’t read the policy. Be sure to read the entire contract, including all endorsements. If you have trouble understanding the wording, ask your agent or broker for assistance. Review your policy again before you file a claim. Be sure you understand the duties you are obligated to fulfill to obtain payment for a loss.
Failure to Notify Your Insurer Immediately
When an accident or loss occurs that’s potentially covered by your policy, contact your insurer right away. Claims are easier to adjust when events have just occurred and the evidence is fresh. Moreover, a delayed response on your part may make your insurer doubt the severity of the injury or damage. Timely notice of a loss is a condition of many business insurance policies. The standard commercial property form requires you to notify the insurer promptly of any loss or damage. Likewise, the ISO general liability form requires you to notify the insurer as soon as practicable in the event of an occurrence, offense, claim, or suit. If you fail to report a loss or claim within a reasonable amount of time, your insurer may deny coverage on the basis that you’ve breached the insurance contract.
Poor Documentation
Good record keeping is essential if a loss occurs because insurers require detailed information to settle a claim. Some of the information your insurer will require is stated in the policy conditions. For example, the ISO commercial property form requires you to provide complete inventories of the damaged and undamaged property, including quantities, costs, values, and the amount of loss claimed. It also requires you to submit a proof of loss. You can substantiate your written records with photos or videos. Document every communication you have with your insurer regarding your claim. Keep a list of the names and phone numbers of everyone you speak to as well as the date and time of the call. If you mail paper documents to your insurer, retain copies for your file.
Failure to Cooperate With Your Insurer
Cooperating with the insurer is a condition of coverage in many business insurance policies. For instance, the ISO commercial property form states that you must cooperate with the insurer in the investigation or settlement of the claim. Likewise, the ISO liability form requires you to cooperate with the insurer in the investigation or settlement of a claim or defense against a suit. If you fail to provide information your insurer needs to process your claim, your actions may give the insurer grounds to deny coverage.1 Even if your insurer doesn’t deny the claim, and your failure to cooperate may delay your claim payment.
Failure to Retain Damaged Property
If property at your premises or worksite has been damaged by a fire or other peril, you might be tempted to throw it away. Don’t do it! Leave the property as it is until an adjuster has inspected it. This is important as a typical property policy requires you to set the damaged property aside for examination. You must also protect covered property from further damage. If you discard the damaged property you may destroy valuable evidence related to your loss. The standard business auto policy contains similar requirements regarding protection and inspection of damaged property. If a vehicle you have insured under comprehensive or collision coverage is damaged, you must take reasonable steps to protect the covered auto from further damage. Before the vehicle is repaired, you must allow the insurer to inspect the auto and any records you have that substantiate the loss (such as photos of the accident).
Utah Insurance Defense Attorney
When you need legal help with insurance defense in Utah, please call Ascent Law LLC for your free consultation (801) 676-5506. We want to help you.
8833 S. Redwood Road, Suite C
West Jordan, Utah
84088 United States
Telephone: (801) 676-5506
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