The specifics of these regulations vary widely from state to state, but, generally speaking, an insurer is required to:
- Acknowledge your claim within a certain time frame, such as 15 days;
- investigate your claim promptly;
- make a good faith attempt to process a prompt, fair, and equitable settlement of claims in which liability is reasonably clear.
Additionally, an insurer may not refuse to pay your claim without a valid reason.
If you feel that your insurance company's agent or claims adjuster has violated your state's regulations, talk to that person's supervisor. If you get no satisfaction, file a complaint with your state's insurance department. If the department receives enough similar complaints, it will conduct an investigation. If it finds that the insurance company has a pattern of misconduct, it may impose a fine, punitive damages, or, for especially grievous offenses, revoke the company's license.
A minority of states allow you to sue an insurance company privately for a regulations violation against you individually. If you find yourself in such a dispute, some legal rules may help you, such as:
- Coverage provisions will be construed broadly;
- limitation and exclusion provisions will be construed narrowly; and,
- ambiguities in the policy will be interpreted in your favor.
In some states, if you are successful in court, you may only recover the amount of your claim. But, in other states, you may also be awarded legal fees and punitive damages.
Here are a few tips that may be useful for dealing with an insurer about a claim.
Before you buy the policy:
Before you have a claim:
When you have a claim:
Please note that this description/explanation is intended only as a guideline.
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