If the insurance company is ignoring your claim or threatening you, speak with a bad faith insurance lawyer immediately. Your insurer must treat you fairly and neutrally. A denial or delay in processing your claim that is unreasonable and unfounded may result in additional compensation.
What Is a Bad Faith Insurance Claim?
Insurance companies are for-profit businesses. It is their goal to minimize claims and pay as little in benefits as possible. However, state laws require them to evaluate claims in good faith. In other words, an insurance company must fairly and neutrally review your evidence and information when applying the policy’s terms and conditions to your claim. In addition, it must either approve or deny your claim without regard to its financial interests. When an insurance company acts in its own self-interest and denies a legitimate claim, it is acting in bad faith.
In most states, you have a bad faith insurance claim if you can show:
- You provided sufficient evidence to support your claim
- The insurance company refused to pay benefits
- Its denial was arbitrary, capricious, or without probable cause
To prove a bad faith insurance claim, you must have strong evidence that documents your claim and the insurance company’s misconduct. A bad faith insurance lawyer can help you review the evidence and build a compelling case against the insurance company.
If you can prove that the insurance company acted in bad faith, you may be entitled to punitive damages. Punitive damages are an additional monetary award used to punish the insurance company for its misconduct. The amount of your punitive damages will vary, depending on where you live and the value of your claim. Your bad faith insurance lawyer can help you calculate your potential punitive damages and maximize your recovery.
How Do I Identify a Bad Faith Insurance Denial?
Not all insurance denials are made in bad faith. Many times, there is a legitimate dispute about the facts and legal issues in an insurance claim. For example, doctors may have differing opinions about your ability to return to work. Or, there may be confusion about whether your claim falls under a policy exclusion or exception. In these cases, it is unlikely that you would successfully prove a bad faith denial of benefits.
However, certain circumstances deserve additional scrutiny. These include when the insurance company:
- Ignores your insurance claim completely
- Does not perform a detailed and complete investigation of your claim
- Disregards or diminishes evidence supporting your claim
- Unreasonably delays a decision on your claim
- Intentionally withholds information about your claim and its investigation
- Fails to follow its own claim and appeal procedures
- Uses improper or misleading settlement tactics
- Discourages you from hiring a lawyer
- Behaves in threatening, harassing, or adversarial manner
A bad faith insurance lawyer can help you assess the company’s tactics and understand your legal rights.
If you believe the insurance company acted in bad faith, it is in your best interest to contact a lawyer. The insurance company will do its best to fight your bad faith claim. You need an experienced and detail-oriented lawyer to rebut this defense and build your best possible claim for punitive damages.
Bad Faith Insurance Claims and ERISA
Different laws apply to different types of insurance policies. If you have a personal insurance policy (one that you directly purchased through an agent), state laws apply. However, if your insurance was provided by an employer, the federal Employee Retirement Insurance Security Act (ERISA) applies. These benefits may include employer-funded or provided:
ERISA preempts state laws, meaning that you cannot receive punitive damages for a bad faith denial in a federal employee benefits claim.
Most states require an insurance company to pay punitive damages when it acts in bad faith. However, ERISA does not include this protection. Simply put, you cannot demand punitive damages in an ERISA claim — even if there is strong evidence that the insurer acted in bad faith.
Additionally, different appeal procedures apply in an ERISA claim. Before you can file a lawsuit, you must appeal your denial with the insurance company. This administrative appeal is one of the most important parts of an ERISA claim. You typically cannot submit additional evidence after your administrative appeal is denied. Before you file an ERISA appeal, you should seriously consider speaking with a lawyer. Otherwise, you may make costly mistakes.
Contact an Experienced Bad Faith Insurance Lawyer
If you need help understanding which laws apply to your insurance claim, contact a bad faith insurance lawyer. Without the help of an experienced lawyer, it can be difficult to develop and present a claim for punitive damages. J. Price McNamara has effectively fought insurance companies for over 20 years. Call the Law Offices of J. Price McNamara today and get started on your case.