Insurance Litigation
Insurance Company Abuse
Over the last several years, insurance companies have become bigger, wealthier and more powerful. One insurance company advertises that it has over $700 billion in assets. Insurance companies obtain that type of wealth by selling policies and collecting premiums, but minimizing payment of claims.
Has your insurance company delayed or denied payment of a claim or offered you pennies for every dollar it truly owed you? Please contact an insurance litigation attorney at The Law Offices of Randall D. Moore for a free consultation and case evaluation.
Insurance companies have a high duty of care to their insureds, which is known as a fiduciary duty. Nevertheless, insurance companies engage in practices that result in wrongful denial of claims , including acts such as not responding to claims, searching for technicalities in the policy that give the insurance company a technical way of avoiding payment, and many times affirmatively breaching contracts or intentionally abusing their power to bully policy holders into taking what the insurance company is willing to pay as opposed to what a fair settlement of the claim would be. Specific examples include the following:
Disability Insurance - There are several technicalities that have to be followed before an insurance company will pay under a disability policy. For example, a person with a disability policy may actually be required to be fired from a job due to the disability as opposed to quitting. There are certain notice requirements that have to be met and there are many medical conditions that are built into the contracts.
The way some disability insurance policies are written, interaction between the medical community and insurance companies is unavoidable. The knowledge our attorneys have through medical malpractice litigation has given us an edge in reading the technical terms of contracts, challenging an insurance company’s denial of a claim, and optimizing a policyholder’s chances of recovering money under the policy he or she purchased. Do you have questions about your disability policy? Contact a disability insurance attorney at The Law Offices of Randall D. Moore today.
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Life Insurance Policies - There are many different types of life insurance policies. Many times an employer will provide a life insurance policy through a group health insurance plan which an employee may or may not know about. Some types of insurance policies have cash value, and these are called “whole life policies.” Other insurance policies have no cash value, but merely serve as life insurance, as opposed to an investment vehicle. These are called “term policies.”
There are multiple ways life insurance benefits can be wrongfully denied. First, there can be issues as to whether adequate notice was given to the life insurance company. Second, there are some forms of death, such as suicide, that may be excluded, and there are some forms of employment and recreation that may not be covered. Other frequently seen problems involve life insurance companies making the unilateral decision on their own to cancel a policy. This can happen when the policyholder is unhealthy or is getting older. Many times through a “clerical error,” an insurance company will cash the policy out, send the policy holder the cash or equity in the policy, therefore canceling the policy.
For elderly people who lose their insurance policies, it is virtually impossible to obtain life insurance, and if life insurance were to be obtained it would be much more expensive. The losses in these cases include the taxable consequences for having to pay money on the equity being cashed out, along with the fact that the policy holder may lose a death benefit which could amount to $500,000,000 to $1,000,000.00. Also, unscrupulous agents can sometimes sign a policy cancellation either directly or indirectly through another party and allow the policy equity to be sent to someone else. If the insurance policy holder has not been receiving yearly statements from the insurance company, he or she may not even know that there is cash value in the policy and may not even know the policy is canceled until it is too late.
If your life insurance policy has been wrongfully cancelled or if you are having difficulty collecting payment on life insurance claim, please contact an insurance attorney at The Law Offices of Randall D. Moore today.
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Health Insurance Policy Claims - This is probably the most common type of insurance denial. Many times an insurance company will deny a health insurance claim, taking the position that the charges were not “reasonable.” There may be issues as to what is a deductible or a covered charge.
Sometimes an insurance company can authorize medical care or hospital care, but subsequently come back and deny such care and recoup money already paid to healthcare providers, which can create huge amounts of medical bills for the insured. Insurance companies have been known to attempt to recoup expenses, after approval and after actually paying the healthcare entity, months after the healthcare was provided. This often happens when the employer does not pay the employees’ premiums on time or files for bankruptcy protection. Healthcare insurance policyholders should be aware that they have certain rights that are independent of the employer’s actions under these scenarios. If your health insurance claims have been unreasonably delayed or denied, please contact an insurance attorney at The Law Offices of Randall D. Moore.
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Accidental Death Policies - Many times these policies will consist of several smaller policies. Often times one policy will deny coverage while others will pay for the same exact incident. There are many technicalities that have to be looked at when making a claim.
In summary, in dealing with an insurance policy, it is critical to understand the terms of the policy, to read the policy before a consumer takes any action, understand what an insured’s rights are, and most important, challenge an insurance company’s refusal to pay a claim. Insurance companies are in the business of taking risk and they charge a handsome price for doing so. They should not be allowed to bully or intimidate policyholders when the insurance is most needed. The Law Offices of Randall D. Moore can help you in determining what your rights are under these types of scenarios. Please contact an attorney at our firm for a free consultation.
Bad Faith Insurance Claims
In Texas, an insurer has the responsibility to deal with its insured with a high standard of care. There is a fiduciary duty involved in insurance contracts. If an insurance company breaches its contract with a policy holder, the policy holder may have a cause of action which in Texas is called “First Party Bad Faith Litigation.” This is an action against an insurance company where the insurance company has without proper cause:
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failed to compensate the insured for loss covered under the policy
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unreasonably delayed making payments
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failed to adequately pay a claim
Please contact an insurance bad faith attorney at The Law Offices of Randall D. Moore today to discuss your case.
Examples include: injuries to the insured by an uninsured driver. If you have an underinsured or uninsured clause on your insurance policy, the insurance company has a duty to compensate you for any loss which you have suffered not covered by the insurance policy of the person or entity causing the injury. Insurance companies tend to fight these underinsured/uninsured claims aggressively. In settling the underlying case, it is critical that you understand the implications and consequences of how it may affect your underinsured or uninsured claim against your policy.
Another example can include your insurance company failing to pay under your automobile policy claiming that the other party was at fault. Usually when this happens, the other insurance company is refusing to pay as well. In these situations it is important to give adequate notice to the insurance company concerning your claim, it is important to consider the timing of making a claim, and it is critical to follow-up and demand that the insurance company comply with statutory deadlines in resolving a claim and/or explaining a denial. Many times insureds will accept a verbal answer without challenging the answer or requesting a follow-up letter from the insurance company.
The bottom line is that insurance companies are in the business of writing risk. They engage in marketing and sales tactics that induce consumers to buy insurance claiming that the insured will be in good hands, will be taken care of by a strong financial company, and will be dealt with fairly. Unfortunately, most of the time this is not the case. Insurance companies have set up a bureaucracy making it virtually impossible to deal with live human beings at the claims offices. The thought is that if it is made hard enough, policyholders will take whatever the insurance company gives them and go about their business. Many times the amount of the claim is so small that this is indeed the case. Often times, however, families are victimized by huge losses and for whatever reason failed to take advantage of representation. The Law Offices of Randall D. Moore is accepting clients who have complaints against insurance companies for wrongful denial of substantial claims. The Law Offices of Randall D. Moore is open to reviewing these cases and taking the cases on either contingent fee cases (client will still be required to pay court costs and expenses of litigation), i.e. if we do not win we do not recover, or on an hourly fee basis.
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Uninsured - Underinsured Coverage
Under the current state of the law as rendered by your Texas Supreme Court, your uninsured and underinsured coverage may be worthless. If you were sold UIM coverage, you may want to re-think that decision. Under current insurance policy language interpretation, our elected Texas Supreme Court has ruled in favor of the insurance industry, in effect leaving the injured insured without adequate remedy. Basically, under most automobile policies, UIM coverage is not effective unless the other driver is "uninsured" as defined in the policy, and until you as the injured party become legally entitled to the benefits. These are words of art with huge importance.
Our Texas Supreme Court has interpreted this language to mean that you are not entitled to recover uninsured benefits or underinsured benefits UNTIL AFTER YOU HIRE AN ATTORNEY, FILE A LAWSUIT AGAINST THE UNINSURED, UNDERINSURED DRIVER, AND GO TO TRIAL AND PROVE AND PREVAIL IN COURT THAT THE OTHER DRIVER WAS AT FAULT AND YOUR DAMAGES EXCEED THE POLICY LIMITS OF THE OTHER DRIVER.
Obviously this takes time and money and is not what you expected when you bought these benefits. Then, to make it worse, if the insurance company pays the verdict within 15 days, you are not entitled to attorney fees or interest for the months or years it may take to finally prevail. Therefore, even if you are in a rear-end collision, or the fault of the other party is clear, and even if your medical bills exceed the amount of the other driver's policy, (which should be an obvious case of an underinsured driver) your insurance company can refuse to pay benefits which you paid for, require you to hire an attorney, and spend money proving your right to the benefits the insurance company sold you, and then escape any consequences of this type of abuse. At The Law Offices of Randall D. Moore, we are fighting this consumer unfriendly law and seeking to make the courts make the insurance companies do what they represented they would do when they sold you the policy. If you are experiencing problems with your insurance company on an underinsured or uninsured claim, contact an insurance lawyer at The Law Offices of Randall D. Moore. We may be able to help you
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