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People buy insurance to protect themselves from the unexpected—illnesses, accidents, property damage, and even natural disasters. Unfortunately, it is not unusual for insurance companies to under-value, under-pay, delay, or even completely deny payment of a claim without proper justification or warning. For this reason, it is very important that insurance policy holders understand their legally protected rights. Below, you will see a breakdown of some of the most common types of insurance claims, as well as how we can help protect you.
Click on the links below for more information:
- First Party Insurance Claims
- General Claims
- Car Insurance Claims
- Health Insurance Claims
- Homeowner Claims
- Natural Disaster Claims
First party insurance describes an insurance policy purchased by an individual directly from an insurance provider. When a policy holder experiences an illness or injury or incurs damage to an insured piece of property, he or she can submit a claim for payment or, in some cases, reimbursement, to their insurer. When a policy holder submits a claim under his or her own insurance policy, it is considered first party coverage. An insurance company dealing with that claim must treat the policy holder reasonably and in good faith. If they fail to do so, a policy holder may bring an insurance claim against the insurer, seeking damages beyond the initial contract benefits.
When insurance claims are made by the insured, there may be a dispute over the scope of coverage, the amount of payment owed, and/or missed or late payments on the part of the insured. Disputes may also occur over misrepresentations made at the time of the policy's sale, and/or the amount of coverage provided by the insurer.
Anyone who owns or drives a vehicle is required to carry some sort of insurance policy. While some individuals carry state-minimum coverage, others pay additional monthly premiums to insure themselves against their vehicle's loss of value, accident related personal injuries, injuries caused to others or many other different types of claims. If you file a first party coverage claim after a car accident, you expect that your insurer will cover your costs in a timely fashion. Unfortunately, this is not always the case. Insurers may reject or delay payment of claims, saying the incurred loss is not within the scope of the policy's coverage. If insurers do not adequately investigate insurance claims and/or unfairly deny legitimate claims, insured parties may file a first-party insurance claim against them.
Types of Car Accident Claims
- Loss of Value to Vehicle
- Personal Injury
- Injury by Uninsured or Underinsured Defendant
- Coverage for Rental Car During Repair Period
- Reimbursement for Property Repairs
Most people carry health insurance policies to protect themselves in the event of a serious accident or illness. Monthly premiums are usually high, but are well worth the cost if a person becomes hospitalized and faces exorbitant medical bills. Sadly, insurers will do their best not to pay these bills, rejecting claims for reasons as varied as being seen by an out-of-network insurer to receiving an experimental medical therapy. Insurers may also reject claims if the insured engaged in risky or dangerous behavior that violated the terms of his or her policy's coverage, if that behavior led to an illness or injury. It is important to understand the scope of your medical coverage prior to receiving procedures, if possible, in order to avoid out-of-pocket expenses. If, however, an insurance company delays or denies payment of a legitimate claim, an insured individual may have cause to file a first-party insurance claim.
Types of Health Insurance Claims
- Hospital Stays
- Doctor Visits
- Prescription Medications
- Emergency Medical Care
Most homeowners protect themselves against financial loss due to property damage caused by fire, wind, tornados, natural disasters, and robbery or vandalism by carrying residential property insurance. Homeowners pay insurance premiums so that they will be covered if damage does occur. After a break-in, catastrophe or natural disaster hits, you expect your insurance company to pay full value on your claim. Unfortunately, insurers may delay your claim or say the limits of your policy exclude coverage for your incurred losses. Failure to investigate or fairly pay your claim can give a homeowner cause to file a first-party insurance claim against an insurer.
Types of Homeowner's Claims
- Damages Due to Forces of Nature (ex: Water)
- Theft and Damage Caused By Vandalism
- Land Contamination
- Damages Due to Appliance Failure
- Damage Due to Mold
- Replacement Cost Issues
Many people carry insurance policies to protect them from damages caused by hurricanes, earthquakes, windstorms, and other natural disasters. Wind and hail insurance pays for damages resulting from hurricanes, tornadoes, wind, and hail. Typically, these policies do not pay for damage caused by floods or storm surges. Coverage for damage caused by rising waters and flooding must be obtained from the National Flood Insurance program.
Homeowners, business owners, and commercial property owners making first-party property insurance claims after a natural disaster may face disputes with insurers concerning policy limits, replacement costs, physical loss or damage, cost of repair damages, business interruption, or application of exclusions. If an insurance company unfairly delays or denies a covered claim, parties insured against natural disaster damages may file a first-party insurance claim.
Types of Natural Disaster Claims
- Flood Damage
- Hail Damage
- Wildfire Related Losses
- Tornado Damage
- Hurricane Damage
- Earthquake Damage
- Lightning Strike
- Excessively Strong Winds
- Blizzard Damage
Houston Lawyer Protecting Your Rights as an Insurance Policy Holder
Insurance companies are legally required to deal with claims in a reasonable and prompt fashion. Texas law requires that insurers acknowledge first-party coverage claims, launch investigations, and / or request further information related to the claim within 15 days of receiving a filed claim. Once an insurer has all the necessary information, the company must notify the insured, in writing, within 30 days of the initial claim, of its approval or denial.
If a decision can't be reached within that time frame, the insurer must explain why more time is needed. The insurance company then has an additional 45 days to accept or reject a claim. If a claim is approved, the insurance company must pay the benefit within five days of the notified approval. If a claim is denied, the insurer must provide a written explanation. At Arnold & Itkin, we know the rights that you are owed as the insured. If you have been denied these rights, you can be confident knowing that a Houston lawyer from our firm will do everything possible to help.
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