What If the Claims Adjuster Denies Coverage?

An insurance attorney can help if your claims adjuster unfairly denies coverage for your claim.

Can an Adjuster Deny a Claim?

Insurance companies are out for profit, and it is not uncommon for adjusters to wrongfully deny, delay, or underpay legitimate claims. If you have had your claim denied when you should be receiving benefits, an insurance lawyer can help you collect the benefits you deserve and even receive compensation for damages that is over and above the amount of the denied claim.

The insurance claim lawyers at Caldwell Wenzel & Asthana know how insurance companies work and the tactics that adjusters use to deny claims unfairly. We know how to negotiate with insurance companies and their lawyers to get you the settlement you are entitled to, and we are fully prepared to take your case to court if necessary.

We offer a free consultation to discuss the circumstances of your insurance claim and determine the best way to proceed. We work on a contingency basis, so there are no fees until we win your case. Call Caldwell Wenzel & Asthana at (251) 444-7000 to schedule your consultation with our team today.

Our Attorneys Know What to do if an Adjuster Refuses to Cooperate

Insurance policies are often drafted in ways that make it difficult for consumers to understand them, but Alabama law is clear about what insurers must due to properly handle a claim.  Requirements for insurance companies are provided by Ala. Admin. Code. R. 482-1-125-.07 as follows:

1. Advising you of status of acceptance or denial of your claim within thirty (30) days, or the number of days specified in the policy, after receiving properly executed proofs of loss.
2. Not denying a first party claim on the grounds of a specific policy provision, condition, or exclusion unless reference is included in the denial.
3. Giving denials in writing, verbally or electronically (e-mail). If verbal, clearly stating reasons for the denial. If the denial is in writing or e-mail, the file should contain a copy of the denial letter or e-mail. Providing a written denial within a reasonable time if requested.
4. Notifying you within thirty (30) days or the time period specified in the policy if more time is needed to evaluate your claim and giving the reasons why.
5. Notifying you if the investigation remains incomplete every forty-five (45) days and providing reasons that additional time is needed for investigation.
6. Paying you within thirty (30) days or the time specified in the policy after accepting liability and agreeing on the amount of the claim.

Despite the requirements, insurance adjusters will attempt to avoid or minimize payments by methods which include:

• Failure to promptly and fairly settle a clear claim
• Unreasonable denial of benefits or refusal to pay the full amount for a valid claim
• Failure to investigate or unreasonable delay in investigating a claim
• Misrepresentation of benefits, coverage or other provisions of an insurance policy that are relevant to a claim, or unreasonable interpretations of policy language
• Imposing arbitrary deadlines or time limits not specified in the policy to make a claim
• Redefining what constitutes necessary medical procedures, home repairs, or auto repairs in order to deny a claim
• Forcing a claimant into litigation in order to delay offering a fair settlement amount
• Asking the insured to sign a release for partial settlement payments or unreasonable offers.

How Our Insurance Lawyers Can Help

When insurance companies use these tactics, our personal injury attorneys would immediately begin investigating what happened and proving that your claim is valid. We would do this by:

• Examining your policy and its wording
• Gathering evidence from the scene, such as photos and videos from surveillance cameras
• Interviewing witnesses and getting their testimony
• Examining police, first responder, and medical reports and documents and repair cost estimates and bills
• Negotiating with insurance companies to see if they will come up with a fair settlement
• Hiring expert witnesses to reconstruct what happened and testify on your behalf
• Filing a lawsuit and taking your case to court if necessary.

Call us today to get started while evidence and witnesses are still available at (251) 444-7000. As your Hurricane Sally claims attorney, we help those injured by neglectful actions of others, whether they are liable for injuries on property that is not kept safe, injuries at work, or injuries in a car accident. As well as helping those with insurance claims due to storm damage. Turn to us for your legal needs.

Actions to Take When Claims Adjuster Denies Coverage

Alabama law allows our attorneys to take two causes of action against insurance companies when they wrongfully deny a claim – we can sue for breach of contract or sue for bad faith. 

• Breach of contract occurs when the insurance company did not provide benefits stated in the contract. You may be able to receive payment for the claim plus extra damages for mental anguish and emotional distress you suffered by not having your claim paid and needed repairs made. 
• Bad faith occurs when an insurance company either refuses to investigate a claim or uses questionable methods for denying coverage. We can sue for mental anguish and emotional distress and also sue for punitive damages to punish companies for acting against policyholders’ interests.

Compensation Our Insurance Lawyers Can Win for You

To win your case our insurance lawyers must be able to show the following elements exist:

1. The insurance company’s policy required payment of the claim.
2. The insurance company unreasonably refused to pay.
3. The insurance company did not deal fairly and in good faith.
4. The bad faith actions caused you injuries or damage.

In a successful lawsuit, our attorneys may win a damage award that includes:

Compensatory damages to cover your:

• Monetary losses — costs of the original accident, damages, and injuries up to insurance policy limits
• Additional losses, such as lost wages or lost revenue through business interruption
• Embarrassment and loss of reputation
• Emotional distress due to the insurer’s improper conduct.

Punitive damages from bad faith actions are additional compensation awarded by a jury to punish the insurance carrier for their behavior and to discourage insurance companies from acting similarly in the future.

Amounts of Settlements

Settlement amounts vary, depending on factors that include:

• The original policy amount you are owed plus other financial losses
• Additional losses, such as your emotional suffering and embarrassment
• Any assessed punitive damages.

Call Us for Help with Insurance Cases in Alabama

Insurance companies do not want to be slapped with huge compensation awards and damage to their reputation, and they are often willing to make a fair settlement once they know you have a lawyer on your side. At Caldwell Wenzel & Asthana, our insurance lawyers in Mobile, AL, will fight to hold insurance companies accountable and get you the maximum benefits you deserve.

Learn more about your right to file a legal claim by calling (251) 444-7000 to schedule a free consultation with our team today.