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Most Americans have some form of insurance. Auto liability insurance, for example, is a requirement to drive in many states, and health care is now mandatory under the Affordable Care Act (AKA “Obamacare”).
Insurance law typically applies to cases of private insurance, such as health insurance, homeowners’ insurance and auto liability insurance. Insurance attorneys work on a variety of matters, including property and casualty claims and bad faith claims.
Without insurance, those who suffer losses, as well as those who cause them, would need to pay those costs out of pocket. A person who has insurance agrees to make payments, called premiums, which are then put into a pool by the insurance company in order to spread the risk over a larger number of policyholders. When an insurance claim is filed, an insurance company may be responsible for paying claims out of the pool.
Jurisdictions differ in their regulation of policy documents and terms. For instance, state law may prohibit the inclusion of certain types of clauses that result in imbalanced arrangements that favor the policy provider.
Special forms of protection, such as crop insurance and flood insurance, may be governed by rules limiting how policies can be used and the circumstances under which insurers can deny or cancel coverage. Auto insurance is commonly coupled with state-mandated minimum liability limits. State-specific regulations can apply to policyholders and providers, so claimants may find it wise to research whether they actually fulfilled their obligations before filing claims or seeking legal damages.
In some cases, claimants may be accused of insurance fraud, or making false statements or applications to gain benefits. Fraudsters use other people's policy credentials to facilitate such crimes. Because many laws also punish insurance fraud accomplices with imprisonment or fines, those who stand accused should research how they can build cases or disprove the claims that they knowingly misrepresented facts for personal gain.
State regulations control how insurance companies are to respond to claims for losses. When an insurance company violates these laws, it may have done so in bad faith. Bad faith claims may involve wrongful denials of claims, making unreasonable demands for documentation or taking too long to respond to a claim.
There is an implied covenant of good faith and fair dealing in every insurance contract. This generally means that both parties agree to act with fairness and honesty so as not to deprive the other party of the right to benefit from the contract. An insurance bad faith claim asserts a violation of that duty. Although it can also be considered a breach of contract, most claims are brought as torts for the chance to receive punitive damages.
If you have a complaint about your insurance company, you should first try to resolve it with your agent or your agent's supervisor. If dealing informally with the insurance company doesn’t work, you can file a complaint with the department of insurance in your state. All states have such a regulatory body, but the laws and procedures differ among them.
After a complaint is filed, the insurance company has a deadline for responding. The state agency does not represent policyholders in legal actions against the insurance companies, but their investigations can help insurance attorneys in preparing lawsuits. If the agency determines that a complaint is invalid, it will notify the policyholder with an explanation.
This article is intended to be helpful and informative. But even common legal matters can become complex and stressful. A qualified insurance lawyer can address your particular legal needs, explain the law, and represent you in court. Take the first step now and contact a local insurance attorney to discuss your specific legal situation.