If you keep up with your premiums as a policyholder, your insurance company will pay for personal injuries and property damages in certain situations. That is how insurance works. As a reliable policyholder, you expect your insurer to uphold its end of the bargain when the time comes for you to file a claim. Unfortunately, some insurance companies unfairly delay or deny claims, leaving policyholders wondering about their options. “Insurance bad faith” describes any instance of insurers shirking their legal responsibilities to policyholders so speak with a qualified Charleston, WV bad faith insurance lawyer if you suspect your insurance has acted unfairly.
An insurance policy is a legal contract between the company and the policyholder. If the insurance company breaks its end of the contract, the company could face legal action. Each state abides by different bad faith laws. In West Virginia, the law defines “insurance bad faith” as any insurance company conduct that violates the state’s statute and results in damages to the policyholder. It can be any action that is not a general and sanctioned business practice. Any breach of duty or action that is deceptive or dishonest could give rise to a lawsuit in West Virginia.
Elements of an Insurance Bad Faith Claim
Like other civil claims, there are certain elements that make up bad faith insurance lawsuits. Typically, a plaintiff must possess these elements to have grounds to file a claim. The elements of a bad faith claim vary state to state. Under common law, a policyholder generally has to prove three main elements for a successful lawsuit:
- You had a valid claim. First, you must establish that your insurance claim was valid and complied with the terms of your contract. You will need documentation of your original claim and the insurance company’s response/denial letter.
- The insurance company unreasonably withheld benefits. Second, you must show that the insurer was unreasonable in its treatment of your claim. What is “unreasonable” will depend on what a reasonable and prudent company or agent would have done in similar conditions.
- You suffered damages because of the insurer’s actions. You must have sustained some type of damage to sue, such as withheld benefits or emotional distress. If the defendant’s actions didn’t cause you any harm, you have nothing on which to stake your claim.
Each element requires certain burdens of proof on the plaintiff. A Charleston personal injury attorney from Tiano O’Dell, PLLC can remove this burden from your shoulders with exceptional legal services and aggressive representation. We understand the facets of bad faith law in West Virginia and can take your claim where it needs to go.
Common Bad Faith Tactics
Insurance bad faith can take many forms, but the most common are unnecessarily delaying or denying a claim. Not all denied claims are insurance bad faith. To qualify as a case of bad faith, the insurance company must fall short of its legal duties to the policyholder, resulting in damages such as emotional distress and financial losses. The insurer’s actions must be unfair or in contrast to accepted industry standards.
The following are the most common bad faith tactics:
- Unreasonable claim delays
- Intentional delays to get the policyholder to drop the claim
- Lack of a proper investigation
- Failure to disclose the existence of coverage
- Failure to notify policyholder of a deadline
- Withholding important paperwork or information
- Offering less than the real value of the claim
- Deliberate policy misinterpretation
- Being dishonest in statements about the policy
- Denying a valid claim
Some insurance companies take advantage of policyholders in an effort to save money. The moment an insurance company’s actions give you pause, talk to a bad faith attorney. Your insurer should give you no reason to suspect dishonest or deceptive business practices. If you believe the company has wronged you in any way during the claims process, you could be the victim of bad faith. An attorney at Tiano O’Dell, PLLC can help you file a claim.
Wrongful Denial of Insurance Claims
Wrongfully denying a claim is one of the most common reasons policyholders bring bad faith insurance claims. A “wrongful claim denial” is one that does not have a legitimate reason behind it. All insurers must disclose the reason for a claim denial to the policyholder. The insurer could claim that the accident never happened, that you don’t have the right coverage, that your policy has expired, or that you failed to notify the company on time.
If the company’s reason for denying your claim is unfair or otherwise unreasonable, the denial could be wrongful. When a company has no legitimate basis on which to deny your life, auto, bodily injury, property, business, or disability insurance claim, you could be involved in bad faith dealing. The same is true if the company denies your claim based on a misrepresentation of your policy, or refused to settle your claim even when the policy clearly expresses coverage. In all of these scenarios, call an attorney.
What Happens If an Insurance Company Denies Your Claim?
Upon receiving notice of an insurance claim denial, review your policy for signs that the denial was wrongful. Make sure you did everything you should have on your end, including paying all your premiums on time and meeting the claim filing deadline. There may be an issue such as lack of evidence of damages that you can fix to solve the problem.
It’s natural to feel frustrated at the denial and jump to the conclusion that it’s a bad faith claim. However, some denials are simply due to miscommunication. If the corporation is, in fact, trying to take advantage of you to make profits, turn to a West Virginia bad faith insurance lawyer for help. All insurance companies have the duty to act in good faith to policyholders. Failure to do so resulting in policyholder harm is grounds for an appeal and possibly even a lawsuit.
Can I Sue My Insurance Company for Denying My Claim?
Yes, you can sue an insurance company for denying your claim—but only in certain situations. You cannot sue if the company has a viable, reasonable explanation for denying your claim. This could include policy exclusions, disputed liability, lapsed policy, and failure to notify. If the reason the company gives for your denial does not make sense with the facts of your claim or the provisions of your policy, the next step toward resolution is an appeal. Appeal your denied claim first through the company’s supervisor, and then through the state’s insurance board.
There are many reasons an insurance company might deny a claim. The main reason for denying a valid claim, however, is to make a profit. At Tiano O’Dell, PLLC, we don’t think it’s right for major insurance corporations to exert their power over policyholders in need —not when they have no legitimate reason to deny or delay a claim. We make it our mission to fight against insurance bad faith and help people with improperly denied claims. We can help you pursue a breach of contract action or a bad faith tort lawsuit, with the purpose of securing damages for medical expenses, emotional distress, lost wages, and even punitive damages for your trouble.
How to File a Bad Faith Insurance Claim in West Virginia
As soon as you suspect bad faith or fraud, retain a West Virginia bad faith insurance lawyer for assistance. It can be difficult to go up against major corporations and national insurers on your own. An attorney can make a world of difference in the outcome of your case if you decide to take action to protect your rights. Use the following steps as a guide to help you file a claim, but always lean on an attorney when in doubt. Here’s what to do:
- Keep copies of correspondence. Keep all letters and emails exchanged between you and your insurance company. Record information from phone calls, such as the name of the agent you spoke with or who investigated your claim. The more detail you have about your situation, the better for litigation.
- Search for a contract violation. If your insurer violated the contract you have with it, you have relatively straightforward evidence of bad faith. Review your contract to find out if your insurance company or agent is in the wrong. Get your hands on a copy of your full policy prior to filing a bad faith claim.
- Document denials, delays, or dishonesty. Documentation of bad faith is crucial to winning your case. If the company denies your claim, request for a supervisor to review the claim. If the supervisor doesn’t reverse the decision, you may need to appeal to West Virginia’s insurance regulatory agency. You will need proof of the denial or delay to do so.
- File an appeal. You can file an official complaint with the state’s agency regarding miscommunication, misrepresentation, claims denials, and statutory violations. The office will review your contested claim and step in to solve the issue if it deems that bad faith has indeed occurred.
- Make a final demand. If trying to settle your claim doesn’t work, submit a written demand letter to the insurance company. The company then has 60 days to file a response. The company can decide to settle or refuse the claim. If the insurer refuses to pay, you can then file a lawsuit.
If all the previous steps do not resolve your issue, you can take the insurance company to court in a bad faith lawsuit. These lawsuits are not simple. You will need to decide with which court to file and the basis of your suit (i.e. negligence, breach of contract, or fraud). Retaining a West Virginia bad faith insurance attorney is important for successfully filing your claim and carrying your case through to the end.
Compensation for Victims of Insurance Bad Faith
If you believe an insurance company acted in bad faith in regard to a claim, it is advisable to seek legal advice from an experienced West Virginia insurance bad faith lawyer. In your consultation, you will have the opportunity to review the facts of your case with an attorney at Tiano O’Dell, PLLC. This is the first step to better understand the proper course of action to follow. If we accept your case, there will be no legal fees unless we recover a settlement or court award. The compensation that may be available to a successful claimant may include:
- The correct compensation and/or settlement of your insurance contract
- Consequential damages may include physical and/or emotional pain and suffering
- Punitive damages may be attainable in those cases where the insurance company acted in an extreme, excessive, reckless, egregious or deceitful manner
It is important to keep in mind that each case is different and will be decided on its own merits.
Call a West Virginia Bad Faith Insurance Attorney
If an appeal does not resolve your unfairly denied claim, your next move could be to sue the insurance company. You will need to gather all evidence and documents that relate to your alleged bad faith claim. Then, contact Tiano O’Dell, PLLC. We will schedule a free consultation to listen to your story and tell you if we believe you have grounds for a lawsuit. We will then explain the next steps if you decide to retain our services. Call (304) 720-6700 to get in touch with us today.