These terms determine how a loss is calculated and paid. They can also be subjective and open to a broad range of interpretation. That could mean big differences in settlement amounts and delays in payments for you as a policyholder from your insurance company.
There are regulations and policy language that protect consumers and determine how a claim is paid. You also have the right to dispute the amount offered by the insurance company in a process called appraisal. The insurance company is required to give the policyholder the benefit of the doubt when the policy is ambiguous. If you feel you’re being treated unfairly in the insurance claim process, you can file complaints with the insurance department.
Bell Operations Systems can help clarify what the policy says and let you know what is owed and what is reasonable. We can assist in filing a complaint and help you get legal opinions and case law from noted attorneys to help move a claim forward. All policies are a little different, and we have policy experts that can find useful additional coverages or apply coverage correctly to avoid roadblocks. We provide insurance claim consulting for individuals across the northeast, including New Jersey, New York, and Connecticut.
We are often called in when an insurance claim has reached an impasse. If you have reached this stage in your claim, there are a couple of things you should keep in mind:
No carrier can unilaterally declare an insurance claim settled by simply sending you a check.
That doesn’t mean that they won’t try to bully you into signing releases or waivers.
We were called in on a year-old claim that an insurance carrier deemed “concluded.” They had brought in their experts and tried to get the insured to sign off on a deeply unfair and poorly investigated claim. They were pressuring the policyholder to settle for what they were given, which would have meant that the policyholder would have to pay out of their own pocket to finish the repairs. The carrier ignored repeated requests by the policyholder to reconsider their position.
We got involved and conducted an independent investigation. We discovered the carrier had acted so badly and in such bad faith that we contacted the district claims manager and resubmitted documentation, which we carefully and thoroughly prepared for the policyholder.
We also assisted the insured preparing official complaints to the State and moved up the corporate ladder to file additional complaints with regional management.
A win for the policyholder. We got the claim paid fairly and the adjuster was disciplined by the state Insurance Department.