National Birth Centers, Inc.

Safe Affordable Choices in Birth

Insurance Claims: Typical Bad Faith Insurance Lawsuits and Awards

When you file an insurance claim with an insurance company, by law, in any state, that company owes you a duty to act in good faith. Simply put, this means that the insurance company must not look for ways to escape its obligation to investigate the claim or to pay you. Doing so would constitute bad faith. Bad faith claims and lawsuits may stem from one or more of a number of actions or inactions by the insurance company from denial of coverage to failure to negotiate a settlement. Here are some of the typical reasons insurance companies get sued for bad faith:

  • Unwarranted denial of coverage
  • Failure to communicate pertinent information to the claimant
  • Failure to conduct a reasonable investigation of the claim
  • Refusal to pay the claim without investigating
  • Failure to deny or pay the claim within a reasonable period of time
  • Failure to confirm or deny coverage within a reasonable period of time
  • Failure to attempt to come to a fair and reasonable settlement when liability is clear
  • Offering substantially less money to settle than the true value of the claim
  • Failure to promptly provide a reasonable explanation for denial of a claim
  • Failure to enter into any negotiations for settlement of the claim
  • Failure to respond to a time-limit demand
  • Failure to disclose policy limits

Bad faith litigation can take many different forms and will, like the underlying cases they stem from, either result in a settlement with the insurance company, an arbitration decision, or a verdict one way or the other. Here are some different types of cases and their outcomes. Keep in mind that the cases presented here are for illustrative purposes only. Each case is unique, including yours, and no one case will have exactly the same result as another.

State Department of Insurance (DOI) are a resource for information on insurance companies’ financial stability, but it also regulates insurance companies’ handling of claims for promptness, fairness in negotiations and good faith settlements. Simply put, you, as a consumer, have a right to file a complaint with them if you believe your insurance claim has been mishandled or you haven’t gotten a reasonable, timely settlement. Another option is to contact an attorney who specializes in insurance bad faith. The attorney is working for you and your best interest and will be quicker and much more aggressive than the DOI.

Complaints and the DOI

Every state has a DOI, known by different names around the country. In California, for example, it is the Department of Insurance, but in Massachusetts, it is the Division of Insurance and in Michigan, it’s the Office of Financial and Insurance Services. Each state has a website for its insurance department (see Resources below for a link that will lead you to your local DOI). Most of the websites allow you to easily file your complaint online. Individual complaints are typically made for such things as improper denial or delay in the settlement of a claim, illegal cancellation or termination of an insurance policy, misrepresentation by an agent or broker, and problems regarding insurance premiums and rates. If your complaint is regarding the handling of a claim, it is possible that the insurance company may be guilty of dealing in bad faith. This means that they have treated you unfairly either in the process of investigating your claim, denying coverage for it, or settling it.

Ask yourself the following questions if you are considering filing a complaint with the DOI:

  • What would you like to see happen and will you get the satisfaction you want from filing this complaint?
  • Will the insurance company be penalized in any way for their actions or inactions?
  • Will you get quick results?
  • Alternatively, would it be wiser to hire a lawyer who specializes in bad faith insurance matters?

    Filing a Complaint vs. Hiring an Insurance Attorney

    When you file a claim, the DOI will ask for all of your documentation and then begin an investigation of the matter along with the thousands of others they handle every day. It may take a long time until they determine what the outcome should be, and that outcome may or may not be what you had in mind. More often than not, the matter will go to mediation and a mediator will attempt to bring the parties together to resolve the issues.

    An attorney who specializes in insurance bad faith, on the other hand, will be quicker and much more aggressive than the DOI. The attorney is working for you and your best interest. While no attorney can guarantee any particular outcome, he knows what your goal is because he will thoroughly discuss the issues with you, and can then advise you on what strategy will help you to reach it. To your attorney, you are a real person with a real problem that needs resolution. To the DOI, you are just another complaint form.

    Should you do both, that is, hire an attorney and file a complaint with the DOI? Most DOIs will tell you that if you have an attorney representing you or you have a lawsuit pending against the insurer, their ability to mediate your claim is limited, and they will often wait until your litigation is resolved before doing any investigation to look into insurance regulations that were not followed by your insurer. At that point, such an investigation may still be appropriate because some government regulations may not have been addressed in the litigation. It is not a bad idea to cover all your bases by doing both.