Our team has assembled this knowledge base for your convenience.
Insurance Coverage Dispute Attorneys
Companies and individuals pay substantial sums every year for insurance coverage to protect their property in the event of damage or loss. The terms of coverage are set forth in the insurance policy, which is generally a lengthy contract, with additional amendments or endorsements.
Often, when a loss occurs, the insured contacts the insurance company, makes a claim, and the losses are paid by the insurance company. But this is not always the case. When coverage is denied, or the insured subjected to an insurance investigation, the attorneys at the Lynn Law Firm can help to determine if the denial of coverage was valid – that is, the policy should have provided coverage for the loss.
Our attorneys have the knowledge and experience to analyze coverage issues and pursue a claim against the insurance company in cases where we believe denial of coverage was improper. We never have a conflict of interest in such claims, as we only represent insureds, and do not perform legal work for any insurance companies. We do, however, have their respect, because they know we will conduct a full investigation and vigorously represent the interests of our client through trial and on appeal, if necessary.
If you, as an insured, have been contacted by your insurance company or their attorney and requested to provide documents or undergo an examination under oath, you should call the Lynn Law Firm for a free consultation as to whether you would benefit from legal representation. As an insured, you have an obligation to cooperate with your insurance company’s investigation of your claim. Sometimes, however, the insurance company has prejudged the circumstances of the loss and the availability of coverage, and your interests will be best protected by consulting with an attorney experienced in coverage issues.
The Lynn Law Firm has represented insureds in a wide variety of claims, most often resulting in an enforcement of insurance coverage and payment on the claim.
We have represented the interests of insureds in coverage disputes, including:
Many of the claims are ultimately resolved by settlement after a vigorous and effective legal challenge to the insurance company’s disclaimer.
The Firm has the unique skills to successfully pursue all aspects of litigation including the discovery phase, motion practice, trial and appeals. The Lynn Law Firm has three members of the venerable American College of Trial Lawyers. In addition, Mr. Lynn and Mr. Shannon have both been recognized by the New York State Bar Association for their outstanding contribution to the practice of law in the field of insurance.
As is the case with all of our clients, the initial consultation with the Lynn Law Firm is free. So if you have a concern that a loss may not be covered by insurance as you expected it to be, call our office at (315) 474-1267 to schedule an appointment for a free consultation, or email us at email@example.com.
Steps In an Insurance Claim
When your home or business is damaged, you will naturally look to the insurance for which you have paid premiums, often for years or decades. But the process of making a successful claim is nowhere near as simple as the process of paying your insurer every month.
Every insurance claim begins, naturally enough, with a claim. You may make your claim through your insurance agent, or directly with the insurance company. It is critical that you submit your claim as early as possible. Delay may provide excuse for the insurance company to avoid its obligations to you.
Once a claim is submitted, the insurer will assign an adjuster to investigate the loss. The adjuster works for the insurance company. You can expect the adjuster to fill two roles. He or she will make an initial evaluation of the claim, in particular whether there is anything that might provide the basis for the insurer to deny some or all of the claim. In addition, the adjuster is generally responsible for developing an estimate of the amount of the loss.
Usually, the insurance company will ask you to provide a statement, which is frequently but not always recorded. Your policy requires your cooperation, and generally this will be unavoidable. It is critically important to be precise and accurate in these statements. If you have any questions or concerns about providing a statement, consult an attorney before doing so but be aware that you must cooperate in a timely fashion.
If your loss is large enough, or the adjuster sees something she believes might provide a reason to deny the claim, or you’re just unlucky, your claim may be referred for a more detailed investigation. Most insurers maintain so-called “Special Investigation Units” who are trained in investigating claims. Investigations may include extensive document demands and/or demands for examinations under oath. If you do receive a call from an investigator, it may be time to consult an attorney. We are happy to speak with you and provide a free consultation to help you determine whether you would benefit from counsel.
The insurance company will prepare an estimate of the size of the loss. Frequently, these estimates understate the amount of the loss, often significantly. You may have a contractor provide an estimate, or a public adjuster may assist you in providing an estimate. You are not required to agree to the insurer’s estimate of the amount of damages. Your policy gives you many rights if you do not agree to the amount of the loss.
In an ideal world, the insurance company will agree to cover the loss, you will quickly reach agreement on the amount due to you, and the insurance company will promptly write a check or checks to you. Many complexities can develop here, however: you may not agree on the amount due, or the company may agree to cover some components of the loss or not others, or you may need to navigate payments with your mortgagee.
Disputes over insurance claims can be addressed in several ways in New York. If a dispute is solely over the amount of the loss, you or your insurer may decide to use the “appraisal” process provided in your policy. If your insurer demands an appraisal, you should consult with an attorney about your rights and obligations. If the dispute is over whether a loss will be covered, your only option may be a lawsuit.
Common Insurance Terms
Insurance terminology can be difficult to fully understand. Here are some definitions of terms that we find require explanation.
Examination Under Oath
An Examination Under Oath or “EUO” is used by insurance companies to gather information regarding a claim and also to challenge a claim. Insurance policies often have a special provision allowing insurance companies to perform an EUO of an insured. Normally an insurance carrier also asks for documents to be produced in conjunction with an examination under oath.
An examination under oath is a very important step in an insurance claim. The failure to participate in an examination under oath or the failure to answer certain questions at an examination under oath could result in a total or partial denial of an insured’s claim. If a policyholder has been requested to produce documents or to participate in an examination under oath by an insurance carrier, the Lynn Law Firm should be consulted immediately.
Reservation of Rights
Insurance companies often issue “reservation of rights” letters after receiving notice of an insurance claim. These letters normally acknowledge receipt of the insurance claim but the insurance carrier reserves the right to disclaim coverage at any time.
The insurance company often undertakes an “investigation” following the issuance of a reservation of rights letter. It is important that insureds take special notice when receiving a reservation of rights letter. A reservation of rights letter is a message to the insured that coverage may be denied.
If you have received a reservation of rights letter in an insurance claim, you should contact the Lynn Law Firm immediately to review your insurance policy and facts to determine if there should be coverage.
Property Damage Negligence
Was your property damaged by someone else? While individuals or businesses that suffer property damage will often look first to their own property insurance, it is frequently possible (and sometimes advisable) to pursue recovery from others either instead of or in addition to your own insurance.
Very often, the responsible party will have liability insurance that may apply to your damage. The Lynn Law Firm has had great success pursuing recoveries for property damaged by others’ negligence.
Examples of situations where pursuing a third party may make sense include:
Insurance Company Bad Faith
Your insurance company has an obligation to deal with you in “good faith” – that is, in a forthright, honest, and timely manner. Insurance companies are not required to cover every claim, but they are required to fairly determine whether coverage is available and provide clear explanations of their decision.
If your insurance company fails to live up to these obligations, you may have recourse that goes beyond what you are entitled to under the policy. The law on insurance company bad faith differs significantly from state-to-state. In New York, for example, the courts have affirmed an insurance company’s obligation to act in good faith but have provided fairly narrow remedies for insureds when they fail to do so.
If you believe that your insurance company is not acting in good faith, you should promptly contact an attorney to discuss your options.
You rely on your insurance agent or broker to get you the right insurance. Most of the time, they do so without difficulty. Sometimes, however, brokers make mistakes, and in some instances these mistakes mean you don’t have coverage that you had planned for.
Business Interruption Claims
In addition to repairing physical damage, property insurance for businesses will often provide for “business interruption” coverage and/or “extra expense” coverage.
These coverages allow businesses to be compensated for business losses–lost sales or customers, or additional expenses necessary to get the business back up and running. Some of these expenses are ones that a company may not automatically consider as insurable–for example, you may be entitled to the costs of additional advertising to recover business after a shutdown or additional security while a building is under repair.
Navigating claims for business interruption or extra expense is more complex than a standard property damage claim. If you have questions about these claims, we are happy to provide a free consultation.