What should you do when your insurance company denies a valid claim under a policy which is paid to date?  It is surprising how often insurance company representatives “misunderstand” their own insurance coverage responsibilities.  You bought an insurance policy and paid the premiums faithfully.  Now that a claim has arisen, you are surprised your insurance company is taking the position your claim is outside of the coverage provided by your insurance policy.  What options do you have?

The insurance coverage attorneys at the Watkins Firm will review your policy, the circumstances surrounding your claim and advise you regarding the validity of your claim.  Many claims that are originally denied by an insurance company are actually valid claims.  Once these claims are challenged by our attorneys, the insurance company is forced to acknowledge their “error” and approve payment of the claim.

Insurance companies do not make profit by paying claims.  They increase their profit by challenging valid claims, and attempting to convince policy holders that their policy does not cover the circumstances surrounding the claim.  If your insurance company denies a valid claim we invite you to contact us for a free consultation at 858-535-1511.  We will discuss the type of policy you hold, the specific circumstances surrounding your claim and the responses of your insurance company.  Our clients value our experience and expertise when reviewing insurance policies to evaluate coverage and the validity of a claim.  We protect the San Diego area from cases of insurance bad faith and help to resolve disputes regarding the denial of valid insurance claims.

Pro-Tip: “60 years ago, a Supreme Court justice of California named Learned Hand decided that insurance was a main fabric of our society that everybody needed to have access to, some kind of insurance so that people don’t just get completely devastated and from then forward a long litany of cases and cases and cases describing different types of rights and different types of things that were passed by the legislature, interpreted by the courts. And it just seems to be growing in weird and bizarre ways. <laugh>. And so, as an older lawyer who’s seen it all, almost, it’s crazy. Some of the things you get covered for like spitting on people are insane.

But it’s true. And so it’s a bizarre fabric that runs through all the kinds of cases we get as civil lawyers and knowing them and pairing them with your client’s case or avoiding them with the other side’s case. And also knowing that most lawyers don’t know about these things. It’s crazy world when we do litigation for people. And I thought, how about a crazy segment on things you wouldn’t know? And some good old fashioned war stories of how things came about. And it’s a fine art between what really is possible and what they’ll tell you. Knowing what is covered is not enough. Knowing how to handle the fact that it may be covered, knowing that it might be covered. That’s the biggest one – might be covered – is a whole new Right created by the legislature and all these court decisions might be covered is powerful stuff.

Now intentional acts are not covered, but unintentional acts are covered. And so there is a great litany of cases that describe what is an intentional act or what is an unintentional act and do you intend the consequences of your act or do you intend, there were no consequences. Like if you go to punch somebody and knock out all their teeth, you’re going to say, well I just thought it would just be a little love tap on the cheek. I didn’t know or have any intent that there would be all of that damage.

And so now we talk about foresee-ability of the damage. So now we have an argument and we’re back to might be covered. So your kid knocked all the teeth out of the neighbor’s kid and you’re going to get sued as the guardian of your child. And your child, they’re going to try to sue. But you’ve got to go through all those statutes. Insurance company comes along and they say, no, you’re not covered. It was an intentional act. And you say, okay, and you agree and now you have nothing. Or you call a lawyer <laugh> who says, yeah, it might not be covered, but it might be. So we’re being sued, don’t pay the claim, pay for our lawyers and we’re taking it all the way to trial and we don’t care what you do. And now the insurance company has got to pay some law firm $200,000 to go to court to defend a case that you may never pay on depending on how the facts come out. Remember, in trial, 95% of cases settle.” – Dan Watkins, Founding Partner

In many cases the insurance company will issue a “Reservation of Rights” letter.  This is known within the insurance industry as a “denial letter” as it tells the policy holder that the insurance company has serious concerns or questions regarding the validity of their claim or the coverage of their policy based upon the circumstances surrounding the claim.  If you have received a Reservation of Rights letter, are concerned about the misleading actions of your insurance company or aren’t sure what action to take if your insurance company denies a valid claim we invite you to review our podcast Episode 35 – Crazy Things You Didn’t Know Were Covered by Insurance as well as the strong recommendations of our clients and contact the Watkins Firm or call 858-535-1511 for a complimentary consultation today.