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Failure To Investigate Claims

Bad Faith Denial of Your Insurance Claim?  Call 213-489-1600

Insurance companies in California owe their customers a duty of good faith and fair dealing.  That means that insurance companies are required by contract and by law to respond appropriately to claims and only deny claims where they have good reason to do so.  If the company chooses to deny a claim for medical coverage, it must do so in compliance with its obligations according to the law and contracts with customers.  Part of that obligation involves conducting a reasonable investigation into a claim before deciding whether to accept or deny coverage.  If they do choose to deny your claim, they must explain their reasons why.

Insurance companies, unfortunately, do not always follow the letter of the law or their own agreements.  Some companies may simply deny a claim without conducting an investigation or without explaining their reasoning, hoping that customers will simply drop their claims.  Insurance companies that deny claims in bad faith to protect their own bottom-line must be held accountable for their actions.  Insurers acting in bad faith should not be allowed to get away with failing to comply with their end of the bargain.  The Los Angeles insurance bad faith lawyers at Gianelli & Morris have been representing California policyholders since 1979.  We have decades of experience fighting for the rights of our clients and preventing insurance companies from denying claims for inappropriate reasons or without conducting appropriate investigations.

Insurance Companies Have a Duty to Investigate Claims

Bad faith in the insurance industry can take many forms.  One of the most common types of bad faith behavior by insurance companies is to deny coverage without conducting a proper investigation into the claim.  When a company fails to investigate before denying your claim, they are demonstrating that they had already predetermined that they were going to deny your claim, regardless of the validity of your claim.  Even if they do pay out part of your claim, they may choose to cover a smaller percentage of your total claim without explaining their reasoning.

The insurance company, however, has a duty to place your interest above their own, and their investigation should be geared toward finding coverage wherever possible, not the opposite.  There is a standard California jury instruction, in fact, used in bad faith insurance litigation, which clearly explains an insurer’s duty.  CACI No. 2332 states:  “When investigating [the policyholder’s] claim, [the insurer] had a duty to diligently search for and consider evidence that supported coverage of the claimed loss.”

Failure to undergo a proper investigation can occur in a variety of ways.  The insurance company may simply send out a representative rather than a licensed claims adjuster to evaluate your claim.  An adjuster may only look at certain areas explicitly identified by a policyholder, rather than looking at the totality of the circumstances, and choose to limit or deny a claim without conducting a thorough investigation.  The adjuster may overlook or ignore evidence readily available or directly provided by the policyholder in order to deny or underpay.  Or, at the end of the process, the insurance company may fail to give the policyholder the reasons for denial or underpayment, providing only a cursory final decision.  None of these behaviors are acceptable, and any of them can constitute grounds to challenge the insurer’s decision and seek additional coverage.

Our Los Angeles Insurance Bad Faith Attorneys Are Here to Help

Denial of a claim without a proper investigation is a serious and prevalent problem about which many policyholders are completely unaware.  If you were improperly denied coverage, you have rights.  Proving insurance bad faith can be complicated and difficult.  You need a knowledgeable, effective, and passionate insurance bad faith lawyer in your corner, protecting your rights and your health.

The insurance bad faith lawyers at Gianelli & Morris have years of experience going up against the biggest insurance companies on behalf of policyholders in California.  We have secured many positive results for our clients over our long history, and we are ready to go to bat to fight for the coverage you deserve.

If you are not receiving money owed to you or are being denied medical services, call the insurance bad faith attorneys at Gianelli & Morris today!

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