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Insurance Claims

Insurance claims involve a huge area of legal issues ranging from automobile and homeowner's coverage issues to health to health insurance or disability insurance claim issues. Please see Article titled Automobile Insurance Issues in Texas under the Articles section of the website that addresses many issues involving automobile insurance claims.

What damages may or may not be covered under an insurance policy has a huge impact of the resolution of claims ranging from personal injury, truck accidents, construction accidents or just accidents occuring at your home.

Are punitive damages covered under your policy? Many of the coverage issues are determined by language in your policy of insurance which most people, including attorneys, seldom read.

By way of example, I recently represented a man injured in a violent collision when he was run over from behind by an intoxicated driver. The drunk's insurance carrier initially said punitive damages were not covered by his two policies of insurance and even stated this position in writing. The position by the insurance company was false. Because of my many years of experience, I knew what to ask for and how to interpret the language in the $1 million policy and the insurance company finally sent a letter admitting that its $1 million policy did cover punitive damages. See also Article titled Intoxication Assault and Intoxication Manslaughter under the Articles section of the website that goes into detail about the case involving the intoxicated driver and why it was important to question the truthfulness of the insurance company when it said punitive damages were not covered.

If your business gets sued for anything ranging from your driver causing a wreck, to employee theft or a visitor on your property getting injured, there is most likely a policy or policies of insurance that may cover the loss. Your insurance company adjuster may just look for reasons to deny the claim or your insurance company may send what is known as a Reservation of Rights (ROR) letter saying that all, or some of the allegations and/or damages, are not covered. The first thing you need to do is have an attorney experienced in reading and understanding insurance policies examine the ROR letter and compare the language in the ROR letter to the language of each policy to determine if the insurance company is correct, or just playing words with certain policy language, to save money. Most attorneys have never really examined and/or interpreted different types of insurance policies or ROR letters and often times dont know what to do next.

What if you loan your automobile to a friend or your child loans their car to a friend? If you loan the vehicle, the other driver is a permissive driver and should be covered under your policy. What if you child loans their car to a friend? Is the friend covered under your auto policy as a permissive driver? It depends. Parents often over react and tell their insurance company they didn't give the friend permission to drive your automobile, even though you knew your child had let that friend and other friends drive your child's car previously. You may have just defeated coverage because your insurance may take the position that the friend was not a permissive driver on this occasion. If your child's friend has a car, or is covered under the parent's auto policy, your coverage is primary because it follows the vehicle and the friend's policy is secondary because the friend is covered under their parent's policy when they are driving any vehicle. If the person in the other vehicle is significantly injured then you definately want two policies applicable to the accident involving your child's friend operating your automobile.

If you have a storm damage or water damage claim, your homeowner's policy has many different sections that may deal with coverage under Your Property Coverage, Losses Not Covered and Policy Conditions of your policy. The insurance company will send an adjuster who may not even be employed by your own insurance company to inspect and write a scope of damage adn repair estimate. Often, the insurance company looks for ways to defeat or reduce coverage because every dollar saved is a dollar that goes towards profits and executive bonuses and stock options. As soon as your insurance company raises issues over a loss or losses not covered for any reason, you need to consult with an attorney experienced in insurance claims.

Business owners usually haev business types of policies covering many different areas of coverage. These policies are lengthy and complicated if you are not familiar wit them. The policies are not all alike even though they may be called a CGL policy or similar policy. If you have a significant business loss you need to have someone on your behalf start looking at the coverages so you know what is, or isn't, covered.

If you get sued for any reason and your insurance company hires an attorney (insurance company retained attorney - ICRA) to defend you in the lawsuit, don't think you can count on the ICRA to look out for your best interests. The ICRA is either a captive attorney (an actual employee of the insurance company) or an ouside attorney who regularly works for your insurance company. If the ICRA is either an employee of you insurance company or regularly does defense work for your insurance company, do you think the ICRA will look out for your best interests or their best interests if they are a salaried captive ICRA of your insurance company or a high hourly rate ICRA who gets a lot of high hourly rate work from your insurance company? Please see Article titled Intoxication Assault and Intoxication Manslaughter and Automobile Insurance Issues in Texas under the Articles section of the website that discusses catching an insurance company lying about coverage and it's ICRA refusing to take any stance on behalf of his client, the insured, regarding the insurance company's initial lie about no coverage. If you have significant lawsuit for damages filed against you and your insurance company a ICRA to defend you, at least consult with an independent attorney knowlegable in this area to make sure the ICRA and your insurance company are defending your properly and looking out for your best interest.

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