Getting Justice for Non-payment of Valid Healthcare and Property Damage Insurance Claims, Or Avoiding Payouts for Unsupported Insurance Claims
Surprisingly: Many insureds named in insurance policies are denied costs for their genuine health needs, personal injuries or property losses, leading to thousands, hundreds of thousands if not, millions of dollars that remains wrongfully withheld from the insured responsible for paying the premium.
Although each insurance claim is different, often times it is debatable whether an insurance practice of denying a valid claim was done in bad faith, or was justified albeit for mere technicality.
Distilling the background and subcategories at play for carrier claim denials of insured submitted claims, can shine light on a grey area of Texas insurance law that remains today in the US. Being better informed of the rights and duties of an insurance company and insured each has can provide more assurance and comfort in knowing how to navigate the claims denial appeals process.
It is worthwhile to learn more about the types of bad-faith insurance law legal issues that arise in Texas under insurance law in large metro areas such as Houston and Dallas, Texas by reading below.
What Forms the Bulk of Bad-Faith Insurance Lawsuits Brought in Texas?
According to Texas Department of Insurance, the problem of insurance coverage disputes is fairly common enough to have government resources devoted to investigating illegal denials of insurance.
Upon denial there is a process firmly in place to get the insurance company to reverse its initial denial. For this reason, the Department of Insurance requires that the insured who was denied first:
- Tell the company he or she intends to appeal, unless there is a medical emergency involved; then to
- File a complaint with the Texas Department of Insurance
- Ask for an insurance review, if necessary.
According to the “Bad-faith Insurance Law” found in the Texas Department of Insurance Code it is illegal for an insurance company to do any of the following:
- Knowingly misrepresent pertinent fact or policy provisions related to the insurance coverage at issue
- Not acknowledging the insured’s communication promptly when it is reasonable to do so.
- Not implementing reasonable standards for investigating claims.
- Not settling claims in good faith where liability is clear
- Forcing practically the insured to file a lawsuit by inducing the insured to do so based on a low-ball offer
- Not keeping records of the insured’s complaints.
- Committing any other act of unfairness
Texas Insurance Code Section 542.002, et seq.
On the other hand, carriers are concerned about their right under the doctrine of “duty to defend and indemnify.” According to the Texas State Bar, typically when an individual or company is sued having insurance, Texas does not recognize a “right” of the party sued to defend. Instead, the right exists only to have the insurance company defend or pay for expenses to defend when a lawsuit is filed.
According to the Insurance Journal review, this rule is also known as the “8 corners” rule, which can be explained and utilized effectively with the proper legal counsel knowledgeable about insurance litigation in Texas. Two often muddled concepts are:
- The “duty to defend” and
- The “duty to “indemnify”
A skilled Texas insurance claims attorney who specializes in coverage disputes with insurance carriers denying reimbursement payment or making bad-faith denials of valid claims, will be able to persuasively argue for a just outcome. With the right insurance lawyer retained, it is more likely that a client can get the just result—whether access to healthcare, recovery of damage to personal property and real estate, or reimbursement expenses incurred in defending against potentially frivolous claims.
Factors Making a Solid Case, or Exposing a Spurious Claim
Under Texas law, an insured who believes that he or she is the victim of bad-faith claims denial relating to health care or property insurance, can file a claim with the state of Texas’ Attorney General’s office.
Generally, the Attorney General’s office is responsible for protecting consumers against abuse by insurance companies and scams targeting vulnerable populations and the elderly.
Such programs affect the following areas of concern insurance law:
- rates, forms, and rules affecting personal insurance coverages such as auto, residential property, title, and credit insurance, or
- forms and rules for life insurance, car accident, and health insurance.
On the side of the company or person accused of wrongfully denying a claim, or the insured needing indemnification, a skilled Texas insurance law attorney would be a reliable resource to use to be advised on these topics at the time of denial of payment or reimbursement. By taking advantage of all possible legal strategies created by the legislature, Supreme Court of Texas, and federal courts, the injured or denied claimant could have a better footing on the protections available for consumers victims of scams or overreaching by large insurance companies.
Common Property Insurance Law Arguments Helpful in Texas Insurance Legal Disputes
A controversial subject in insurance law recently in the US today has been the effect of the coronavirus on businesses that carry commercial insurance. According to the Houston-based law firm Dennis Doyle, LLP, there are innovative ways to have the carrier reimburse the business to avoid having to dissolve or declare bankruptcy.
Typically government programs are a safety net for small businesses to rely upon. However, the concept of “interruption insurance” is another option you may consider pursuing so long as an effective legal argument can be made on your behalf to demonstrate that it applies.
Examples of such interruption include:
- loss of income and other damages suffered as a result of a disaster.
- A natural disaster, commonly understood.
- Disaster other than natural disasters such as “forced shut-downs” due to a non-natural disaster.
There are strong incentives to attempt to pursue these claim with the right Texas insurance lawyer competent in the above law practice area to recover the following:
- Fixed costs
- Overhead insurance coverage
- Temporary costs
- commission and training,
- other general “business-related expenses,”
- and/or lost streams of revenue.
Admittedly, each factor can or may not be appliable in your insurance law case, as the policyholder under a given insurance plan. An experienced Texas insurance lawyer will have the know-how to determine the best route to take to bolster a case for an unjustified denial of a property loss or the more novel “business interruption” claim.
Legal Advice: Why do I Need to Hire a Dallas Insurance Lawyer?
As many Texas lawyers have valuable legal services to offer at high prices, there are some concerns likely how much an insurance lawyer is worth as your personal advocate. Based on the nuances of insurance law in Texas, evaluating an insured’s policies, their meaning and predicting how the terms may be interpreted in your particular situation—are undoubtedly priceless in terms of notwithstanding the incredibly high average rate of Texas insurance claims lawyers and firms, who can charge between reportedly $130 to $450 per hour, per Clio.com’s most up to date statistics.
Based on the skill and years of experience of the Texas insurance lawyer handling the organization or second-party, or carrier, you, the policyholder and first-party, can recover greater amounts if the lawyer stays up to date with the everchanging landscape of Texas insurance bad-faith insurance litigation.
Without the policyholder having a valued and trusted in-house or outside counsel as its disposal, you may end up needlessly being exposed to risk and liability for actions that you aren’t even responsible for. The ramifications are that many companies will face similar situations of having to close down affecting the local and national economy in ways that cannot be fully measured.
Why Should I Hire a Skilled Dallas Insurance Lawyer?
Given the fast-changing world of health care and business structures with personal injury resulting in wrongful death and car accidents occurring at high rates involving devastating effects on individuals’ homes and businesses, it is important to have a skilled lawyer who can distinguish him or herself from others in the field in giving you legal advice.
Whereas many Texas insurance claims lawyers may be generally knowledgeable about how to represent a business entity, a particularly skilled and incredibly talented Texas employment attorney will be intimately familiar with the most recent decisions in employment law, ready and willing to use whatever tools in his or her arsenal to prosecute or defend the case.
Many top-rated law firms specialize in these cases, including Dallas-based employment law firm The Law Offices of Mark A. Ticer, Austin-based Dunham, LLP, San Antonio-based Lang Law Firm, P.C., among others in the Houston, San Antonio, greater Austin and surrounding areas, offer an initial free consultation to help strategize your best course of action during a time of stress and uncertainty about the future.
For such a Texas law firm competent in insurance law in the state of Texas, a specialist will ask you, the client, questions to maximize the value of your case or minimize liability in exploring your legal options—whether you are a relatively inexperienced small business owner, homeowner, or a large corporation with greater assets to protect, or an patient treated by a doctor or hospital unable to receive the necessary medical treatment needed. Such representation often necessitates employing novel legal arguments and arguments for fundamentally changing the law to benefit you, the client.
In any case, you should be prepared to create a narrative of facts detailing everything that you remembered before, during and after the incident leading up to the insurance dispute, including keeping meticulous records of expenses made during the litigation, or in the case of the responsible merchant, the costs to defend.
As a client whether for the organization or another party to a dispute, it is also imperative to share any business malpractice or personal insurance company insurance policy maintained and investigate other potential actors responsible for the wrongful act. Also important is it that your attorney test the strength and validity of the rival insurance claims.
Forming an Attorney-Client Relationship: Call a Houston Insurance Lawyer Today to Discuss Your Case and Odds of Victory for the Company!
Whether you are the policyholder without a safety net under an insurance policy or a carrier seeking to minimize liability for potentially unmeritorious health insurance claims, having the right attorney on your side can navigate the vast and ever-changing landscape of Texas employment law and ever evolving case precedent. The attorney-client relationship forms upon consultation when you consider hiring the attorney. Once formed, this relationship helps prepare the client to bring a winning case to receive compensation where there is clearly established liability and avoid liability for insurance claims that have no support in fact or law and are mere conjecture and conspiracy.
Whether you are looking for a Houston, Austin, Dallas or San Antonio-based insurance claims lawyer, Lawsuit.org will help you pinpoint the right one by offering a free consultation to obtain the just results that either you, the policyholder, the carrier needs.