Small Widget Spot

March 7, 2017

Don’t Let Your Insurance Company Treat You Unfairly!

Don’t Let Your Insurance Company Treat You Unfairly!

Don’t Let Your Insurance Company Treat You Unfairly!

Most of you have insurance.  You insure your autos, your homes, your health (medical insurance), your income (disability insurance) and your lives. You may also insure your businesses against damage to property used for commercial purposes and loss of income. Your insurance includes protection against lawsuits filed by a third party against you, and you expect your insurance company to defend you in that lawsuit and protect you against a judgment for money damages.

Fear of the Future

We buy insurance not because we want it but because we need it – fear of the future motivates us to protect ourselves against injury to ourselves, our families and our property.   The prudent person buys as much insurance as he or she can afford – sometimes even more. We seek from our insurance company peace of mind and security against the risk of financial injury caused by the unexpected.

Frenemies?

Your insurance company is a friend when you agree to purchase the insurance.  However, often that same insurance company becomes your enemy when you make a claim. The claims process is often a hostile and difficult one with a burdensome amount of paperwork and frequent requests for more information. Usually with the goal of finding a way to turn down your claim or limit payments.  Some insurance companies reward their claims handlers for keeping claim costs down by basing their compensation on how little they pay on legitimate claims.

Power and Control

Insurance companies are powerful financial corporate structures.  They have large treasuries.  While the purchase of a policy may take place at your home or business or at a local office, things are different when a claim is made.  Nearly all of the time you are dealing with someone who is hundreds if not thousands of miles away. A face to face meeting is rare, except when an investigator shows up at your door unexpectedly. Indeed, your insurance company has the power and control over you in your relationship with it.

Consider these points:

  • Your insurance company fixes the price; there is no bargaining.  You can lower your cost only by accepting less insurance
  • It chooses the language for your policy; you are stuck with the policy terms your insurance company selects
  • Your claim is paid when your insurance company decides to pay; it determines when and how much you receive
  • Dealing with your insurance company is on a take it or leave it basis

What Can You Do?

What can you do when you believe your insurance company acts unfairly?  How do you combat “low-balling” or wrongful refusals to pay you what the insurance company promised to pay you for the protection that you purchased?

You can go to your state Department of Insurance. However, these state executive departments are generally ineffective.  More than one-half of the states under-fund their Departments of Insurance, so they have inadequate staffs and resources to handle complaints from the public. In some states, the Department of Insurance has been graded as low as an “F” by an independent agency. Not surprisingly, when a claim is denied your insurance company will usually refer you to the state Department of Insurance if you disagree with the claims decision, knowing that you will receive little help.

Unfair Claims Practices Act

What your insurance company does not tell you is that there are ways to combat its wrongful denials.  For example, in nearly all states, there is an Unfair Claims Practices Act which lists 16 unfair claim practices which insurance companies cannot engage in.   You are never told about this when your insurance company denies a claim.

In addition, all insurance companies must abide by a duty of “good faith and fair dealing” in their investigation, administration, and decisions regarding your claim.  If your insurance company violates these duties to you, you can sue and obtain money damages for what is owed you under your policy plus damages for your worry and anxiety and in some instances attorney fees.  And, in the cases of malicious and fraudulent claims handling, your insurance company may be liable to you for punitive damages based on a civil fine which you receive to punish the company for its wrongful conduct.

Don’t put up with insurance company abuse and unfair treatment

We can help you evaluate your claim and determine if you need to sue to get what is rightly yours under your insurance policy. You paid for protection; YOUR insurance company should provide it! — Guy O. Kornblum

Mr. Kornblum welcomes your comments at gkornblum@kornblumlaw.com.

October 17, 2016

What Happens When Motorists Don’t Have Insurance?

What Happens When Motorists Don't Have Insurance?

In our last post, we shared an an overview of what Uninsured/Underinsured Motorist Coverage (UM/UIM) is and why you should have it in your auto policy. Another staggering fact is that despite efforts by states to curb the number of uninsured motorists on the roads, the Insurance Research Council found 12.6 percent of drivers nationwide were driving without coverage in 2012, the last year for which data is available. All told, 29.7 million people were driving uninsured during that year nationwide.
How Much Coverage do you Need?
As a result, we recommend primary policy limits of at least $300,000 per person and $500,000 per accident, and an excess policy above that which provides at least $1 Million in additional coverage for UM/UIM. To obtain such, the insurer must offer this level of coverage and you must purchase the same amount of liability insurance coverage as you purchase for this UM/UIM insurance.
Making a Claim
There are certain requirements in making a UM/UIM claim under the governing statute, California Insurance Code §11580.2.
There are three classes of people who are covered by a vehicle policy with UM/UIM coverage. These include:
  1. The person named as the insured, his or her spouse, and his or her relatives while residents of the same household. Persons in this category are given the widest coverage. For example, they do not have to be riding in the insured vehicle at the time of the injury. If they are in a vehicle which is uninsured or underinsured that can qualify for coverage. They can even be injured as pedestrians and qualify for coverage.
  2. The second group includes any person in or upon or entering into or alighting from an insured motor vehicle. So the only question is if the vehicle is insured.
  3. The third group is more limited – any person who is entitled to recovery for care or loss of services because of bodily injury to which the policy provisions apply. This applies primarily to “loss of consortium” (damage to the relationship and loss of services) claimed by one spouses for injury to another.
There are three alternative means by which a claimant can preserve a UM/UIM claim (and thus not have it barred):
  1. File a complaint against the negligent driver (and owner of the vehicle if the driver is not the owner) within two years of the accident (this is the limitation period for filing in California).
  2. Conclude an agreement as to the amount to be paid for the UM/UIM claim with your insurance company.
  3. Submit a demand for arbitration to the insurance company by certified mail, return receipt requested within the two year period.
Hit and Run Coverage
There is also UM coverage for an accident resulting from a “hit and run” driver. Here there is only UM coverage because the offending vehicle has disappeared and there is no insurance available for that vehicle.
In order to qualify for this coverage there are three requirements:
  1. There must be “physical contact” between the “hit and run” vehicle and the insured vehicle (to avoid fraudulent claims).
  2. Within 24 hours of the accident, it must be reported to the police or sheriff.
  3. Within 30 days of the accident, a statement under oath must be provided to the insurance company setting forth the facts and circumstances of the claim.
Who is Protected?
Remember, UM/UIM coverage protects you, the occupants of your car, and insured family members who are residing with you if any of them is a victim of an accident by a motorist who carries no liability insurance (i.e. insurance who provides coverage for claims by third parties) or the amount of liability insurance coverage is less than the amount of UM/UIM coverage you have.
How it Works
So, again (I gave a different example last issue) here is how this coverage might work as underinsured motorist coverage.
You and two family members are hit by a vehicle being driven negligently and suffer injuries. The negligent driver has liability coverage of $100,000/$300,000. There is no additional insurance – i.e. excess or umbrella coverage for that driver. You have primary coverage of $300,000/$500,000. Thus the amount of liability insurance protection for the negligent driver is less than the UM/UIM coverage you have.
There are three claims against the negligent driver. The most his insurance company will pay is $100,000 per claim, and $300,000 total for all claims. You have more protection under your UM/UIM coverage: There is an additional $200,000 per person under your primary policy UM/UIM coverage ($300,000 limits minus the $100,000 liability limits of the negligent driver’s policy), subject to the $500,000 per occurrence (i.e. accident) limits as reduced by the total of payments made under the driver’s policy (if $300,000 is paid out, there would be only $200,000 left in the aggregate of your primary policy) plus the $1 Million additional coverage applied to all claims under your UM/UIM excess coverage. So there is more insurance money available for these claims.
As noted, if the negligent driver is not insured (or it is a “hit and run” accident that qualifies as noted above), then the entire amount of your UM/UIM coverage is available to pay for the claims arising out of the accident.
Which Coverage to Buy
As a general rule the cost of this additional insurance protection for you and your car’s occupants, those family members who are residing with you is normally not that great. But in order to qualify for this coverage you must purchase liability insurance (i.e. which protects you from suits by others resulting from your negligence) in the same amounts as the UM/UIM insurance that you want.
Make sure you cover this with your agent or broker when discussing your auto insurance.
Next: The Uninsured/Underinsured Motorist Claim: What are the Insurance Company’s Responsibilities in Handling the Claim? 
 
In addition to representing our clients, Mr. Kornblum also serves as an expert witness in insurance claims and legal malpractice claims (www.jurispro.com), and as a mediator (www.kornblummediations.com). For more information, please  contact our San Francisco office at 415-440-7800.
October 17, 2016

The Importance of Having Uninsured and Underinsured Motorist Coverage

The Importance of Having Uninsured and Underinsured Motorist CoverageUninsured Motorist and Underinsured Motorist Coverage (UM/UIM) is available as additional insurance coverage in your auto policy. Many overlook or don’t understand the importance of this coverage.

What is this coverage? It is purchased as part of your vehicle coverage. It is a separate type of insurance that protects you, the occupants of your vehicle, and others who are family members living with you, from being injured by a negligent motorist who is driving without or with insufficient insurance coverage on that vehicle to pay for the injuries caused.
Why is it valuable? If the negligent driver injures you or someone in your car, and has no insurance, then your insurance company steps in as if it was the insurer of that negligent driver and your policy then provides funds to pay for that wrongdoing. This is uninsured motorist protection.
Underinsured protection is different. It protects you and your passengers from the negligent driver who does not have sufficient insurance to pay for your claims. California is a “set off” state. That is, what you collect from the negligent driver is subtracted from the limits of the underinsured motorist coverage you have. (See the example below.)

Frankly, in California in the underinsured coverage situation, you can never collect your full limits because of this reduction; thus, you pay for coverage you will never have! But that is the way it is structured in our state. A change should occur so that the full limits are available so we are not a “set off” state anymore.

Example: If you are injured by a negligent motorist with only $15,000 per person coverage in that vehicle’s policy (the minimum limits required), and you have greater coverage for UM/UIM, say $300,000 per person, you have an additional sum of $285,000 available to pay per person for the injuries caused by that negligent motorist. As noted, the amount of coverage for the negligent driver is deducted from your limits so you have the difference available. The “per person” limits on your policy are limited to the “per occurrence” (i.e. for one accident) limits of that policy. For example, you may have $300,000 per person coverage but $500,000 per accident, so the total amount available is limited to $300,000 for any one person, but $500,000 for all persons injured in an accident.

How much is it worth? Under California law, you must be offered the opportunity to include UM/UIM coverage in your policy at least for the minimum limits required of $15,000 per person and $30,000 per occurrence. While the statute does not require insurance companies to offer this coverage above limits of $30,000 per person, and $60,000 per occurrence, many insurers do. However, there are conditions to purchasing these greater limits. To qualify for the increased UM/UIM limits you must purchase the same liability limits (governing claims by others if you are negligent).
Do not sign the waiver: To delete this coverage from your auto policy, you must sign a written waiver of it. That is not wise. Indeed I recommend not only that you include it but that you also apply for much higher limits to protect yourself, other occupants of your vehicle, and family members living with you from being injured by a negligent driver who does not have sufficient liability insurance to pay the full cost of the injuries resulting from that vehicle’s negligent operation. Most carriers will offer higher limits, but you should confirm that through your insurance agent.
Why do you need this coverage? The answer is because there are over 2.6 Million drivers on the road without any insurance coverage for injured victims from their negligent driving. Wow, you say! How does that happen if proof of insurance is necessary to register a vehicle. It is easy: as noted, the required minimum limits is only $15,000 per person, and $30,000 total for any one accident. In any case of real injuries, this is hardly enough to pay for medical bills, let alone income loss or pain and suffering. Also, policies get cancelled or premiums are not paid on time, so the vehicle remains uninsured for liability of a driver who negligently injures another, a passenger or someone in another vehicle.
With so many drivers without insurance on our highways, it is critical for you to purchase the highest amount of UM/UIM coverage you can. But it will not happen unless you ask your insurance company about this, and also shop to get the best coverage. It is not expensive.
Seldom do agents or brokers selling vehicle insurance explain the importance of UM/UIM coverage. At least that is my experience.
Get as much as you can: In addition to getting the highest amount of UM/UIM coverage for you and your family, I also recommend you explore obtaining excess UM/UIM coverage of at least $1 Million. The main reason for having it is so you have this additional $1 Million protection above your primary policy’s coverage or you and your family.
Our work: Recently, an article in Forbes magazine featured a story on a case in which we represented a young man who was very seriously injured by an intoxicated driver who had no insurance. Fortunately, his family had primary UM/UIM coverage plus an excess policy which provided for the son’s medical and other needs. They were so thankful that they had acted prudently and asked for and obtained this coverage.
Don’t overlook this aspect of insurance protection. For more on this topic, visit our website, or call one of our offices (see numbers below) for other articles on personal insurance that we believe you should have. (We don’t sell insurance or benefit from your purchases; but we are relieved when a client who has been injured by a negligent motorist who has no or insufficient insurance has large limits of UM/UIM protection so that we can obtain adequate compensation for the injuries.)