Reading the Fine Print on Your Insurance Policy
It is vitally important to understand the policy of insurance that you have purchased from a company because, as with all contracts, it sets forth all of your rights and obligations in terms of benefits received for various types of injuries and claims. Often, policies have language requiring that you give the insurance company notice of an occurrence which might give rise to a claim even before the claim has been made. You must strictly comply with any such provision or risk having the insurance company deny coverage for the claim.
The first, and most important, step in pursuing a claim without a lawyer or bringing a lawsuit, is to carefully read your policy so that you know the exact scope of your rights and benefits so that you can be sure to comply with all of the requirements and deadlines imposed by the policy (some of which are so small and almost impossible to read).
Some policies do not provide benefits for certain types of injuries or claim . Policies can contain exclusions for specific types of damage such as water damage, mold or fire, and better policies will explain the circumstances under which coverage is provided. A better policy will typically provide more comprehensive coverage that specifically explains the scope of coverage.
There are often exclusions for failure to take certain steps to cut down on the loss. A better policy will explain those steps and other exclusions or limitations.
A better policy will tell you the real limits of your coverage and whether you will ever have insulation put back into your walls, what specific coverage applies to specific items in your home and whether you will receive money to rent a place while your home is being repaired. Even a better policy will probably not cover all of the money you need but a better policy will at least explain the coverage that is provided.
Understanding your policy is crucial to ensuring that you follow all of the terms and conditions of your agreement with the insurance company. Failure to comply with all of the terms and conditions could result in the denial of your benefit or claim.
How to Know if You Have a Valid Lawsuit
Most people have heard the expression, "you sue your insurance company when…" and then the listener often stops the speaker from continuing. This is because most people associate suing an insurance company as a bad faith practice that consumers sometimes incorrectly accuse their insurers of doing. What is well known is the fact that you must have grounds for suing an insurance company. Some common grounds for suing an insurance company include:
- Failure to pay a claim.
- Late payment; or
- bad faith practices.
A failure to pay claim is fairly straight forward; it simply means that you were not paid when you believe you should have been. A late payment could be a payment sent to you days or weeks after it should have been sent. For example, if two neighbors have similar losses and submit claims, but one is sent their check several days or weeks before another, this is late. Bad faith practices are different in that your insurer may be acting in a manner that would be considered low or unethical. For example, let’s say that your insurance company has been maintaining contact with you, and paying your damages and claims regularly, but they still deny payment of certain claims you make for expenses not covered in the policy. You should be aware of these things when making a claim and wish to pursue the matter of taking legal action. You should be sure of the facts of your case before proceeding.
Gathering the Evidence You’ll Need
Evidence is the cornerstone of any legal case, and it is particularly crucial when dealing with an insurance company. An insurer will likely have a team of highly-trained professionals reviewing your case, so it is important that you present the best possible argument for your claim. In order to accomplish this, you must be able to provide evidence that is not only supportive of your claim, but that is also admissible in court. Documentary evidence in particular can be invaluable when suing an insurance company without a lawyer as it helps establish the facts of the case and may prove that the company did not comply with its own policies. You should collect all materials that relate to your case, including: You will also need to gather copies of any relevant correspondence between you and the insurance company. This could include written communications, emails, voice-mail messages, or text messages. If more than one representative at the company has contacted you, be sure to keep track of all information for each person involved to avoid any confusion later. Be sure to take notes and write down what was said when speaking to an insurance company representative on the telephone. Finally, you may want to enlist the help of an expert before filing your case to ensure that you are fully prepared should you have to take legal action against the insurance company.
Filing an Insurance Department Complaint
If you’re still grappling with a denial or delay, consider filing a complaint with your state’s insurance department. As the department that oversees licensed insurance companies in that state, filing a complaint can spur action from insurer. Each state has its own department of insurance, which functions as a regulatory agency for insurers. Filing a complaint could prompt the department to investigate the insurer or to take some other action that helps expedite your claim. To file a complaint with your state’s insurance department, you must provide them with your full name and contact information. You will need to provide them with the full name of your insurer, the policy number, and all relevant details about your claim. In some states, you can file a complaint online, by mail, or over the phone. The department will then review your complaint and determine what action, if any, they may take. Keep in mind that a finding by a state’s insurance department does not guarantee a successful recovery for your claim. However, it is possible that the insurance department’s reaction to your complaint could prompt the insurer to adjust their handling of your claim.
Navigating Small Claims Court
Small claims court can be your best friend when dealing with an insurance company. Small claims court is designed for people without a lawyer. The process is informal and the small claims court judges are used to people without lawyers. They can often be helpful or at least ask the right questions. On the other hand in federal court, you are not likely to get any help.
What types of cases are heard in small claims? Almost any case that is based on a contract, for example, most insurance cases, are allowed in small claims court. A case must be based either in contract or a tort. It’s hard to sue at small claims court for a business dispute like "this business promised to deliver a certain delivery every week and for six months, it didn’t so I want damages." But if that business promised something in the contract, it would be OK.
Small claims court is strictly a forum for pursuing money damages. You cannot sue an insurance company for injunctive relief, pain and suffering or punitive damages in small claims court.
What is the maximum amount of damages available at small claims court? Generally up to $10,000. Some counties are limited to $5,000 and other may allow up to $25,000. There are reporting requirements for amounts over $5,000 but most of the smaller counties will allow $10,000.
Where do I file? Your local small claims court. You will often try to get it in the county court where the loss occurred. That way, the insurance company is familiar with the court. That said, you need to file within two years of the breach of contract, the more time you wait, the more complicated it becomes.
What will I have to pay to sue an insurance company in small claims court? In most states, small claims court filing fees are between $15.00 and $50.00. In Washington state, the maximum cost is ten percent of the small claims jurisdictional limits. For example, a plaintiff in small claims court in Pierce County paid $500.00 for a $5,000.00 lawsuit.
How does small claims court work? First, sit in on a few small claims court trials. Find one most like yours and listen to how the judge handles the trial and the parties. Don’t forget other parties sue insurance companies too. If the trial is in front of a jury, you would want one person who knows nothing about insurance and one person who has some insurance knowledge.
Making a Case Presentation
The most important thing about this step is that many pro per litigants do not do it. So if you do it, literally almost nobody will have done it before you. And that’s great.
It makes you special and unique in the eyes of the Judge or jury. You have to prepare your case so that you can present it to whoever will be deciding it, whether it is a judge or jury. This means you need to prepare an outline that lays out the structure of the case, along with preparing copies of exhibits (documents and things you presented to the insurance company in your claim with them). As a side-note, when preparing your case, you will usually use the format of a closing argument – what you would say after the presentation of evidence is done. The reason for this is that it is usually easier to assemble expounding on what has already been given than drafting an opening statement (what you would say at the beginning) and then explaining it all again. The key things you want to cover in your "preparation" are:
• Legal Standards – What the law says has to be done by the others
• Identify your Theory of Recovery – What your viable legal theories are
• Identify All Possible Defendants – Who you are suing, who the insurance company is really responsible for
• Whom to Sue First – Who you sue first. Sometimes the order can matter
• What Documents You’ll Need – What documents you have, what documents you need
• What Documents to Prepare – What documents/evidence is important and available for you to present
Overwhelming? Possibly, but this is a step that shouldn’t take more than an hour or two. You should have all of your documents already, and you probably have a good idea of some of the main facts and general organization of things from the initial preparations on the forms you filled out with the SF 95 or the Tort Claim Notice. An example of how it all might come together is something like the following: Tort Claim Notice Denial United States of America Duty to Protect (with standard >500-ft standard). As a result: 1. Construction of working barrier was not sufficient… 2. Failure to install appropriate warning signs 3. Failure to warn of hazards 4. Failure to create a reasonable graduated slope 5. Over-working grade on existing slope 6 . Failure to inform public of the risk of impassable mud pits An additional example might look more like this: Tort Claim Notice Denial United States of America Duty to Protect Requires standardized plan for access. As a result: 1. Gate/guard was not at full height, allowing for double-axels to get around 2. No provision – in practice – for how the gate was opened Stepping back from that, you can switch things around in the outline above, it really depends on your style and what works best for you. My recommendation is do a lot of these while you’re preparing, and find out your style. If you can simplify your list, great, it’ll make things easier. But as you prepare these, you can look back at the relevant facts of the accident and the damages it caused you. Having the materials you submitted to the insurance company available is important for this, so you can look back at your initial statement and see everything you put down. Using this you can try and figure out logic for why they’ve denied your claim or made a lower offer. Finding this logic is important because it makes it easier to mock and make fun of how they are wrong. In all reality, you will want to do this. Finding the mistakes they made is the best way to get under the skin and show them the judgment should be against them. Again, this falls back into the same pattern we have covered in prior sections and articles: People do what they feel they can get away with. If they feel they can fool you by denying your claim and making an insufficient offer then they will. One last thing, as you are preparing, keep the following in mind: While the case will cover a great deal of the actual interaction with the insurance company, this will not handle issues of scope beyond the denial and claims handling process. In these cases we were already in federal court, on an FTCA basis because it involved landslide and other environmental care issues, but many times people will find themselves in state court based on state law violations in how the claim was handled, what they did to you and others, etc. Some may also be able to argue for a constitutional claim: If the government agency has created a "liberty interest" that is protected under the constitution, then you may be able to seek relief directly under your constitution’s enforcement. Separate from the FTCA, generally.
Best Practices for Court Appearance
When you sue someone or some company in court, you are coming into an official forum where everyone has to follow the same rules. Sometimes the parties will agree to settle a matter before trial, so generally the only time you will end up in court unrepresented is when the other party has not settled. The defendant will have a lawyer and they will know the court system, so you need to be ready for them once you enter the courtroom. There are a lot of people who can guide you through the court process when it comes to suing an insurance company without a lawyer. But the most important thing that you need to remember is that you have to act professionally at all times. You cannot attack someone personally, you cannot raise your voice, you cannot curse, and you cannot get out of control. You have to treat every session with formality and use the highest level courtesy. This means that you cannot approach the bench without permission. You have to talk to the judge like you were talking to your boss, and you have to acknowledge the presence of the court clerk, the other lawyer and all witnesses. If you do not act in a responsible manner, you will be asked to leave the courtroom. You must present your evidence in an organized manner. Write everything down to keep your thoughts on track, and you should give a copy of everything to the court clerk. When you present evidence, you might be given a chance to explain it to the court. If you have a lot of information to share, you should try to talk fast but clear. Everything you say will be quoted, so you need to train yourself how to speak professionally. For the defense, the case is a job. For you, it’s your life; but the court does not have to hear the emotional garble that you have. People can be sympathetic to your cause, but they still have a job to do. This means keeping order in the court, keeping a proper schedule, and getting through the day. While the judge might be lenient, you should always represent yourself in a classy manner in order to have a good perception in the eyes of the court.
Why to Consider Mediation or Settlement
Mediation is a process in which both parties sit down with a neutral mediator who facilitates discussion between the two of you to see if a settlement can be achieved. This can be a good option to avoid trial, but should only be done if you feel that you have a reasonable case that you would like to present to a judge. You would not want to initiate mediation or settlement negotiations if you do not feel confident that the potential award would be worth the time and effort to pursue. If you do decide to go this route, you should discuss it with your insurance company (or their legal team) to see if they are open to this type of dispute resolution. If mediation or settlement negotiations are successful, you will come up with an award that both parties will be satisfied with, and mediation fees can be shared amongst both of you or negotiated.
When You Need to Get a Lawyer Involved
There are some cases where after filing the initial paperwork a lawyer may take over. When that happens you may or may not end up getting trapped paying a ton of money for cases that may already be lost. Not every case will require a lawyer, such as with small property damage enterprise, like with a roof or home repair job, and even mediation can be handled by an individual once they have learned the ropes and estimating is a skill that can be done on your own as well. Once it comes time for answering a motion, or a deposition, or possible dismissal of what you’ve filed, it might be time to admit you need a lawyer’s help. It does not make you a loser in any sense of the word either, it may be in your best interest to simply consult a local attorney and find out your options and how to best go about getting it resolved.
So you may get to a point in your case where you feel totally overwhelmed or underqualified. The opposing side may threaten to simply wipe you out by their own attorney and you’ll do anything to avoid that. Filing a request for a judge to rule on the validity of the suit could be handled without an attorney if you feel comfortable enough in facing the judge and jurors , but it is also possible that the defendant may file a counterclaim against you that seeks punitive damages like they spent on litigation costs and that could be too much for you to handle.
You may have found at some point that they are not as open to mediation as you thought and you feel intimidated in litigation and court procedures, which are different from typical real life. You need concrete proof that your case has merit, and that is usually what causes people to choose to have a lawyer rather than attempt to go up against them on their own. So sometimes it takes simple evidence and conviction to go forward into court and other times it can be an incredible amount of work and research.
Even a single meeting with a lawyer to discuss issues in a case you’re handling is available for the asking, usually with no strings attached and no fees. Simply going over questions that have risen without the threat of being overcharged for further advice can be incredibly valuable when you need to know it all, so don’t hesitate to seek legal counsel for individual issues.