Attorney Portrait Insurance

Secrets About State Farm Car Accident Claims

| Read Time: 3 minutes

One of the leading injuries, if not the leading injury of car accident victims, is whiplash. In fact, whiplash injuries affect more than one million people in the United States every year. To make matters worse, whiplash victims must also frequently deal with insurance companies like State Farm after their accident. If you have sustained whiplash injuries in a car accident, you might have questions such as: How long does it take State Farm to settle a claim?  What is my potential State Farm settlement for whiplash?  Will State Farm help me maximize my settlement? The purpose of insurance is to help provide compensation in the event of an accident. However, there are a number of things insurers don’t want you do know. So let’s dive in and discuss the three secrets about State Farm car accident settlements that you’ll want to know to help you maximize your State Farm settlement for whiplash. Secrets of State Farm Car Accident Settlements State Farm claims that its goal is to help injured victims recover. However, State Farm’s ultimate goal is to collect the maximum amount of premiums while paying the minimum number of claims. Thus, it is important to know how State Farm operates so that you can effectively get the compensation you are entitled to recover.  Secret 1: State Farm May Attempt to Use Your Past Against You State Farm will dig into an individual’s past to find information that could justify reducing or denying a claim. For example, consider a car accident victim who is involved in a rear-end collision and sustains serious whiplash. If the victim sustained a similar injury in the past that may have contributed to their symptoms, the State Farm settlement for the whiplash injury might be reduced. State Farm will often use this tactic to reduce an injury victim’s potential recovery. Therefore, it is important to be careful with what medical records you provide to State Farm. Every request for medical records made by State Farm should be reviewed by an attorney. In fact, it is prudent to engage an attorney to assist with the entire process. Secret 2: You Do Not Have to Accept State Farm’s Offer to Settle The issues following a car accident can range from physical to emotional to economic. Financial pressures are bound to present a hardship for most injury victims. Unfortunately, State Farm is aware of these financial burdens on victims and will often use them to its advantage. However, know that you do not have to accept any offer made by State Farm, let alone their very first offer. While any amount up front may seem appealing, you very well may be entitled to even more. An attorney can help you review your offer and determine whether it is a fair representation of the compensation you will need to recover.  Secret 3: Don’t Feel Pressured to Provide State Farm with a Statement State Farm adjusters will try to pressure you to make a recorded statement. However, despite their insistence, you do not have to provide one.  Regardless of whether you are navigating a State Farm rear-end collision settlement, whiplash settlement, or any other car accident settlement, don’t feel pressured by State Farm. If the adjuster has questions about the accident or injuries sustained, there are other avenues available to them.  If you don’t feel comfortable communicating with State Farm on your own, contact an attorney to help you communicate and negotiate your claims on your behalf. Not only will this relieve some pressure from your shoulders, but it may also allow you to maximize your ultimate recovery.  Contact Our Team Today Experienced attorneys are able to recognize when State Farm uses these “tricks” to offer a lower settlement. The attorneys at Johns Law Firm have six decades of combined experience helping clients in the most difficult times of their lives. Further, we know State Farm’s secrets and will fight to help you get the compensation you need to recover. Contact our team today to discuss your case and see how we can help you with your State Farm settlement for whiplash. 

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Attorney Portrait Insurance

New Orleans Insurance Disputes: Should You Hire an Attorney?

| Read Time: 3 minutes

When you experience an accident or property damage in New Orleans, you expect your insurance company to help. After all, you pay premiums every month so that you have coverage in an emergency. However, insurance companies don’t always come through on their end of the bargain. What should you do if your insurance refuses to pay your claim? Some people give in to the pressure of insurance company intimidation and simply take the financial loss. Other people want to fight the insurance company to recover the compensation they deserve. If you want to dispute an insurance claim denial, you need an experienced New Orleans insurance attorney on your side. Our skilled insurance attorneys at the Johns Law Firm will challenge unfair insurance denials and negotiate for your maximum compensation. Call our New Orleans insurance dispute lawyers for a free consultation. Keep reading to learn more about disputing an insurance claim. How an Insurance Attorney Can Help Our experienced insurance attorneys spent the early days of our careers working for businesses and insurance companies. This experience with insurance company disputes gives us insight into how insurance companies work, including strategies they use to deny claims. We counter these unfair tactics with legal advocacy that attempts to get you a maximum insurance settlement. Our law firm employs talented investigators who will uncover all possible evidence. We use this evidence to support your insurance claim dispute. Since your insurance company must maintain a duty of “good faith and fair dealing,” we point out where they are acting unfairly. Then our New Orleans insurance attorneys negotiate with the insurance company for your maximum compensation.  What Documents to Bring to Your Attorney When you meet with one of our New Orleans insurance attorneys for a free consultation, bring any evidence to dispute your insurance claim denial. To prove that your insurance claim is valid, you should bring the following relevant documents: Your insurance policy, Photos of the damage, Medical bills, Pay stubs, Property repair invoices, Emails or text messages from your insurance company, Letters from your insurance company, Notes from phone conversations with your insurance company, Police reports, and Names and contact information for witnesses. If you don’t have some of these relevant documents, our experienced investigators can attempt to access them. Our law firm will collect all essential information to dispute your insurance claim denial and argue for your maximum payment. What Information to Provide to the Attorney Along with documentation, you should give your insurance attorney a statement describing your experience. Your attorney needs as much fact-specific information as possible. Keeping in mind the “W” questions of journalism can guide you to a complete description of events: When did the incident occur? Where did the accident happen? What caused the incident? Who witnessed the accident? What damage resulted from the incident? Why did the insurance company deny your claim?  It’s best to speak to an insurance attorney before you give a statement to the insurance company. You may feel overwhelmed after an accident or property damage experience, so it can be difficult to provide a complete account of your experience. An attorney can help you think of all the relevant information before you speak to the insurance company. Get Help from a New Orleans Insurance Attorney If you experienced an insurance claim denial, you need an insurance attorney. At the Johns Law Firm, our experienced insurance attorneys help clients who have had insurance claims unfairly denied. We will collect all the relevant information to support your claim and challenge the insurance company to pay you what they owe. Contact us today for a free consultation. We will review the details of your claim and let you know if we can help. If we take your case, we work on contingency, meaning you owe us no payment until we win your claim. Call us today to start your challenge to an unfair insurance claim denial.

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Attorney Portrait Insurance

Third-Party Bad Faith Claim

| Read Time: 3 minutes

If you are injured by the negligence of another person, their insurance company is usually responsible to pay for your injuries. However, sometimes an insurance company refuses to settle for a reasonable amount, even when their liability is clear. If this happens to you, an experienced personal injury attorney can help you pursue a third-party bad faith claim against the insurance company. What Is a Stowers Demand? Many third-party bad faith claims are governed by the Stowers doctrine in Texas. The Stowers doctrine applies when you suffer damages that exceed the defendant’s insurance policy limits. Stowers Demand Letter To comply with the Stowers doctrine in Texas, your attorney would start by sending a Stowers demand letter to the insurance company. The letter must: Include a demand for compensation within the policy limits; State clear terms for accepting the demand; Provide a reasonable amount of time for the insurance company to respond;  Demonstrate that any subrogation claims and hospital liens have either been settled or will be resolved with the proceeds from the settlement; and Offer to fully release the defendant from further liability. If the insurance company rejects your Stowers demand, your next step is to go to court. Pursuing a Bad Faith Claim If you win a jury verdict for greater than the policy limit, then you may be able to make the insurance company pay the extra damages by bringing a third-party bad faith claim. The defendant is the one who would usually be on the hook for damages in excess of the policy limit. So technically, the defendant is the one who would have a bad-faith claim against their insurance company. But you can get a court to issue a turn-over order. This requires the defendant to give you their cause of action so you can actively collect against the insurer.  To succeed on a bad faith claim, you must demonstrate that: Your Stowers demand letter complied with the requirements above; Liability for the amount of the policy limit or more was reasonably clear; and You actually won a verdict in court for more than the policy limit. The most difficult element to prove is that liability was reasonably clear. If there was a fair dispute about whether the defendant was negligent, whether your negligence contributed to the accident, or the amount of damages, then it is not bad faith for the insurer to reject a Stowers demand, even if you later win. Why Would I Want to Settle for the Policy Limit If My Damages Are Greater? Even if your damages are significantly greater than the policy limits, it often makes sense to accept a settlement for the amount of the policy limit. The reality is that nothing requires an insurance company to indemnify a defendant for any more than the policy limits. And most defendants simply don’t have the assets to pay off large verdicts. This means that even if you go to court and get a verdict for an amount above the policy limits, you could struggle for years to ever recover that money. The defendant also has a motivation to settle within the policy limits. Doing so helps them avoid the risk of having a personal judgment against them. Such a judgment can lead to wage garnishment and liens on their assets that can follow them for years. This is why an insurer must accept a Stowers demand where liability is reasonably clear. With a Stowers demand, you can reach a settlement with the insurance company that gets you your money right away. You won’t have to spend years of uncertainty waiting for a jury verdict while struggling to pay your bills. How Do I Know If I Can Pursue a Third-Party Bad Faith Claim? If you suffered injury in an accident caused by someone else, contact our personal injury attorneys at the Johns Law Firm. We can help you determine whether a Stowers demand might be the way to go and handle every aspect of your personal injury claim. Our decades of experience working both for and against big insurance companies put us in a strong position to negotiate on your behalf. Call or contact us today to learn how we can help you get the compensation you deserve.

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Attorney Portrait Insurance

How to Deal with an Insurance Adjuster After a House Fire

| Read Time: 2 minutes

A house fire can be a devastating experience for a homeowner, and dealing with an insurance adjuster in the aftermath can only make matters worse. Though it can be a complicated process, you don’t have to go through it on your own.  If you or a loved one has been affected by a house fire, know you are not alone. Even if an insurance company has denied your claim, this is not necessarily the end of the road. The fire damage lawyers at the Johns Law Firm have the knowledge and experience necessary to fight back against your insurer. Read on to learn more about the fire insurance claim process and find out how we can help. How to Handle the Fire Insurance Claims Process The insurance claims process can be difficult to navigate, especially when it involves fire damage to your home. However, there are some things you can do to help maximize your insurance claim proceeds. Below are a few important things to keep in mind during the insurance claims process: File Your Claim as Soon as Possible It is crucial to comply with your policy and file your claim within the appropriate timeframe. Otherwise, you may forfeit your right to recover damages at all.  Request an Advance In some scenarios, you can get an advance payment against your claim. If you were forced to evacuate after the fire, this advance can help pay for basic necessities that you were unable to grab before relocating. Secure Your Property and Mitigate Damages Insurance policies require that you “mitigate damages.” In short, this means that you must take reasonable steps to minimize further harm to your property. This includes taking action to protect it from the elements, vandalism, and looters. Keep Track of Your Expenses Your policy may provide reimbursement for living expenses if you have to relocate after a fire. Thus, it is important to keep a careful record of all receipts, bills, and expenses. Don’t Feel Rushed Your insurance company will probably want you to close your claim as quickly as possible. However, don’t feel pressured to do so before you are ready. If you have received an offer for payment that you feel is not enough, contact a lawyer who can evaluate your case before moving forward. How the Johns Law Firm Can Help with Your Fire Damage Claim The Johns Law Firm has what it takes to assist with your fire damage claim. Our knowledge of this area of the law allows us to help assess and calculate damages, advocate for you against the insurance companies, and work toward a speedy resolution of your claim.   Our team of lawyers has extensive experience handling these types of claims, and we want to help. If your insurer has wrongfully denied your claim or failed to adequately compensate you for your damages, contact the Johns Law Firm today. 

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Attorney Portrait Insurance

How Long Does an Insurance Company Have to Pay a Claim in Texas?

| Read Time: 2 minutes

Are you waiting to hear back regarding an insurance claim you filed in Texas? If so, you might be wondering what you need to do next. The lawyers at the Johns Law Firm understand that this can be a complicated process to navigate on your own. Read on to find out more about the insurance claims settlement process in Texas and how we can help. Does an Insurance Company Have to Respond to My Claim?  In short, yes. Under Texas law, an insurance company is required to respond to a claim that is filed. Section 542.055 of the Texas Statutes provides that an insurer must do the following within 15 days of receiving notice of a claim from a claimant:  Acknowledge receipt of the claim; Commence an investigation into the claim; and  Request relevant information, statements, and forms from the claimant to assist with the investigation of the claim. An insurer’s failure to acknowledge that they have received your claim is in violation of the statute. However, the statutory requirements don’t end there. An insurer must also notify you of whether or not your claim has been accepted. In most scenarios, section 542.056 of the Texas Statutes states that an insurer must notify a claimant of acceptance or rejection of a claim within 15 days after the insurer receives all items, statements, and forms required to investigate the claim. An insurer can sometimes extend this to 45 days, but they must have a sufficient basis for doing so. Also, if the insurer rejects your claim, they must also provide you with the reasons for the rejection.  It is important to know your rights. If an insurance company has rejected your claim without a good reason, or they have failed to respond within the appropriate timeframe, you may need to take action. An experienced lawyer can help advocate on your behalf. Can I Speed Up the Process?  You cannot shorten the statutory timeframe that insurance companies have to work with. However, there are still things you can do to speed up the claims process. Because an insurer generally has 15 days to investigate the claim from the date they receive the requested information from you, sending these items as quickly as possible is to your advantage.  After an accident, try to compile as much information as possible to provide to the insurance company. Having witness statements, accident reports, and proof of loss forms completed and ready can help speed up the process.  When Does the Insurance Company Have to Pay the Claim? If an insurer notifies you that they will pay a claim or part of a claim, they must do so within a specific amount of time. Under Texas law, they cannot continue to delay payment. Section 542.057 of the Texas Statutes states that an insurer must generally pay the accepted claim “no later than the fifth business day after the date notice is made.” In fact, if an insurer fails to do so, you may be entitled to damages.  How a Lawyer Can Help If you are dealing with an insurance company that has delayed responding to or paying your claim, you might feel like there is nothing you can do. However, this is not the case. Know that you have rights, and there are actions that you can take. Don’t let an insurance company continue to delay your claims process. A lawyer can help protect your rights and fight on your behalf. Contact the team at the Johns Law Firm today for a free consultation to see how we can help you.

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Attorney Portrait Insurance

Texas Insurance Code 541 and 542

| Read Time: 3 minutes

In Texas, insurance companies owe a wide range of duties to their policyholders aimed at ensuring claims are promptly adjusted and settled in a fair manner. An insurance company that breaches these duties can be liable to the policyholder for additional damages, penalties, and attorney’s fees. The reason insurance companies are so closely regulated is the inherent advantage they have over their insureds who are depending on coverage from the insurance company that they paid premiums for.  In Texas, there are two separate bodies of law that penalize insurance companies for acting in bad faith. The first is a common law implied covenant of good faith that requires an insurance company to treat you honestly and fairly. In addition, Chapter 541 of the Texas Insurance Code lays out in detail when an insurer engages in an unfair method of competition and unfair or deceptive acts or practices. In addition, Chapter 542 details an insurer’s duties to pay claims in a timely manner. If you believe your insurance company acted in bad faith, you should contact a Texas insurance attorney as soon as possible. Proving a Bad Faith Claim in Texas When proving a bad faith claim in Texas, it is important to understand that you have the burden of proof. This means that you, with the help of your lawyer, must demonstrate how the facts of your case meet the requirements of a bad faith claim. There are two ways that you can prove your bad faith claim: either as a common law bad faith claim or a statutory bad faith claim. Common-Law Bad Faith Claim To prove a common law bad faith claim, you must show that your insurance company denied or delayed your claim even though liability was reasonably clear. The Texas Supreme Court recognized a common law claim for bad faith in 1983. English v. Fischer, 660 S.W.2d 521 (Tex. 1983). Since then, the Texas Supreme Court has upheld the common law claim for bad faith despite the passage of statutes prohibiting insurers from engaging in certain actions that give rise to specific penalties.  Statutory Bad Faith Claim To prove a statutory bad faith claim, you must prove that your insurance company violated Texas insurance code 541 or 542.  Causes of Action You Can Bring Under Chapters 541  There are several different causes of action you can bring against your insurance company under Chapter 541 of the Texas Insurance Code. These claims can be brought against both your insurance company and insurance professionals, such as adjusters.  Misrepresentation of a material fact or policy provision; Failing to reach a settlement in good faith when liability is reasonably clear; Failing to reasonably explain why a claim was denied; Failing to affirm or deny coverage within a reasonable time; and Refusing to pay a claim without conducting a reasonable investigation. A Texas insurance lawyer can help you determine which of these causes of action is best suited to your case. First-Party Bad Faith Claims It is important to understand the type of bad faith claim that applies to your case. A Texas insurance attorney can help you figure out which type of claim you should file. First-Party Bad Faith Claim A first-party bad faith claim arises when you file a claim against your own insurance company after an accident or event. For example, you have a house fire and file a claim with your insurance company for the damage to your dwelling and personal property. If your insurance company fails to settle your claim when it is clearly liable under the terms of the policy, you can file a first-party bad faith claim against your insurance company. Damages There are two major types of damages available in bad faith suits against an insurance company. These include actual damages and attorney fees and court costs. Actual damages refer to the financial harm you suffered as a result of your insurance company acting in bad faith. It is also important to note that you can recover three times your actual damages if you can prove your insurance company knowingly violated chapter 541 of the Texas insurance code. A Texas insurance attorney can help you determine the amount of damages you could recover. What Should You Do If You Believe Your Insurance Company Has Acted in Bad Faith? If you believe your insurance company has acted in bad faith, you should contact a Texas insurance lawyer today. We at The Johns Law Firm will determine the appropriate avenue to prove your bad faith claim. We will fight your insurance company and strive to get you the compensation you deserve. Contact us today to schedule your free consultation.

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Attorney Portrait Insurance

Bad Faith Insurance in Texas: Know Your Rights

| Read Time: 5 minutes

In Texas, insurance companies owe a wide range of duties to their policyholders aimed at ensuring claims are promptly adjusted and settled in a fair manner. An insurance company that breaches these duties can be liable to the policyholder for additional damages, penalties, and attorney’s fees beyond what is owed under the insurance policy. The reason insurance companies are so closely regulated is the inherent advantage they have over their insureds who are depending on the coverage they paid for.  In Texas, there are two separate bodies of law that penalize insurance companies for acting in bad faith. The first is a common law implied covenant of good faith that requires an insurance company treat you honestly and fairly. In addition, Chapter 541 of the Texas Insurance Code lays out in detail when an insurer engages in an unfair method of competition and unfair or deceptive acts or practices. Somewhat related is Chapter 542 of the Texas Insurance Code, which provides deadlines for an insurer to pay and settle claims. If you believe your insurance company acted in bad faith, you should contact a Texas insurance attorney as soon as possible. Proving a Bad Faith Claim in Texas When proving a bad faith claim in Texas, it is important to understand that you have the burden of proof. This means that you, with the help of your lawyer, must demonstrate how the facts of your case meet the requirements of a bad faith claim.  There are two ways that you can prove your bad faith claim: either as a common law bad faith claim or a statutory bad faith claim. Common-Law Bad Faith Claim To prove a common law bad faith claim, you must show that your insurance company denied or delayed your claim even though liability was reasonably clear. The Texas Supreme Court recognized a common law claim for bad faith in 1983. English v. Fischer, 660 S.W.2d 521 (Tex. 1983). Since then, the Texas Supreme Court has upheld the common law claim for bad faith despite the passage of statutes prohibiting insurers from engaging in certain actions that give rise to specific penalties.  Statutory Bad Faith Claim Under Chapter 541 There are several different causes of action you can bring against your insurance company under Chapter 541 of the Texas Insurance Code. These claims include:   Misrepresentation of a material fact or policy provision; Failing to reach a settlement in good faith when liability is reasonably clear; Failing to reasonably explain why a claim was denied; Failing to affirm or deny coverage within a reasonable time; and Refusing to pay a claim without conducting a reasonable investigation. Insurance companies, adjusters, and other personnel can be sued and held liable for bad faith insurance claim handling. There are numerous business practices that insurance companies may engage in that fall under the umbrella of bad faith. For example:  Undervaluing claims Delaying adjustment of claims Delaying payment of claims Misrepresenting terms of the insurance policy Pressuring a policyholder not to hire an attorney Ignoring portions of the claim during investigation and adjustment Canceling or changing the terms of insurance after making a claim Failure to communicate with the policyholder Not providing reasons for the insurance company’s determinations Failing to assign qualified personnel to adjust and investigate your claim Request unnecessary information to delay the claim adjustment process Alleging the insured engaged in fraud or criminal behavior without reasonable justification Bad faith normally requires you to prove that the insurance company didn’t just make an error, but that it engaged in intentional or grossly negligent conduct aimed at harming its insured. I often like to classify bad faith claims as either being obvious or not so obvious. An example of an obvious bad faith claim is where the insurance company knowingly makes misrepresentations to a policyholder. For example, the insurance company denies your insurance claim after being told by its own experts that the claim is covered by your policy. Another example of obvious bad faith may be an insurance company that misrepresents the terms of your insurance policy or changes the terms of the insurance policy without your knowledge.  Not so obvious bad faith often deals with the valuation of your claim. In many cases, an insurance company will estimate the value of your claim on the lower end. Although frustrating, this itself may not be bad faith. You need to compare the insurance company’s investigation and reports to what you are claiming. If your dispute with the insurance company is over the value of specific items that you are claiming, there may not be bad faith if the insurance company can prove that its valuation was reasonable. However, if the insurance company has ignored portions of your claim or estimated your damage in ways that are unreasonable, you may have a good claim for bad faith.  Damages for Bad Faith Conduct and Unfair Trade Practices If you establish bad faith, the following damages can be recovered:  Treble Damages, i.e. three times the amount the insurance company should have paid you. To get treble damages, courts tend to require that you prove the insurance company intentionally or knowingly acted in bad faith.  Attorney’s fees, interest, and court costs.  Interest on the delayed payments. Don’t Forget About the Prompt Payment Statute Chapter 542 of the Texas Insurance Code creates a number of requirements for insurers to respond to, investigate, and pay insurance claims. These requirements are separate and apart from the bad faith practices prohibited under Chapter 541. If an insurer violates this law, you are entitled to recover attorney’s fees and damages in the form of an annual 18% penalty.  To collect these damages, the law requires: (1) the policyholder had a claim under the policy; (2) the insurer is liable for the claim; and (3) the insurer failed to comply with a requirement of the statute.”  There are a number of specific requirements that you need to meet to collect attorney’s fees and damages for breach of the prompt payment...

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Attorney Portrait Insurance

What Is Double Indemnity?

| Read Time: 2 minutes

A double indemnity clause is a type of provision found in many life insurance and accidental death and dismemberment policies. This type of clause allows for additional payout in the event of accidental death. However, insurance companies often make it difficult to classify the death as “accidental,” preventing you from getting the payment you may be entitled to. Contact the Johns Law Firm today to see if you qualify for a double indemnity claim and find out how we can help.  Double Indemnity Life Insurance Definition Double indemnity life insurance clauses require an insurer to provide a larger payout if the insured died as a result of accidental death. Very often, this additional payment will be double or even triple the amount that is provided for in the policy. Approximately 5% of all deaths in the United States are the result of an accident. Life insurance companies offer additional payouts for accidental deaths due, in part, to the low likelihood that you will die due to an accident.  Sometimes, however, insurers will try to deny double indemnity claims to avoid making additional payments that may actually be owed.  What Qualifies as an Accidental Death Determining what constitutes an “accidental death” is more complicated than you might think. Insurance policies will frequently carve out many exceptions to coverage under the policy. Below are some examples of deaths that generally qualify as accidental:  Murder,  Motor vehicle accidents,  Drowning, Falls, and Any other death not considered an “accident” by the insurer. But, for most causes of accidental death, the insurer will attempt to find an exception to coverage. The following are some common exceptions to coverage for a double indemnity claim:  Murder of the insured by a beneficiary under the policy; Accidents caused by the insured’s own alleged negligence; Accidental death where the insured was intoxicated; Suicide; and Natural causes. Even though there are many exceptions to coverage, this does not always mean that your claim should be denied. Having a lawyer who understands what does and does not qualify as an accidental death can greatly improve your chances of having your double indemnity claim paid.  What Can I Do If the Insurance Company Denies My Claim? Unfortunately, many insurers will deny double indemnity claims that should be paid. However, even if your claim is denied, you may be able to contest it.  For example, an insurer might deny a double indemnity claim based on their determination that the insured committed suicide. But, if you can prove that the death was, in fact, an accident and not a suicide, then your claim should not be denied. Likewise, an insurer might deny payment of the double indemnity benefit because it believes the accidental death was the result of the insured’s own negligence or intoxication. While these may seem like fairly standard exclusions, insurers can stretch their meanings to deny coverage. Why? A double indemnity payment is a huge hit on an insurer and it will do anything it can to avoid doing so. The good news is that having an experienced lawyer in your corner to argue on your behalf can make all the difference.  Dealing with the aftermath of a loved one’s death is challenging, and navigating a double indemnity insurance claim and subsequent denial can make matters feel even worse. At the Johns Law Firm, we want to make sure you feel taken care of.  If you or someone you know has had a double indemnity claim denied by an insurer, contact us today to see how we can help. 

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Attorney Portrait Information

TX Life Insurance – Two-Year Incontestability Clause

| Read Time: 4 minutes

A life insurance policy is a contract between your insurance company and you, the policyholder. While the benefits of life insurance are clear, there is always a risk that a claim is denied because the information is omitted from an insurance application. To offset this risk, the Texas Legislature and most other states have enacted a law requiring all life insurance policies to contain an incontestability clause. See Texas Insurance Code, Section 1131.104. This law states that your insurance company cannot contest the validity of your life insurance policy after it has been in force for two years from its date of issue. The purpose of an incontestability requirement is to protect you from a challenge to the validity of your policy long after the policy has been issued. The idea behind this requirement is that a life insurer has a duty to investigate the medical history of its policyholders and must take affirmative steps to void a policy or readjust a premium within the first two years that the policy was issued.  However, a life insurer can refuse to pay a claim after the two-year incontestability period if it can prove that the insured made intentional misrepresentations in the insurance application. Texas Insurance Code, Section 705.104 Additionally, Texas Insurance Code, Section 1131.104 says that a statement you made relating to your insurability can’t be used against you in a suit contesting the validity of your policy, provided that your policy has been in effect for two years or more. However, your insurance company can use a written statement against you after the two-year incontestability period to try to prove that you made a material misrepresentation in your life insurance application. If your life insurance company tries to challenge the validity of your life insurance policy, you should contact a Texas insurance lawyer as soon as possible. How Does an Incontestability Clause Help You? When you purchase a life insurance policy, the clock begins running on the incontestability clause’s effective date. If your insurance company has not found an error in your application within two years of the date of the issue, it cannot cancel your policy unless one of a handful of exceptions is met. In other words, the insurance company has two-years to contest the information in the insurance policy.  If applicable, your beneficiaries will receive their benefits due to your policy even if your insurance company claims that misrepresentation in your application made the policy invalid. A Texas insurance lawyer can help you understand how the incontestability clause in your life insurance policy can help you. What Are Some Exceptions to Incontestability Clauses? Nevertheless, insurance companies can often cancel or modify your life insurance policy in a few circumstances. Misstated Age or Gender First, if you misstated your age or gender on your application, your insurance company may modify your insurance benefits to reflect your true age and gender. This is because many insurance policies contain a “misstatement of age” provision that specifies the insurance benefits will be adjuster based on the insured’s actual age.  Death during the Application Process Second, if you die before the incontestability clause expires, your insurance company may be able to cancel your policy if the applicant made any misrepresentations in the policy application. Importantly, the misrepresentations do not have to necessarily be material or intentional. Any misrepresentation or omission, even slight, can normally be used to cancel a policy before the expiration of the incontestability period. However, if the applicant did not make any misrepresentations or omissions in the policy application, and subsequently dies within two years after the policy was issued, the life insurance company is obligated to pay the claim.     Nonpayment of Premiums The life insurance company can always cancel a policy for failure to pay premiums regardless if it occurred before or after the two-year contestability period.   Insurance Fraud: Intentional Misrepresentations Your insurance company may also void your policy and refuse to pay if they can prove that the applicant engaged in insurance fraud. Insurance fraud occurs when you make deliberate misrepresentations to obtain benefits you’re not entitled to. The issue of fraudulent misrepresentations versus negligent omissions is the key source of conflict in many life insurance disputes. For example, a life insurance company may claim that an applicant’s failure to disclose a medical condition on the application is evidence of fraudulent intent. However, in most cases, that is not true. Many applicants innocently omit certain details about their medical history on a life insurance application. Think about all of the times you have been to the doctor and consider if you can recall every medical condition or diagnosis you have had. Many life insurance companies will seize upon an innocent omission to try to deny the claim. If your life insurance claim has been denied due to an alleged misrepresentation in the policy application, do not be dismayed. Insurance companies make money by denying legitimate claims. However, a Texas insurance lawyer can advise you as to whether one or more of these exceptions might apply to your case. What About Misrepresentations Caused by an Agent’s Negligence? One issue that comes up often is a misrepresentation or omission in the insurance application that was not the applicant’s fault. Instead, it was the fault of the insurance agent. Most of the time when you apply for life insurance your agent will walk you through the application and write down your information. In fact, it is not uncommon for the application to take place over the phone. We recently had a deposition in a case where the insurance agent admitted that he never asked questions as they actually read on the insurance policy. Think about that. How can you provide honest responses in an insurance application when the agent does not even ask you the correct questions.  Sometimes courts will impute the agent’s negligence onto the insurance company. This means that any misrepresentations or omissions in the application are the faults of the insurance company and the policy cannot be...

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Attorney Portrait Information

Appealing Your Long-Term Disability Denial

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Having your long-term disability claim denied can be stressful and confusing. If this is an issue you are dealing with, you should take heart in the fact that most long-term disability claims are denied. This should not be surprising. Insurance companies make money by denying claims. What Is the Next Step? You are likely required to file an administrative appeal. Appealing a denied long-term disability claim is not easy. However, a long-term disability appeal is a lot like a redo. You get a second chance to compile and present medical and vocational evidence to try to have your claim accepted. For many, the assistance of an experienced disability insurance attorney to navigate the process is essential. ERISA Versus Non-ERISA Policies The Employee Retirement Income Security Act (“ERISA”) governs many employer benefits including disability insurance. If your disability benefits are provided by your employer, ERISA likely applies. ERISA regulates most aspects of how disability claims are processed. This includes the timeframes for making a claim determination. Under ERISA, when a claim is denied, an employee must appeal in accordance with the administrative appeals process. A policyholder cannot file a lawsuit for wrongful denial of the claim until the administrative appeals process has played out. The process of filing an administrative appeal can be time-consuming. In most cases, a policyholder will have 180 days from the date the claim has been denied to appeal. Only after the administrative appeal is denied can a policyholder file a lawsuit. Non-ERISA disability policies are governed by state contract law similar to most other insurance policies. There is no administrative appeal process. If your claim is denied, you can file a lawsuit. Steps to Making Your Disability Claim Even though you may have already received short-term disability benefits, this has little to do with whether you qualify for long-term disability benefits. For long term disability claims, your medical history and medical records are critically important. A policyholder must establish that he or she has a disabling condition. It is the policyholder’s burden to establish within a reasonable medical degree of certainty that a disabling condition exists and that the policyholder’s ability to work and earn wages has been impaired. Long-term disability policies tend to either be “own occupation” and “any occupation” policies.  Under “own occupation” policies, a policyholder is considered disabled when, due to an illness or accidental injury, he or she is unable to perform their current job. With this type of policy, the policyholder can qualify for benefits even if he or she can perform a job or occupation that is different from their “own occupation.” This differs sharply from “any occupation” policy in which an applicant is disabled when he or she is unable to work any type of job. For example, under any occupation policy, a contractor whose disability does not prevent him from working a light-duty job could not recover long-term-disability benefits. Many long-term disability claims involve significant potential recoveries and it is not uncommon for insurance companies to aggressively litigate claims. Experts often take on a significant role in disability claims. If your claim is disputed, you need a qualified team of experts to help establish that you are disabled. Establishing a Condition That is Consider Disabling Disability claims first and foremost are driven by medical opinion. A policyholder seeking benefits has the burden of establishing that he or she has a medical or psychological condition that is disabling. As a rule of thumb, the condition needs to be objectively serious. If your condition is insignificant or ill-defined, you probably will not qualify. Further, your physicians or medical experts need to help establish that your condition impacts your ability to work. This issue can be tricky depending on whether you have an “any occupation” or “own occupation” policy. Vocational evidence often comes into play in long-term disability claims. Vocational evidence is simply evidence related to your education, work experience, and ability to earn a living. In many cases, the insurance company may hire an expert to state that you can work your regular job, or, in the case of an “any occupation” policy, a different job. Similarly, an experienced disability attorney should retain a vocation expert to establish that the client is disabled within the meaning of the policy. The strength of a vocational expert’s opinion regarding disability largely depends on your objective medical evidence. If you have not been evaluated by the correct specialists to establish a disability, your claim will probably not be approved. This is why having an experienced long term disability attorney to assist you can be instrumental.   Why are claims denied? In many cases, disability claims are wrongfully delayed or denied, causing hardship and stress to the policyholder. However, sometimes claims are denied simply because the policyholder did not present enough evidence with their initial claim. It is the policyholder’s burden to establish the existence of a disabling condition. Most disability claims are denied due to a supposed lack of supporting medical or vocational evidence. For example, a policyholder may present evidence that they have been diagnosed with fibromyalgia but provide no further information as to how it impacts their ability to work. While fibromyalgia may, in reality, be a disabling condition, the fact the policyholder did not link their condition to vocational status may prevent their claim from being approved.  On the flip side, the insurance company is working hard with a team of experts to deny your claim. Most insurance companies have a list of preferred medical experts who they routinely send disability claimants to for evaluation. The insurance company’s experts will often differ sharply from your treating physicians and will almost always conclude that you are not medically disabled. While this is not fair, it is the way the disability process works. If you feel the insurance company is stacking the deck against you, you should consult with a disability insurance attorney.  What to Do After a Disability Claim is Denied? When a claim is denied, the policyholder should be provided...

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