Most adults do their best to secure and maintain life insurance, homeowners insurance, flood insurance, and coverage for other disasters. For many, paying the monthly premiums for insurance is difficult, yet they do without in other areas to ensure those premiums are paid. Then, when they need a medical procedure, they are involved in an auto accident, or their home is damaged, they fully expect the insurance companies will do as they promised and pay the claim.
We are constantly bombarded with insurance commercials that portray the companies as our friend—someone who will be there when the need arises. What insurance companies don’t tell customers is that their primary concern is their financial bottom line. If there is any way to avoid paying your claim—or to severely underpay the claim—they will take that route more often than not. When an insurance claim is denied, or a customer is offered an amount that will not even begin to cover the damages, it is time to fight for what is rightfully owed.
Attorney Peter J. Diiorio at New Orleans Legal, LLC, helps each and every client do just that. New Orleans Legal is a personal injury and civil litigation trial practice, dedicated to solving problems, including those related to insurance disputes. We want to make things right for our clients, for their families, and their futures. We have seen firsthand the toll these insurance denials, delays, and underpayments, as well as the ensuing litigation, can take. Our goal at New Orleans Legal is to get our clients through the process as efficiently and easily as possible while delivering the results they deserve. In short, we put our clients first, standing ready to meet their needs at every turn.
Is It Common for Insurance Claims to Be Denied?
According to Consumer Reports, most homeowners’ claims are relatively small; therefore, the insurance company may pay up fairly quickly. The bigger homeowner losses are the worrisome ones. Homeowners who had claims of $30,000 or more had the biggest hassles when it came to collecting—a whopping 41 percent of those with larger homeowner claims experienced delays, denials, disputes, disagreements over damages, and slow payout, while about 19 percent of those with claims below $30,000 experienced these issues.
According to Kaiser Family Foundation, 1 in 5 in-network healthcare claims were rejected in the year 2017. This means those that need medical procedures, tests, or treatments may not be getting the assistance they need—and deserve. While it makes little sense to most of us, insurance companies seek to spread risk, keeping as much money in their organization for as long as possible.
Auditing software, known as “claims review programs,” are used to sift through millions of claims. This software is often known as a “denial engine” because the intent is to lower the amount of money paid out. These auditing programs work by finding technical errors in billing codes used when the claims are submitted. Since the program’s algorithms vary by insurers, the odds of denial or approval are not exact.
What are the Most Common “Tricks” Used by Insurance Companies to Deny Claims?
Many insurance companies have perfected the art of delay, deny, and dispute. When an individual is on the receiving end of such tactics, it can leave them feeling hopeless, helpless, and frustrated. Some of the most common tactics used by insurance companies include the following:
- After a car accident, asking for a recorded statement with the goal of having the individual say something that can be taken out of context to derail the claim. Even when an individual says he or she is “fine,” when asked how they are doing (something we all do) can be used to claim there are no injuries from the accident.
- Asking an individual to sign an authorization for the adjuster to obtain medical records, thereby learning all sorts of personal details that can be used against them. The goal will be to discredit the individual, showing the injury is false or related to a prior issue. Medical records should never be signed over without first talking to an experienced attorney.
- Asking an individual to agree to a quick (small) settlement, signing a full release before he or she has had time to discover the full extent of their injuries, or, in relation to a homeowner’s claim, before he or she has had time to discover the full extent of the damages to their home.
- Misrepresenting the coverage of the insurance policy—there may be much more coverage than an individual is led to believe.
- Disputing damages or medical needs, attempting to attribute these to a pre-existing condition.
- Denying liability altogether for a life insurance claim, a flood insurance claim, or a homeowner claim.
Insurance Disputes and Bad Faith Insurance
An insurance dispute can happen for many reasons, but the most common are claims denials and slow payouts. Insurance companies may also extend a settlement negotiation much longer than it should reasonably go on. Policyholders can enter into a dispute with any insurance company regarding any type of insurance—life insurance, homeowners insurance, flood insurance, other types of property insurance, boat insurance, auto insurance, health insurance, and more.
Bad faith insurance refers to an insurance company’s attempt to “renege” on its obligations, either through refusal to pay a legitimate claim, refusal to investigate and process a claim within a reasonable period of time, misrepresentation of an insurance contract’s language, or failure to disclose policy limitations and exclusions to policyholders. When bad faith on the part of your insurance company is suspected, an experienced New Orleans insurance dispute/bad faith insurance attorney should be consulted, as state laws exist to protect the consumer.
How Can New Orleans Legal Help with Your Insurance Dispute?
In all matters related to insurance disputes, Peter Diiorio at New Orleans Legal provides clients with individualized attention and diligent representation. For clients facing legal problems or insurance disputes, Peter Diiorio will promptly take the necessary legal action to give them the relief they need. New Orleans Legal takes immediate, aggressive action to solve every single client’s problems.
In the case of an insurance dispute or bad faith insurance claim, that means recovering the maximum amount. At New Orleans Legal, Peter Diiorio has a network of leading experts to support each case and will work tirelessly with his team of professionals. Contact Attorney Peter J. Diiorio at New Orleans Legal, LLC, for a free consultation.