Unscrupulous insurance companies will use your insurance policy as a basis to deny claims rather than as a basis to pay them. Flawed, faulty, or unfair insurance policy interpretation is characteristic of the widespread and out of control tactics insurance companies will use to delay, reduce, or deny payment of your claim.
When you purchase insurance, you are entering into a contract between yourself and your insurance company. This contract, or policy, establishes all terms and conditions of your insurance coverage.
An insurance contract is considered a contract of adhesion. Simply put, this means that the carrier draws up the policy and presents it to the policyholder, the insured. Because the insured has no input to amend the terms of the policy the burden of ambiguity is placed on the insurance company. The benefit of doubt must be made to the favor of the insured.
But insurance companies successfully bank on the chances that the majority of policyholders do not understand their rights. To the contrary, insurance companies will assert that there is no flexibility beyond their interpretation of your policy. When you file a claim, these companies will seek to delay or deny your claim based on what it considers any perceived or contested policy ambiguities.
As an example, assume that you have filed a claim for damages to your vehicle caused by a traffic accident. In the course of your claim you are advised by your adjuster that your claim is under additional investigation because a specific portion of your policy excludes coverage for portable equipment which is not permanently installed on or in the vehicle. You counter that permanently installed is vague and that you presented your vehicle to your agent for inspection at the time the policy was purchased. Further, you disclosed all equipment installed on the vehicle when the policy was issued. You have a reasonable expectation that this equipment is covered under the terms of your contract.
In this instance your insurance company is delaying payment of your claim by redefining the language of the contract. You have adhered to your obligations of disclosure, and you have paid your premiums. What should you do?
You need to do your personal homework. Review your information. Have you studied the policy language? What would the prudent and reasonable person conclude? Is your argument valid? Did you adequately present all details relative to your vehicle at the time you insured it? Did you have a legitimate expectation that the subject equipment was covered?
- If you believe the facts support you, continue to pursue your position. Your best weapon in protecting yourself against questionable claims practices is to know your policy.
- You must study and understand your insurance policy. Your insurance company assumes you will not do this.
- You have a duty to disclose all relevant facts at the time you apply for your policy or your policy can be declared void.
- Your insurance carrier likewise has a duty to fairly apply the terms of the contract.
- Be assertive in your demands to effect a satisfactory conclusion to your claim.
Insurance companies will search for claims specific ambiguities in your policy to their benefit in order to avoid payment of your claim. They must be able to support their conclusions.
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