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Dawson and Rosenthal
Dawson and Rosenthal

San Diego Improper Insurance Claim Investigation

You pay your insurance premiums faithfully and in full, assuming your insurance company will be there for you when you need them most. Unfortunately, some companies choose to prioritize profits over their customer’s needs. The attorneys at Dawson & Rosenthal, P.C. hold insurance companies accountable for their actions when they constitute bad faith. Contact us today to schedule a free initial consultation and learn more about your legal options.

Clients all over the San Diego area rely on us because:

  • Bad faith insurance law is all we do, which allows us to dedicate the entire power of our firm to your case.
  • We have more than 50 years of legal experience.
  • We have a reputation for being one of the best bad faith insurance law firms in the entire country.

What Is Improper Claim Investigation?

California law requires insurance companies to follow certain rules after they receive a valid notice of insurance claim. There are two main rules when dealing with insurance claims:

  • Insurers must look for coverage rather than a reason to deny coverage.
  • Companies cannot put their own interests ahead of those of the policyholder

An improper claim investigation may arise when an insurance company fails to reasonably investigate a claim before issuing a denial, or if it unreasonably or willfully delays the claims process.

Is Improper Claim Investigation Considered Bad Faith Insurance?

Insurance companies have a duty to serve insured policyholders and execute the terms of an insurance contract in good faith. Failure to do so, such as conducting an improper claim investigation, constitutes bad faith under California law. Simply, an insurance company must act reasonably to provide coverage for a valid claim in accordance with the terms of a contract. Failing to investigate a claim within a reasonable time frame or refusal to pay a claim without investigation represent two of the most common reasons for insurance bad faith claims.

California Laws Surrounding Improper Claim Investigations

Each state has specific laws that pertain to insurance company conduct and investigation of claims in good faith. An insurer has a legal duty to search for evidence that supports a claimant’s assertions, according to a precedent set in the landmark case Mariscal v. Old Republic Life InsuranceWhen an insurance company only seeks to find evidence to deny the claim, it is putting its own interests above the policyholder’s, which is an act of bad faith. When an improper claim investigation case goes to trial, a judge will ask a jury to consider certain factual considerations outlined in CACI 2332:

  • The plaintiff suffered a loss giving rise to a valid insurance claim
  • The plaintiff presented the claim in a reasonable and appropriate manner (i.e., within the terms set by the contract)
  • The defendant failed to conduct a thorough and proper investigation in the interest of providing coverage
  • The plaintiff suffered harm
  • The defendant’s failure to provide a fair and thorough investigation was the proximal cause of the harm the plaintiff suffered

What to Do If You Suspect an Improper Claim Investigation

You have legal options if an insurance company gives you the runaround or fails to complete a proper investigation. Take the following steps to protect any future claim for insurance bad faith:

  • Continue to follow the terms set forth in your policy regarding prompt and truthful reporting.
  • Document everything – take notes about phone calls and inquiries about claim follow up.
  • Contact an insurance bad faith attorney. Sometimes, the simple act of getting legal representation involved will move an insurance company to take your claim more seriously.

Bad faith law is all we do at Dawson & Rosenthal, P.C. Since we only take a few cases at a time, we’re ready to dedicate the power of our firm to your case. If you believe you’ve been a victim of an improper claim investigation, contact us today to schedule a free case evaluation.