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Dawson and Rosenthal
Dawson and Rosenthal

San Diego Unfair Claim Evaluation

You have certain rights and responsibilities as an insurance policyholder when it comes time to make a claim. On one hand, you must reasonably notify an insurance company of a valid claim and follow the instructions outlined in your policy. In exchange, your insurance company must complete a fair and complete evaluation of your claim and put your interests before its own. Unfortunately, some insurance companies prioritize their profits over the needs of their policyholders. When this occurs, it’s insurance bad faith.

If you believe your insurance company has been acting in bad faith, you may be able to file a claim for damages. Contact the attorneys at Dawson & Rosenthal, P.C. to schedule a free review of your legal options today.

What Is Unfair Claim Evaluation?

An insurance company may engage in an unfair claim evaluation when it uses unjust or deceptive practices when providing the valuation for a claim. Unfair claim evaluations address instances of bad faith when offering claim settlements or outright denials.

What Are Examples of Unfair Claim Evaluation?

Several different bad faith actions may constitute an unfair claim evaluation. Some of the more common include:

  • Making a payment of a claim without an accompanying statement describing coverage.
  • Unreasonably prolonging a claim investigation by repeatedly requesting the same information.
  • Issuing a defense of comparative negligence without conducting a claim investigation and providing evidence of how a policyholder might be partially responsible.
  • Attempting to close a claim by offering far less than it’s worth, based on the evidence contained in the contract and application.
  • Forcing a policyholder to file a suit to compensate for an offer that’s much less than an insurance company actually owes.
  • Failing to provide a fair settlement when liability is clear.
  • Failing to provide a reasonable explanation of a denial of a claim, based on the terms of the policy.

Is An Unfair Claim Evaluation Considered Bad Faith Insurance?

California law requires insurance companies to use reasonable conduct and care when investigating, evaluating, and paying insurance company claims. Failure to fulfill the terms of an insurance contract or provide a prompt valuation of an insurance claim represents bad faith under state law.

Unfair Claim Evaluation Laws in CA

Each state sets its own laws regarding insurance conduct, especially concerning claim evaluation. Under California insurance law, policyholders have a legal right to:

  • A reasonable settlement offer. In general, an insurer must offer and cannot force a policyholder to accept a settlement that’s unreasonably low. Using a home loss as an example, an insurer cannot substitute cheaper materials or workmanship to save on costs.
  • An independent estimate. If an offer from an insurance company seems unreasonably low, a policyholder has the right to request an independent estimate to submit to an insurance company.

Remember that an insurance company must legally act within a policyholder’s best interests when evaluating a claim. Taking shortcuts, denying a reasonable request for medical benefits, or offering much less than a claim is worth without explanation could all give rise to a bad faith claim.

What To Do After An Unfair Claim Evaluation

If you suspect your insurance company is acting in bad faith, the following actions could help secure your right to compensation:

  • Document everything. Make note of every phone call, keep every letter from the insurance company, and take notes about long waiting times or other unreasonable actions.
  • Talk to an attorney. If you believe your insurance company offered you an unreasonably low settlement, ask for a bad faith attorney to review your case.

At Dawson & Rosenthal, P.C. bad faith insurance law is our only focus. Trust the firm with 50 years of experience in dealing with insurance companies. Contact our San Diego office and schedule a free review of your legal options today.