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Columbus, Ohio Employment Law Attorney


Columbus, Ohio
Employment Law Attorney

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Your Options When Insurers Don't Act in Good Faith

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Insurance is a promise. When you buy an insurance policy, you pay monthly premiums up front, in exchange for which the insurer promises to full the policy later, paying your covered claims and communicating with you about its actions promptly.

Unfortunately, insurers don't always uphold their end of the bargain. When this happens, it is considered an act of "bad faith" by the insurer. It is essentially a form of consumer fraud.

Consumers who feel their insurance company may have acted in bad faith have legal rights. Our Ohio state law governing unfair trade practices prohibits insurers from being unfair to customers . Among the things insurers can't do:

  • Mislead you about what's covered in your policy
  • Make a payment, settlement, or payment offer that doesn't include all amounts due, without adequate explanation
  • Deny a claim due to a specific provision in your policy, without naming the relevant clause
  • Fail to acknowledge your written inquiry about a claim within 15 days
  • Fail to tell you within 15 days what documents you need to submit to substantiate your claim
  • Fail to take steps to investigate your claim within three weeks of receiving it
  • Offer claim or settlement amounts that are unfair
  • Ask you to accept a settlement that's less than the amount awarded to you in an arbitration
  • Fail to advise you if your claim has been accepted or rejected within 21 days
  • Fail to send a letter explaining why your case remains unresolved if it is still open 90 days after you file a claim

In general, courts want to see an insurer acting consistently and reasonably. For example, if an insurer singles out your claim for denial even though it's similar to many other claims the insurer approved on your insurance program, that could be viewed as unreasonable. If an insurer denies your claim while knowing there is no legal basis for that denial, it's said to be acting with reckless disregard -- another example of bad faith.

Another trick insurers may use to try to avoid paying your claim is known as post-claim underwiting -- that is, after you submit a claim, instead of paying the claim the insurer begins an investigation into whether you are really eligible for your already-issued insurance policy. Insurers are supposed to complete their investigation into your eligibility before they issue your policy. Starting an investigation after you file a claim can be a simple stall tactic to avoid paying your claim in a timely manner.

Post-claim underwriting has been on the rise nationwide. For instance, California levied millions of dollars in fines and required three insurers -- Blue Cross, Blue Shield and Health Net -- to restore coverage to thousands of customers in that state whose policies were rescinded after post-claim underwriting investigations.

As you can see, the laws governing insurers' behavior are complicated. If you believe you may be a victim of an insurance company acting in bad faith, contact the consumer-fraud attorneys at Stepter Law Office to learn more about your rights.

 

Ohio Employment Law Blog

Your Options When Insurers Don't Act in Good Faith

Insurance is a promise. When you buy an insurance policy, you pay monthly premiums up front, in exchange for which the i...

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Columbus, Ohio 43214

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