Insurance company claims denials may result in you having a case against them for "bad faith".
So, you paid insurance premiums all these years and figured, 'if I ever have a claim, it's covered, they'll pay for the loss'. But, you had a claim and they won't pay.
In most States, the Insurance Regulations and the Insurance Policy require your insurance company to investigate, evaluate and pay valid claims. Sometimes, they refuse to do this. They less they pay on claims, the most profit they make. You may want to request that they provide a written explanation for why they denied your claim and upon what sections of the insurance policy they are relying. You may also ask them to reconsider their denial.
If the company persists in denying your claim, you may have what's called a "bad faith" case. In most States, the law is that the insurer has an obligation to act in good faith toward its policyholders in reviewing and paying claims. If they recklessly disregard their obligations, they may be in bad faith. In Pennsylvania, for example, there is a specific bad faith law which permits you to recover not only the amount owed under the claim, but also attorneys' fees, costs, interest and even punitive damages. It is up to the Court to decide whether to award these extra damages.
You will want to make sure you have a copy of your insurance policy. Discussions that you may have with your insurance company should be backed up you with a confirming letter. You can be sure that the insurance adjuster is documenting your discussions with him/her in what is called a "claims log" or "claims activity log". They have to report to a claims manager who reviews their work. When possible, request to speak to the highest-ranking person available in the claims office. Usually this will be either the claims manager or unit manager. Even if you are mad, which is understandable, keep your conversations and letters polite. Remember, if it turns into a bad faith case, your letters and discussions will become evidence. As the cliche goes, you want to be part of the solution, not part of the problem.
Bad faith insurance issues get complicated often. You may want to speak with a lawyer to discuss your options. In most cases, once an insurance company makes a decision, they will not easily back down and you have to be persistent and willing to pursue your claim.
