When making an insurance claim, promptly notifying the insurer is critical to success. Delays can have serious consequences, ranging from dilution of policy benefits to having the claim denied altogether. Similarly, failing to provide insurance companies with the information they need to evaluate coverage also can cause problems. When Payne & Fears is involved with a claim from its outset, we: (1) review our client’s available insurance policies; (2) ensure, when possible, that the client’s insurance companies are timely notified of claims; and (3) follow up to ensure that the insurer has the information its needs to adjust and pay the claim. We also ensure insurance companies follow all applicable claim-handling laws, which require them to respond to claims in good faith and within certain time limits. These first steps are critical to ensuring timely payment of claims.

Navigating the Insurance Claims Process: Supplying Insurers With All Relevant Information

It’s no secret that insurance companies look for reasons to deny claims. Many claim denials stem from a lack of information, an insurance company’s misinterpretation of the facts of a claim, or an insurance company’s misapplication of the law. If a claim is initially denied, as many claims are, it is important to immediately respond to the denial, to provide the insurance company with accurate facts and law supporting coverage for claims, and to request that the insurance company immediately reconsider its coverage position. Payne & Fears helps its clients challenge insurance claim denials and articulate their best coverage arguments. Providing insurance companies with this kind of claim support at the outset increases the likelihood of prompt and full payment of insurance claims.

Navigating the Insurance Claims Process: Escalating Claims

If even after we challenge a claim denial, the insurance adjuster still is not taking the claim seriously, it may be time to escalate the claim and force the insurance company to involve a higher-level decision-maker or its coverage counsel. Claim adjusters often have limited authority. They may deny certain kinds of claims under certain kinds of policies regardless of whether the facts and the law support coverage. In these instances, Payne & Fears send demand letters to the insurance company, sometimes with a draft lawsuit attached, giving the insurance company a hard deadline by which to pay the claim or face a lawsuit. These steps often trigger action by the insurance company that leads to resolving the claim without litigation. 

Navigating the Insurance Claims Process: How We Can Help

We help business policyholders navigate the entire insurance claims process, from timely tendering a claim, to anticipating and responding to coverage defenses insurers are likely to raise, to involving decision-makers and counsel empowered to resolve the claim. Insurance companies are more likely to adjust a claim fairly and in good faith when the insurance coverage attorneys at Payne & Fears are involved from the outset.

It is always our goal to get claims paid promptly and fully, without litigation. Using these tactics and others, we have had decades of success getting clients’ claims paid fully and promptly without litigation. Many insurers know Payne & Fears by reputation and have been on the wrong side of court decisions in favor of our clients. We provide our clients with clear and effective counsel throughout the claims process.