The term “insurance bad faith” is generally defined as a legal term that is used when an insured individual is treated unfairly – by an insurance company that they are a customer of.
Most insurance policies include provision for the insurance company to act in a fair and just manner to the policy holder, which is simply known as “good faith”. This is an overall understanding that both the insured and the insurer will deal with each other honestly.
However, many legitimate insurance claims are rejected by insurance companies which can leave policy holders wondering what to do next. Injured victims face a system where insurance companies routinely deny or devalue legitimate claims, delay payment of income benefits, refuse to approve the necessary medical care, and even offer lowball settlements in an effort to save money on their end. In the event that the insured feels that they have an honest claim that has been rejected, a tort claim can be filed against the insurance company in an effort to have the policy honored and any other associated costs addressed in a compensation claim.
If you or someone you love has had an insurance claim rejected, we can help to review the details of both the policy and the application and determine if there are grounds to file a lawsuit. You will need a knowledgeable lawyer with hands-on experience dealing with these types of insurance claims. Our Windsor insurance claims lawyers at Greg Monforton & Partners have helped recover millions in claims for our clients. Founder Greg Monforton has extensive experience working as a lawyer and as the former president of the Ontario Trial Lawyers Association (OTLA) he worked specifically on trying to reform Ontario’s automobile insurance laws.
We can review your claim and discuss the options available to you during a risk-free, no obligation legal consultation. Our firm works on a contingency fee basis and does not receive any payment unless you win.
The Insurance Claims Process in Canada
The insurance claims process will vary depending on the type of insurance policy you have. However, there are certain steps you can take to make sure that you are not being taken advantage of.
The first step is to review your insurance policy so you understand the terms and conditions. This includes checking to see if your loss or event is covered and if there are any exclusions, losses or events that are not covered.
The next step is to identify if there are any specific claim procedures you must follow and how long you have to submit your claim for compensation. Insurance companies will only pay out for the specific losses or events described in your insurance policy.
If you decide to make a claim, it is important that you contact your insurer as soon as possible. Most insurance companies have deadlines for filing a claim. In Ontario, Canada, the insurance industry is regulated by the Insurance Act (R.S.O. 1990, c. I.8).
The time limit usually varies between 90 days to one year from the date of the loss or event. You will need to provide your insurer with all the supporting documentation required by your particular policy. For a car insurance claim, this would include a copy of the police or accident report or a death certificate for filing a life insurance claim.
After the forms have been submitted, your insurance company will appoint an insurance adjuster to evaluate your claim and inform you whether or not you have a valid claim according to the terms of your contract. In some situations, insurers may require additional information such as medical records to rule out fraud and determine if it will pay out your claim.
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Why Insurance Claims Are Denied
There are several reasons why an insurance claim is denied. The insurance adjuster may believe that your claim lacks merit, is hoping you will not pursue the claim further or chooses to believe another version of events than your own, even if that version appears to be factually incorrect.
Insurance companies may also interpret or manipulate the language in their policies in order to delay payment or devalue or deny a claim altogether. An insurer may allege any of the following:
- Your policy has lapsed because you failed to pay premiums or pay on time
- Your policy does not cover or excludes your specific loss or event
- Your loss or event falls outside the policy’s coverage or below the deductible
If you suspect that your claim was unfairly denied or devalued, contact a reputable insurance claims lawyer in Windsor right away. We can use our skills and resources to deal with the insurance company on your behalf to help fight the denial.
Call (866) 320-4770 now for our free consultation.
Common Causes For Insurance Claims
Due to the many different types of insurance policies that are available, there are a number of different causes that can require a policy holder to make a claim on their policy.
Some of the most common include:
If you are in a car accident involving injury or property damage, you will be required to file a claim with your auto insurance company. Regardless of who is at fault, you will need to report the accident to your insurer within seven days. Failure to report it as soon as possible may result in denial of your claim. Under the Ontario Limitations Act, you have two years after the date of the accident to file your claim.
There are four types of mandatory insurance coverage in Canada: accident benefits, third-party liability, direct compensation-property damage (DC-PD), and uninsured auto coverage.
Accident benefits coverage provides you with benefits if you are injured in an accident, such as medical care, rehabilitation, income replacement and more. These benefits are paid on a no-fault basis, which means you can obtain benefits whether or not you are liable.
Third-party liability coverage helps protect the insured driver and/or registered vehicle owner in the event he or she causes injury, death or property damage to a third-party as a result of negligence. In Ontario, all drivers must carry a minimum of $200,000 in third-party liability insurance.
DC-PD coverage protects any damage to your vehicle or its contents, including the loss of use of your vehicle and its contents as long as you are not at fault for the accident. It is referred to as direct compensation because even though someone else is liable for the damage, you may collect directly from your own insurer. If you are at fault, you can make a claim under your optional collision coverage.
Lastly, uninsured automobile coverage provides protection for any injuries you or your passengers sustained if an uninsured driver was at fault for the accident. This may also cover your damaged vehicle if the at-fault uninsured driver is identified. A Windsor car accident lawyer can help you better understand the claims process and determine liability after an auto accident.
Unlike auto insurance, having home or personal property insurance is not mandatory under the law. However, this type of insurance does provide coverage in the event your home becomes burglarized or vandalized. The amount you receive will depend on the specific coverage you purchased. Filing a claim for destroyed or damaged property may also qualify you for additional living expense reimbursement.
It is important that you contact your insurance provider as soon as possible. Make sure to be as detailed as you can about the circumstances and damage. If possible, take photographs or video of the damage. A claims adjuster will then contact you to investigate the circumstance of your loss, determine all the facts, examine any documentation and determine the extent of what is covered in your policy.
You will also be asked to complete and submit a Proof of Loss form. This form among other claim forms can be accessed through the Insurance Bureau of Canada (IBC) site. You must include a complete list of all damaged, destroyed or stolen items. If possible, attach proofs of purchase, receipts, owner’s manuals and warranty, and a copy of the police report. Any false statements may result in a voided claim.
If you have home insurance, weather-related damages caused by wind, hail or water are usually covered. However, most policies in Canada do not cover loss or damage as a result of overland flooding. This is any type of flooding when bodies of water, such as a river, lake or dam, overflow onto dry land. Most policies do cover plumbing leaks, busted pipes and water that backs up through sewers.
Damage to vehicles caused by fallen trees and other debris caused by strong winds and hail are also covered if you have comprehensive or an all-perils policy. A comprehensive policy provides coverage for your home and its contents from loss or damage from all perils aside from those excluded in your policy, such as overland flooding or earthquakes. A peril is considered a chance event that is unexpected and accidental.
If you become seriously ill, critical illness insurance is a form of health insurance that provides a lump-sum payment to help with your medical care. Although coverage will vary based on your specific policy, illnesses usually covered by critical illness insurance includes heart attacks, strokes, multiple sclerosis, organ transplants, blindness, paralysis, Alzheimer’s, kidney failure, and cancer.
Coverage can also vary based on the degree of severity and other conditions associated with the illness. For instance, if you are diagnosed with a type of cancer that is serious, but non-life threatening and treatable, you may not be entitled to make a claim. This includes coverage for a pre-existing condition.
You can only make a claim if a licensed, treating physician diagnoses you with a critical illness covered by your insurance policy. Typically, you would receive a lump-sum payment in 30 days after your claim has been approved. Your insurance policy ceases once your claim is paid out.
Disability insurance, also referred to as income replacement insurance, provides a monthly income replacement benefit if you become disabled and are unable to perform your normal work duties. This benefit replaces between 60 to 85 per cent of your regular income, up to maximum limit, and ceases once you start earning income again or you no longer meet the definition of disability within your policy.
There are also two types of coverage: short-term and long-term disability insurance. Short-term disability coverage allows you to claim benefits for no more than 6 months while you are ill. Long-term disability coverage on the other hand usually begin when your short-term disability benefits end or your sick leave benefits end from your employer. Most plans replace 60 to 70 per cent of your regular income.
In the event of your loved one’s death, there are several steps you and your family need to take in order to successfully file a life insurance claim. You will need the policy number, a claim form from the deceased’s insurance provider and a copy of the death certificate. Be sure to contact the local authority in your province or territory to order multiple copies of the death certificate online.
You can also reach out to the OmbudService for Life and Health Insurance if you cannot find the insurance policy. Once a life insurance claim is complete, it generally takes 30 to 60 days to process. The beneficiary may experience a delay in payment dependent on a number of factors, including how long the deceased had the policy and how the person died. If the death was due to the negligence or recklessness of another, it may be in your best interest to contact a wrongful death lawyer in Windsor for legal counsel.
In almost all of these situations, policy holders and their dependents need to be sure that the policy that they have paid for will be able to help provide monetary compensation for their losses until their situation stabilizes.
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Types of Bad Faith Lawsuits
Throughout Canada most insurance companies are instructed by law to act in good faith to their policy holders. More specifically, this means that the insurance company cannot look for legal loopholes to relieve itself of its obligation – which is to investigate the claim and then, pending the results of that investigation, to pay the victim a compensation settlement that is equivalent to the damage provision that is outlined in the policy.
Some common reasons why bad faith lawsuits are filed may include:
- Failure to explain why a claim was denied
- Failure to conduct a fair investigation of the claim and its cause
- Failure to provide a fair settlement value
- Outright refusal to pay a claim without investigation
- Failure to disclose important information to the policy holder
- Failure to pay the claim within an acceptable period of time
- Failure to respond to a time-limited demand
…. among many others.
When it comes to insurance policies, it is critical that you know your rights and responsibilities. It is also important to remember that insurance companies and their underwriters are not your friend. Their primary obligation is to provide a profit to the shareholders of the company and in order to accomplish that, insurance adjusters must use every tactic available to ensure that the absolute minimum amount of compensation is paid in almost every claim. Our Windsor insurance claims lawyers are well-versed in bad faith insurance tactics and will fight for the justice and fair compensation you deserve.
We look forward to helping you. Call (866) 320-4770 now.
Benefits of Hiring an Insurance Claims Lawyer
Preparing, filing, and disputing insurance claims can be a real challenge. Insurance companies do not always have your best interests in mind and often want to pay out as little as possible on claims. In order to get all the benefits you are entitled to under your insurance policy, you should retain the services of a qualified lawyer to represent you during this process.
Hiring an insurance claims lawyer can be intimidating and seem like a complicated process but having legal representation may help increase your chances of obtaining fair compensation for your claim. We can conduct a detailed investigation into your claim and determine why your claim was denied or devalued by citing specific policy provisions and handle all of the communication with the insurance company so you do not have to.
We will also handle your case on contingency, which means you do not owe us any legal fees or costs upfront. We only get paid if we recover a settlement for you.
Need Help? Contact Our Windsor Insurance Claim Lawyers Today
If you or someone you love has had an insurance claim rejected, they may still be eligible to receive compensation for any losses they may have sustained – including mental fatigue and stress related to the initial rejection of their claim.
The entire team of personal injury lawyers at Greg Monforton and Partners understand the pressures that individuals and their families can go when dealing with insurance companies and can provide the knowledge and experience to help bad faith victims navigate the re-filing process.
With our office located in Windsor, Ontario, we proudly provide effective legal counsel to insurance victims throughout the province including:
…. and almost all of the suburbs and towns that surround these cities.
To learn more about how we can help with your insurance litigation – or perhaps to determine if you have adequate grounds to file a claim – contact our office today at (866) 320-4770. Our intake team will answer your call and after some brief questions about the nature of your inquiry, you will be quickly connected to one of our lawyers.
For those that would prefer to start immediately, simply fill out and submit the “Free Case Evaluation” form that is located at the top of this page – it is 100% free to send.
Greg Monforton & Partners – we only get paid when we obtain a recovery. Ph: (866) 320-4770