Why Hire a Lawyer Now?

If any of these 11 issues affect you, consider hiring a lawyer

 

  • Lapse of Term Life Policy Within Six Months Prior to Death
  • Underpayment of Claim
  • Contentious relation with insurance company adjuster
  • Recorded Statement
  • Request for financial documents or inspection for origin and cause
  • Reservation of rights letter
  • Examination Under Oath (EUO) request
  • Arson
  • Act of insured caused loss
  • Polygraph examination request
  • Relationship with public adjuster goes bad

Lapse of Term Life Policy Within Six Months Prior to Death - Term life insurance policies in Illinois do not simply lapse or terminate after non-payment of a premium. First, there is a mandatory 30 day grace period within which to make up the missed premium. If however the insured dies within the grace period then the benefits are owed to the beneficiary and the default premium is deducted from the death benefit. 

 

Illinois law also requires insurers of policies payable by quarterly or less frequent payments to give a very specific notice prior to declaring a life policy forfeit and terminated. In the absence of this required notice, Illinois law mandates a six-month non-forfeiture period within which the insurer cannot declare the policy forfeit, and if the insured dies within that six months, then the death benefits are owed. Unfortunately, a beneficiary may incorrectly believe the policy had already terminated because of non-payment of premium, and insurance company correspondence indicating the policy is terminated prior to the death of the insured. If the notice was improper, however, then the benefit may still be owed if death occurred within these six months, even though no claim was ever made.

 

Illinois law allows lawsuits for breach of contract to look back ten years, so if your loved one passed away within six months of a default in payment of the premium, you may still be able to collect the term life insurance benefits within ten years. Fill out my contact form today so I can begin reviewing your case with you.

 

Underpayment of Claim - If your property suffers a complete loss and the insurer attempts to settle the claim for less than the full policy amount, they may be using sharp tactics to deny you the full amount of your claim. If you obtain a bona fide bid by a reputable contractor but the insurer attempts to lowball you with an internally generated, highly detailed, counter-estimate, you may be the victim of the insurance industry's tactics.

 

Contentious relation with insurance company adjuster Many people believe insurance company advertising and assume they willingly pay the correct amount after the fire. There is usually a honeymoon period where the insurance company adjuster is very friendly and accommodating. He knows public adjusters are courting you and you may be considering hiring an attorney. The insurance company usually does better negotiating a fire claim where the homeowner does not have professional representation. This special time does not always last and sometimes the honeymoon is very short lived indeed.

 

I have spoken with many fire victims whose insurance adjuster forced them out of their hotel soon after the fire as a heavy handed way to force a quick temporary housing decision. Sometimes the adjuster will contact the hotel without first informing the insured to let it know the bill will no longer be paid. The adjuster may demand a recorded statement early on or suggest you take a polygraph exam (see below) as a way to intimidate you.

 

If your insurance company adjuster shows any signs of aggressive behavior you should seriously consider professional representation such as hiring an insurance claim lawyer with insurance claim experience. This is a long adversarial negotiation under the best of circumstances and if you get a pit bull style adjuster he will wear you down no matter how strong you think you are. For him it is not personal, it is about saving his company money, sometimes at the expense of a good faith claim on your part. For you it is very personal and you are liable to get angry, frustrated, and commit some type of error that will prejudice your claim.

 

Recorded Statement Under many policies the insurance company has a right to request a recorded statement. This is similar to an examination under oath in that it is recorded and often later transcribed. The difference is that you are not under oath. That does not mean, however, that you are free to lie. Material misstatements of facts can always be used as a basis to deny coverage so in this respect the same pitfalls await an unwary homeowner in a recorded statement or an examination under oath. "Did you store accelerant?", "was the property locked?", "what is your income?" and "when were you last living at the property?" are all questions with broader ramifications than they first appear.

 

If the insurance company requests you submit to a recorded statement first ask if it is a condition of the policy. If so, agree to give the statement but request a future date that is convenient to you, the insurance company adjuster, and your legal representative. Also demand a copy of a transcript of the recorded statement for you to review and subscribe to it.  Don't feel as if having legal representation makes you look evasive or guilty, your insurance company has a generously staffed legal department.

 

Request for financial documents or inspection for origin and cause – Most policies allow the insurer to conduct a reasonable investigation to satisfy itself as to the merits of your claim. At the same time the policy gives you a duty to cooperate with the investigation. Your failure to cooperate may be independent grounds for denial of coverage.

 

Oftentimes a homeowner will get a request by the insurance adjuster for tax returns, bank statements, and credit card statements as part of their right to investigate. Think though, what is it they are investigating? Financial motive or fraudulent claim. Demand the insurer or its representative hold as confidential any such documents turned over.

 

Couple this investigation into motive with a fire of indeterminate origin and an overzealous adjuster may send you its origin and cause investigator and a denial of coverage letter claiming arson and citing your motive and opportunity.

 

If you get a request for financial documents or a cause and origin inspection you will probably need to comply under the terms of many policies. You should also consider hiring an attorney to determine the extent of your compliance requirements. An attorney can also ensure the adjusters file contains your side of the story.

 

I will often send in the financial documents on behalf of a client with my evaluation of how they show no motive. Insurance company case supervisors and attorneys read these letters in the case file as they determine their position. Showing them how the homeowner will showcase the facts if litigation does occur can go a long way towards avoiding litigation in the first place.

 

Reservation of rights letterIf you get a letter from your insurer in which it claims to reserve its rights with regard to your insurance claim, you should immediately consider legal representation. Essentially what the insurance company just said is that while it will continue adjusting and negotiating your claim, don't take that as affirming coverage because it may eventually decline to cover your loss.

 

Insurance companies do not send reservation of rights letters to policyholders lightly. The letters cause high anxiety to its customers and strain the negotiating process. They are based on some information developed by the insurer that has led it to believe some defense to coverage may exist.

Because all information the insurer develops from this point forward may confirm or refute its belief that coverage may be declined, an attorney should be consulted to read the policy, evaluate all prior communications, and develop facts if available that tend to confirm coverage.

 

Examination Under Oath (EUO) Most homeowner policies allow the insurer to demand you submit to an examination under oath. The typical location of the examination is at the office of the insurance company attorney and is attended by a court reporter, the insurance company adjuster, the insurance company attorney, and you the insured. Similar to a deposition except there are no court rules of procedure governing their length or content.

 

In my experience insurance companies use this tool towards the end of the claim, after the sworn statement in proof of loss has been submitted. Typical areas of inquiry include personal background information, items of high value, and any areas where coverage may be in dispute. The written demand for examination under oath may also direct you to bring documents relevant to the above topics of inquiry.

 

Because these examinations under oath are intimidating, many people reach out to an attorney after receiving such a demand. This is a good idea because your answers can either help or hurt your claim. Claims can be denied for material misrepresentations of facts presented during an examination under oath and an attorney can help prepare you for the types of questions that may come up. Coverage or denial for loss caused by intentional acts can hinge on seemingly innocent twists of factual scenarios. Your attorney can help by asking clarifying questions where a vague answer might lead to erroneous conclusion by the insurance company.

 

The problem with hiring an attorney at the point of receiving a demand for an examination under oath is that the claim has already been prepared and processed. Instead of helping you present the claim during the examination which they helped you prepare, the attorney coming in at this late date must deal with a claim prepared by you or a public adjuster. Such claims may contain problems that might have been avoided by having legal representation throughout the claim process. The examination under oath at this point might thus present a final opportunity to correct prior positions that are inconsistent with the policy language and may lead to denial. Better to have an attorney prepare your claim properly in the first place and use the examination to confidently present the facts supporting coverage.

 

Arson If your fire was intentionally set you should retain an attorney. It does not matter if no one in your household did it; if someone intentionally set it, consider representation. Until the authorities and insurer are satisfied that someone else started the fire, without your knowledge, you will be the prime suspect. The insurance company may not pay your claim if you started the fire, caused someone else to start it, or if they think they can make a good faith allegation of either.

 

If the cause of the fire cannot be readily determined the insurance company will bring in an origin and cause fire expert. These experts make mistakes and have been known to erroneously assert that accelerants were present. The insurance company may mistakenly decline coverage under the theory of arson. You need an attorney to ensure the insurance company is held to the level of proof required by the case law in Illinois before it declines coverage alleging arson.

 

While I will represent you for your fire claim, if you are ever accused of arson by the authorities I would also recommend a criminal attorney. It is still beneficial to have an attorney experienced in fire loss such as myself work your case up to that point to ensure your rights are protected and potential defenses are preserved.

 

Act of insured Caused Loss This is related to arson except there is no malicious or economic intent to start the fire. An example would be a suicide attempt by a family member that catches the home on fire. A domestic altercation may lead to a kitchen fire. In each case the loss is caused by an act by an insured. Intentional acts by an insured are generally grounds for denial of coverage.

 

There are certain defenses to coverage denial in these cases that may lead to partial or even full coverage. Such defenses include asserting the rights of an innocent co-insured or invoking a mortgage saving clause to have the lender obtain coverage. Illinois statute provides protection in certain circumstances from denial of coverage for loss caused by intentional acts of a co-insured that is part of a pattern of domestic abuse. Vandalism by another is a defense against a charge of an intentional act by an insured. That the fire was not incendiary in cause is a defense to an accusation of an intentional act of the insured. Because these defenses are very fact specific and are sometimes based on interpretation of past legal cases or obtaining additional facts you should definitely consider hiring an attorney early on who is experienced in fire claims.

 

Polygraph examination request Illinois law makes it an improper claims practice to "request or require any insured to submit to a polygraph examination." IL. Admin. Code Title 50, Ch. 1, Sub Ch. 1 § 919.60(d). Notwithstanding this prohibition some old time insurance company adjusters still make such requests to intimidate the insured. If a polygraph exam is even suggested you should immediately seek the service of an attorney experienced in insurance claims. If the insurance company is going to violate your rights by requesting a polygraph then the rest of the claim will not go any better. If any insurer or its representative ever asks you to take a polygraph, send an immediate follow-up letter describing the request.

 

Relationship with public adjuster goes bad When a homeowner hires a public adjuster to represent their interests the relationship can go wrong in several ways. I constantly get calls from frustrated fire victims who lose confidence in their public adjuster. Often the adjuster will negotiate what I call the low hanging fruit of the claim. For example, lets say a claim for personal property damage is in reality valued at $200,000 and the insurance company comes to the table with an initial offer of $120,000. After preliminary negotiations the public adjuster gets the insurer to agree to $140,000 and then attempts to pressure the homeowners to take the offer and move on with their lives.

 

Hiring an attorney at this point to fight for the final $60,000 is difficult at best. First, the public adjuster now has a lien on the insurance proceeds and any settlement check will have them as a co-payee such that the proceeds cannot be cashed without their signature. The attorney must now go over the entire claim just to fight for the final money and the homeowner therefore faces the prospect of paying two fees. In many cases though, such public adjusters are not operating according to laws governing their profession. Violation of such laws can provide the basis for voiding the contract or at least asserting a breach of contract.

 

Such a request for my services therefore represents two separate cases, one for breach of contract against the public adjuster and one for negotiating the insurance claim where the adjuster left off. I generally decline such requests for representation notwithstanding the merit of many of these cases.

 

   

 


© 2006-2017 Steven B. Pollack