David C. Pellegrin
Insurance is a tool people use to protect against the consequences of the death of a loved one, damage to property, health challenges, and other unexpected events. Insurance company commercials promise quick payment and no fuss when it is time to collect on a policy. The reality is that disputes between insurance companies and policyholders are common. Insurance companies often dispute the amount or kind of benefits due, and sometimes disputes arise as to whether payment is due at all. Most insurance policies contain pages of exclusions that limit the insurance company’s exposure in certain circumstances. Litigation over the scope and application of these exclusions is common.
The Pellegrin Firm represents policyholders in connection with life, accidental death & dismemberment, health, and property insurance claims. Denials of claims happen all the time, and people often give up as opposed to pushing forward and taking advantage of their legal right to challenge denials. Depending on the type of policy, there may be an internal appeal process with the insurance company. It may be necessary to bring the claim to court state or federal court. Insurance policies are governed by a confusing tangle of state and federal law and visiting with an experienced attorney is important.
Life insurance disputes can arise when the insurance company argues that the death of the insured was not covered under the policy, either on the basis that the application contained misrepresentations or an exclusion – such as death due to drug abuse or an alleged suicide – applies. It is important for beneficiaries to at least consult with a lawyer if such benefits are denied. Similar disputes can arise in the context accidental death & dismemberment policies, policies which are sold individually and as riders to life insurance policies. Courts don’t always agree with the insurance company’s reasoning, and insurers are sometimes willing to pay some money in a settlement if the beneficiary pursues litigation.
Health insurance in America is extremely complicated. Insured people seeking treatment will often run into new terms like “in-network,” “out-of-network,” and “medical necessity.” A first denial of a particular treatment is not always the end of the road. The insurance company almost always offers an internal appeals process, and denials unjustified by the policy can be challenged in court. It is worth it to seek out a free consultation with an attorney if you have questions about health insurance issues.
Property insurance in a place prone to natural disasters like Louisiana is an extremely important issue, and this is another area in which disputes are common. Policyholders and insurers often disagree on the amount of money needed to repair damage. Also, disputes sometimes arise over whether the loss is due to a covered event (for example a rainstorm versus a flood in a standard homeowner’s policy). Louisiana law allows for bad faith damages for failure to timely and properly pay a property insurance claim.