When tragedy strikes, we are often left emotionally vulnerable. When an expected safety net, like homeowner’s insurance, also fails us, the resulting confusion can lead to anger.
Hopefully, this listing of common reasons for why insurance claims are denied (and what can be done to avoid denial) can help bring calm and sense back to a stressful situation.
An insurance company must explain to you, in writing, why any insurance claim has been denied. Phone conversations are not enough to be a denial.
Basic reasons for denial include not paying premiums on time, not filing a claim in time, and not documenting the damages claimed. These are all legitimate reasons for denying a claim and do not leave much ground to fight the denial.
A more complicated matter comes from an insurance policy’s exclusions lists. For instance, home insurance in many coastal counties does not include an option to cover wind or hail damage, so these claims can be denied. Flood damage is also covered by a separate insurance, so those claims must be made with the appropriate organization, and not with your homeowner’s insurance company.
Homeowners may also be denied coverage based on how they presented the damage claims to the insurance company. Without good documentation, a company can deny your proof of possession. Homeowners are also expected to try to prevent further damage from occurring after the initial incident. For example, if a wind storm created holes in your roof, it is your duty to temporarily cover those holes, instead of allowing later rainstorms to further damage your home.
If you believe your insurance company is denying your claim without a legitimate reason, you can follow these steps below on your own, or you can find a Texas homeowners insurance claims attorney to help you take legal action:
At Millin & Millin, we are dedicated to helping you get your insurance to pay out what is owed to you.
If you are having to file an insurance claim, it’s likely due to the fact that you have just suffered through a terrible event. Having to deal with the unscrupulous tactics of an insurance company is the last thing you need on your plate during this time.
Depend on the responsiveness of the bad faith insurance legal team of Millin & Millin to get the justice you need when seeking your rightful compensation from deceitful insurers.
While most business owners are probably familiar with the more common types of insurance claims, they may be at a loss when it comes to seeking coverage for more rare types of damage. After a year like 2020, business owners are probably dealing with some pretty rare kinds of losses.
Thankfully, those losses may be covered by a civil authority clause.
While a civil authority clause may offer coverage for losses caused by coronavirus restrictions, making a successful claim under this provision can be difficult, partially due to coronavirus claims being a new type of claim without clear precedents. Because of this, insurance companies may attempt to deny these claims using bad faith tactics.
Today, your McAllen bad faith insurance lawyers at Millin & Millin will go in depth regarding what you should know about civil authority coverage.
A civil authority clause is a provision of some business interruption insurance policies meant to protect the policyholder from the financial damage caused by a closure that was a result of orders made by a government official or other civil authority.
Essentially, if your business is closed after the government has prohibited access due to a natural disaster, you may be able to file an insurance claim under a civil authority clause.
It’s worth remembering that, under these forms of clauses, coverage is offered based on damage done to property other than the insured property itself. This means that if your store was damaged by a hurricane, you probably wouldn’t file a civil authority claim. However, if the hurricane caused damage to the road that once gave access to your business and authorities declared access to the affected area prohibited, then you may be able to make a civil authority claim.
A local or state government or other civil authority may order evictions or prohibit access to regions for many different reasons. A civil authority clause may include these, as well as a few other types of damages:
Keep in mind that not every civil authority clause will cover all of these types of closures. Insurance companies will use the specific language in your policy in an effort to argue against your claim.
If your civil authority closure business interruption claim has been denied, you may want to speak to a bad faith insurance attorney to determine whether or not your claim was wrongfully rejected.
Due to the relative unfamiliarity of coronavirus-related business interruption claims, certain insurers have used bad faith tactics to deny rightful coverage. Nevertheless, there are also ways that these claims can be denied that don’t necessarily constitute bad faith:
This list of possible denial justifications is non-exhaustive, and just because your insurer is using one of these arguments doesn’t mean that they are in the right to do so. If you have any reason to believe that your business interruption claim was wrongfully denied, reach out to the bad faith insurance attorneys of Millin & Millin for an argument that stands strong in your favor.
Request Your FREE Consultation
Life insurance is a valuable resource for anyone, as it pays out a lump sum to family and/or other dependents in the event you pass away during the term of the policy. A life insurance policy affords the peace of mind that loved ones will be financially protected in the event of your death, and that the money provided will be able to pay for expenses such as a mortgage, outstanding debts, living costs, and other expenditures.
Being aware of your life insurance policy and its coverage is important, especially right now with a global pandemic leading to much loss of life. The insurance lawyers of Millin & Millin want to provide you with some critical information that can help you to better understand life insurance at this point in time.
While COVID-19 has presented challenges across industries, the life insurance sector has largely been unaffected. Life insurers are not pulling out of the market, and as premiums remain steady, industry watchers are seeing COVID-related claims already being paid out, less than one year from the outset of the pandemic.
In most instances, traditional life insurance policies, including whole and term life, cover COVID-19 related deaths. There are, however, exceptions where a policyholder may have their claim denied by their insurance provider.
Reasons claims are denied frequently include:
An inaccurate or incomplete application may result in claim denial for reasons including not disclosing travel plans, not providing truthful information regarding income or even failing to accurately provide information about your health, such as your weight.
In the event that a policyholder loses their life within the first two years of coverage, an insurer will closely examine the claim and thoroughly review the initial application. It is important to be truthful and transparent throughout the application process, and policyholders are encouraged to ask questions should they not understand aspects of the application.
Should a policy lapse as a result of non-payment, it's likely a beneficiary will not receive a payout if the policy isn’t reinstated prior to the policyholder’s death. While most companies extend a 30 or 31-day grace period for late premium payments, you will remain covered as long as your insurance provider is paid within the allotted time.
In the midst of the pandemic, insurers may extend this grace period, with some state regulators already making these extensions a requirement. Insurance companies are willing to work with policyholders, and if you’re experiencing financial difficulties in making payments, it’s important to reach out to your insurer to discuss your options to avoid a lapse in coverage.
In the event of an accident, accidental death and dismemberment insurance (AD&D) is another form of coverage that can provide a payout. However, if a person dies as a result of illness or disease, an AD&D policy will not be paid out. AD&D coverage is sometimes added to a standard life insurance policy as a rider, and in those instances, the primary policy will payout in the event of a COVID-19 related death.
It’s important to understand your insurance coverage and your rights.
In the unfortunate event that you should lose a loved one and have a viable insurance claim denied, the insurance lawyer of Millin & Millin can help to right the wrongs done against you. We have years of experience handling bad faith insurers and can make sure you get what is owed to you.
The owner of Cheers in Boston is suing its insurance carriers over what it claims was a wrongful denial of its business interruption insurance claims. Hampshire House, the owner of five restaurants and a distribution center, claims to have lost millions of dollars due to the pandemic.
As the novel coronavirus spread across the globe earlier this year, businesses closed and residents stayed inside in an effort to stem the tide of coronavirus cases. In the months since those closures, many businesses have faced a business coverage denial by their insurance carriers. In some instances, business owners are claiming that their carrier is wrongfully denying these insurance claims based on ambiguous policy language that legally should be interpreted in the policyholder’s favor.
The Hampshire House lawsuit is filed against Fireman’s Fund Insurance and Associated Indemnity Corporation, as well as their parent company Allianz Global Risks United States Insurance Company.
The suit against the company argues that it breached its contract with Hampshire House and failed to act in good faith.
“Hampshire (like others who purchase business interruption insurance) has faithfully paid its premiums. Yet, when Hampshire made a claim because of a catastrophic business interruption caused by state and local emergency orders, the defendants summarily and arbitrarily denied Hampshire’s claims,” the plaintiffs argue, according to the Boston article.
Hampshire House closed all of its facilities as a result of the pandemic and a state order issued earlier this year. The Cheers locations also relied heavily on tourism, according to the suit. Hampshire House continues to pay insurance premiums of up to six figures. It carries $10 million in business interruption insurance and estimates losses of several million dollars.
“Hampshire (like many businesses) has relied on its business interruption insurance to cover what it is supposed to cover – replacement of business income and payment of ongoing expenses in order to rebuild its businesses,” the filing states.
The suit argues that Allianz instituted a practice regarding COVID-19 insurance claims that led to “improper denial of countless business interruption claims”. Plaintiffs cite a post on the carrier’s website regarding coronavirus claims that read, “In general, any standard property and business interruption coverage must be triggered by physical loss or damage to property at an insured location and infectious disease is usually not a covered peril.”
Hampshire House argues that Allianz failed to make a “good faith investigation, determine coverage and adjust Hampshire’s claims because defendants reached a pre-determined conclusion to deny coverage”.
Attorneys for Hampshire House argue that insurance policies have long been interpreted in the policy holder’s favor by the court. This is allegedly largely due to the fact that these policies are created and sold by carriers in an effort to make money. Language that is ambiguous or “attempted catch all language” should be interpreted in the policyholder’s favor.
“While the insurance industry may cry afoul about their bottom line, too many small business owners, restaurant owners, gym owners, hotel owners, and medical providers are staring bankruptcy in the face,” attorneys for Hampshire House wrote in a statement. “This is a survival moment and all options must be on the table.”
Many business owners are filing business interruption claims for the first time this year. As COVID-19 has spread across the globe, shutdowns and social distancing have necessarily followed it. Businesses that rely on a healthy economy are finding themselves facing substantial financial difficulties.
One way to seek financial support for the time your business will be closed is through a business interruption insurance claim. Unfortunately, insurance carriers know that an unprecedented number of businesses will be looking for help, and they will likely try to deny as many claims as they can to save themselves money.
In fact, insurance companies have already begun lobbying with state and federal legislatures in order to argue they shouldn’t be made to pay these claims.
If you’ve been denied a business interruption insurance claim, the insurance lawyers of Millin and Millin can help you find a way to get the compensation you need. We would be proud to negotiate on your behalf with your insurance or in a court of law.
If your business interruption claim has been denied, don’t give up hope. Many businesses are making these claims due to the novel coronavirus pandemic, and insurance companies are attempting to avoid paying out as many claims as possible.
Carriers may send out notices to policyholders telling them their claims will be denied, but you should still file if you need coverage.
There are also many ways you can argue for your right to coverage. While this may mean that you will need to adjust your claim in order to be successful, you should not accept a denial as the final answer. Circumstances surrounding the coronavirus are unique, and because of this, the process may take more adjusting than is usual but that does not mean it is impossible.
Another important part of filing and arguing an insurance claim, especially in these circumstances, is understanding your insurance policy. These policies aren’t light reading, but it’s important to have an understanding of what exactly your insurance covers.
For instance, a policy may deny claims strictly related to a virus, but there may be coverage for business interruptions related to a civil authority’s shutdown. Finding a way to argue your claim is key, which brings us to our last point.
Insurance policies can be very complex and often use “legalize” or complicated language that can confuse the average individual, so it is vital that you consult with an insurance attorney as soon as you possibly can.
A lawyer can help you fight your insurance denial while you deal with other concerns caused by the interruption. Plus, utilizing the knowledge and assistance of an attorney can give you the peace of mind that you’re doing all you can to fight the denial.
Business owners are going through an incredibly difficult time. Many people are facing sickness and financial hardships, and businesses that rely on a stable economy are fighting to make ends meet.
At Millin and Millin, we know that running a business isn’t easy in the best of times. When an insurance carrier denies a business interruption claim that you need, that doesn’t make business any easier.
Let us help you fight your business interruption claim denial so that you can start getting back on your feet.
COVID-19 has monumentally shifted how the world does business, putting a great deal of small business owners in financial hardship. While the government has given small businesses and large corporations some monetary relief, the case still stands that business owners are living through a time of great financial turmoil.
Business interruption insurance might be the only form of survival throughout this time of slowed business. Unfortunately, some insurance providers have taken measures to prevent businesses from getting the assistance they most definitely deserve.
But there is still hope. The trusted team at Millin & Millin is willing to work tirelessly to fight for your rights during these (financially) trying times, and guide you through all there is to know about business interruption insurance claims.
Business interruption insurance is a crucial topic throughout this pandemic. Many business owners have been forced to close down operations, causing detrimental losses for many businesses across the US.
There are several aspects that determine whether or not you will be able to obtain financial aid through your business interruption policy. Factors that will affect eligibility may include the state where the policy is located, the type of business covered, and whether the policy-holder is a franchisee or franchisor.
Business interruption insurance is meant to protect business owners against financial strain in times when going about normal business isn’t possible. Usually, a business interruption insurance policy is established to handle costs including lost revenue, daily expenses, rent bills, and other financial losses.
Business interruption insurance can offer relief for numerous unprecedented situations. Certain companies have claimed coverage for cybersecurity breaches, while others have received aid upon product recalls.
Unfortunately, lots of insurance providers have found ways to deny valid claims made by policyholders, but you don’t have to accept this as your final determination. The court system is designed to protect policy owners from unjust treatment by insurers.
Note that before you can get any sort of financial recovery aid, you have to initiate a claim.
The first thing you’ll need to do is verify whether your business qualifies. You can begin this process by seeking a copy of your current business insurance policy and declaration page. Your insurance agent or a lawyer can assist you with this, as the language and wording in your policy can be quite complicated. It’s possible that your policy might include additional contingent coverage for diseases like COVID-19.
Once that’s settled, you can then file a claim, and keep track of deadlines. Timing matters when handling insurance claims, and whether your policy’s time frame calls for 60, 90, or 180-day claim notice, you’ll have to work within these time frames.
Calling or emailing your insurance provider is a great place to start with the claims process.
To present your claim for consideration, you must carefully examine the damage you’ve suffered and document those losses. These include loss of sales, extra expenses such as payroll, rent, materials, and replacement inventory. Make sure to also take note of sales trends and business cycles to concisely demonstrate coronavirus-related losses.
Other factors you’ll have to look into in this time are periods for restoration, along with your attempts to subsidize losses. By keeping all the necessary documents and remaining in touch with your insurance provider, you may give yourself a fair shot at securing coverage.
If for whatever reason your claims are still rejected, there are other approaches toward recovery aid.
If you believe you’re entitled to financial recovery due to COVID-19, the team at Millin & Millin can help.
Our well-versed insurance attorneys can thoroughly go over your insurance policy, and with that information, help you develop a plan of action for getting you the coverage you deserve.
Contact us today at (956) 631-5600 for a free case review and for some peace of mind through these financially trying times.
For two decades, Millin & Millin, PLLC has represented hundreds of policyholders in their fight against insurance companies who wrongfully denied or underpaid their commercial property insurance claims. During this time, our firm has litigated claims for business interruption and property damage for hotels, retail centers, churches, office buildings, warehouses, and public schools all over the country.
Due to the government’s decision to issue shelter-in-place orders because of the COVID-19 virus, we know that many business owners are suffering tremendous losses in revenue. While many have coverage for business interruption and orders issued by a civil authority, we expect the industry to attempt to avoid paying trillions of dollars in legitimate claims. Insurance agents and adjusters will tell you that your building must sustain “direct physical loss or damage” before coverage is triggered, but we know this is not always the case.
Simply put, insurers will save themselves money by issuing a broad range of wrongful denials, and they will eventually settle the relatively small proportion of lawsuits filed by policyholders who are willing to fight for what is rightfully their money. Millin & Millin, PLLC is uniquely qualified to represent consumers like you in this battle. Call or email us today so that we can conduct a free review of your policy and provide you with advice you need to make the appropriate decision for your business during this tumultuous time.
The 2017 hurricane season was the most expensive in U.S. history, causing over $200 billion in damages. This was especially true of Harvey in Texas.
As a business owner in the Rio Grande Valley, your business is much more susceptible to flooding, hurricane damages, and other weather-related damages. While commercial property insurance will help to cover physical damages to your business, Business Interruption Insurance (also known as Business Income Insurance) helps to cover expenses and lost income that come as a result of the disaster.
With the 2018 hurricane season underway, now is the time to consider purchasing Business Interruption Insurance. If you are unfamiliar with how it can protect your business after a major catastrophe, your bad faith insurance claim lawyers at Millin & Millin would like to inform you about how it can be the protection you need to save your business.
Please consider the following information.
Business interruption insurance is an additional rider that you can purchase from your commercial property insurance provider or other specialized agency. There are various types of this insurance which cover a variety of different situations and damages including:
Extended and contingent coverages can be purchased as additional riders of regular business interruption insurance.
What your policy covers is dependent on the business assets that you want to protect. Every policy will be unique to a business owner’s specific needs. As always, it is important that you read through the policy and have a solid understanding of the coverage.
Generally, business interruption insurance can cover and protect:
Coverage is triggered when an incident - as specified by the contract - causes damage to your business and extends for however long as determined by the policy. Please be aware that business interruption insurance is limited and any losses that exceed those limits are the responsibility of the business owner(s).
There are a number of factors that play into the amount of coverage your business needs. Consider the following when determining what level of coverage you may need:
In an area like the Rio Grande Valley, which can experience a major disaster like a hurricane, it is important to have coverage that will protect your business for more than a few days.
However, even with the right commercial property insurances in place, your insurer may attempt to underpay or outright deny a valid claim. When this happens, don’t allow bad faith insurance tactics to derail you or your business. Depend on the responsiveness of the bad faith insurance legal team of Millin & Millin to get you the justice you deserve when seeking your rightful compensation after a natural disaster like a hurricane.
Contact us today at (956) 631-5600 to get the legal representation you need. Millin & Millin serves the greater McAllen metro area and the whole Rio Grande Valley.
