How Insurance Companies Find Loopholes to Avoid Paying Claims When you pay for an insurance policy, you expect that your insurer will honor and fulfill the terms of said policy when you need it. Unfortunately, that is not always the case. A large number of policyholders find themselves baffled by claim denials or delays, as insurance companies take advantage of technicalities to avoid honoring policies. With how insurance companies find loopholes to avoid paying claims, it is important to know that a denial or delay is not the end. An attorney at Bordas & Bordas may be able to help you. Common Ways Insurers Deny Claims Through many policy loopholes, technicalities, and more, insurance companies try to avoid paying claims in full. There are some common methods insurance companies employ to do this. Vaguely Written Policies Long, drawn-out clauses in policies may be intentionally confusing for policyholders to dissect. If part of a policy seems vague or open-ended, the insurer may have left an opportunity for themselves to make a decision that benefits them over you. This may result in a denial or delay based on the wording. Policy Exclusions Many insurance companies have a list of policy exclusions readily available that policyholders may not be aware of. Should the policyholder file a claim, insurers will often rely on an exclusion as a means to reduce or deny the claim, even if it seems outlandish. Deadlines and Errors Often, with claims, insurance companies set strict deadlines. Policyholders must provide documentation and follow specific procedures while still meeting these deadlines. The intricacy of the process may allow insurers to take advantage of any small issues that occur, giving the insurer an opportunity to deny your claim. Pre-Existing Damages Insurance companies may also argue that certain damages or injuries were not a part of the reported incident. They may allege that the damage existed before the incident, allowing insurers to try and place the responsibility on the policyholder. Intentional Process Delays Some insurance companies intentionally try to make the claims process as long as possible to deter policyholders from pursuing full claims or settlements. Signs of intentional delay may include consistent requests for the same information, going through multiple inspections, as well as purposefully taking long pauses between communications. The Importance of Legal Advice Navigating the insurance claim process in the aftermath of an accident that may have caused injuries or the loss of a loved one can be difficult. Many insurance companies rely on the average policyholder not knowing enough about the loopholes insurance companies use and being unable to fight for the full benefits of their policies. Having an advocate with experience in challenging insurance companies in court may significantly impact how an insurance company responds to your claim. A legal representative may help you learn about the full breadth of your claim, talk you through denials, and help protect you from underhanded tactics. Contact an Experienced Attorney Who Understands the Tricks Used by Insurance Companies To Avoid Paying Facing insurance companies after a denied claim is not a task that you need to handle alone. Considering how insurance companies find loopholes to avoid paying claims, working with experienced legal professionals is essential. Our bad faith insurance attorneys at Bordas & Bordas are dedicated to standing up for you against insurance companies. Schedule a consultation with our team today to learn how we can help you hold insurance companies accountable.
What Is a Dispositive Motion?
The legal process is filled with plenty of terms that lawyers, paralegals, and judges recognize instantly but are unknown to plaintiffs and defendants. Many of these terms are important for you to understand but really aren’t so mysterious—including the concept of a dispositive motion. Dispositive Motions, Explained At first glance, you may think the “dispositive” of dispositive motion relates to a positive or negative request or outcome. That’s not quite correct: The “dispositive” comes from dispose, which makes understanding this term much easier. A dispositive motion is meant to dispose of the case. It asks the court for a ruling that addresses the legal issues of the case and terminates it in advance of the trial. Generally speaking, there are two kinds of dispositive motions, both of which you may already be familiar with: 1. Motion to Dismiss Motions to dismiss are usually made early in the case and provide a way to test the sufficiency of the pleadings. This isn’t a look at the facts of the case—just the allegations to determine if the case should or shouldn’t continue. Basically, a motion to dismiss asks: If you accept as true everything the other party says, have they alleged enough to state a claim under state or federal law? If the answer is yes, the judge will deny the motion, and the case will proceed. If the answer is no, the judge will enter a motion explaining their reasoning and dismiss the case. 2. Summary Judgment Unlike a motion to dismiss, a summary judgment motion specifically looks into the facts of the case. However—and this is important to understand—the summary judgment process isn’t a substitute for jury trials, which remain a vital part of the legal system and are constitutionally protected by the Seventh Amendment. Basically, a summary judgment motion determines if there are issues of fact that require a jury in the first place. For example, if Party A says the traffic light was green and Party B says it was red, the judge will deny the summary judgment and let the jury decide. Even if Party A has given contradictory statements, is a friend with another of the parties to the case, or has a prior conviction for false swearing (i.e., lying under oath), these are issues of credibility that a judge can’t decide. The case will proceed to trial, where the jury will be presented with and weigh the evidence—and reach its own verdict. However, if Party A and Party B both state the light was green and there is no other evidence to dispute that fact (and it’s the only material fact of the case), a summary judgment could be issued. Every case is unique, of course, but the general idea of a summary judgment is to determine whether there is enough evidence to proceed to a trial phase. Qualified attorneys can guide you through dispositive motions to help you understand the process and next steps. If you live in the Ohio Valley or greater Pittsburgh and need help with a personal injury case, reach out to Bordas & Bordas to learn more about your options.
