Unfortunately, it has been a record time for fires all over California.  We all worry about the safety of our families, followed by fear over safety of our homes and businesses. When we pay for insurance, we shouldn’t have to also worry about being paid for our losses…or do we?

We help people all over California. If you or your loved ones have been denied lawful payment for your loss by your insurance company, please call us. Insurance companies have a duty to us, their insured policyholders, to act in good faith when responding to claims for settlement to cover our fire losses.

What Do I Do if I Suffer a Fire Loss?

• IF YOUR LOSS IS FROM A FIRE IN AN AREA WHERE THE GOVERNMENT HAS CALLED A STATE OF EMERGENCY, you are entitled to an advance on living expenses for covered losses, to get you settled immediately after the loss– even before you submit receipts and document expenses.

 

• Ask your insurer for a list of what living expenses will be covered, and be sure to keep receipts for them.

 

• You will then be required to submit a claim and proof of loss, and coverage for additional living expenses shall be for a period of up to 24 months or up to your policy limits.[i]

 

• For any fire loss, call your insurance company as soon as you have a covered loss. Note the date, time of your call and with whom you spoke. Confirm all conversations in writing (an email or letter). Request:
  • A full copy of your insurance policy, including all riders, updates, exclusions and the declarations page.
  • Any information they will require you to file to submit a claim.

 

• Take pictures of all of your losses and keep proof of costs and replacement costs and all out of pocket expenses, including receipts, estimates for repair or replacement. Note: Your insurance company cannot make unreasonable demands on you for proof of your loss.  [ii]

 

• Send your insurance company a written claim with proof of losses as soon as possible (and keep a copy of it all!) Important: Your insurer must tell you all deadlines that apply to your claim. [iii] If you miss the deadlines, you may lose all rights against the insurance company to be paid.

 

• Keep a log of all communications with the insurance company (including the date and time of the communication, whom you spoke to and what was said). Confirm it in an email.

 

• If you are unsatisfied with the handling of your claim, the amount offered for your losses by the insurer, or if the claim is denied, speak with an experienced attorney immediately. If you do not file suit within one year, you may lose all rights for compensation.

What Does the Law Require of My Insurance Company Once I File a Claim?

 

• When investigating the claim, your insurer has a duty to diligently search for and consider all evidence that supports coverage of your loss. If your insurance company does not do this, call an experienced California lawyer immediately because you may have a claim for the implied covenant of good faith and fair dealing based on the insurer’s failure or refusal to conduct a proper investigation of your claim.

 

• California courts have held that to fulfill its obligation to you, the insurance company must give at least as much consideration to your interests as it gives to its own interests. If the insurer seeks to discover only the evidence that defeats your claim, then it is holding its own interest above that of you, its insured, and it will be liable to you for your losses. [iv]

How Much Do I Need to Cooperate With My Insurance Company’s Investigation?

• You must cooperate with the insurer’s investigation of your claim, but you do not have any duty to cooperate with harassing adjusters or unreasonable requests. If you feel wrongfully pressured, request the adjuster to communicate in writing with all questions they have for you and then promptly respond in writing, or seek an attorney’s advice.

 

How Much Time Does My Insurance Company Have to Investigate My Claim?

• Your rights are initially protected only once you file a written claim with your insurance company, and then only until they either agree to pay or they deny your claim. Do not wait- file the claim as soon as possible, and if you do not file it within the time allotted, you may lose all rights to be paid for your losses, no matter how bad your losses or how unreasonable the insurer may be in responding to you.[v]

 

• Once you file a written claim under California law, you are entitled to prompt and timely responses from your insurer.  The company must respond to your communications within 15 calendar days and give you a complete response based on known information. This includes answers to your questions.[vi]

 

• In California, insurance companies are required to accept or deny your claim within 40 calendar days after receiving proof of your claim.

 

• If an insurer denies or rejects your claim for fire loss, it must do so in writing and shall provide you a statement listing all of the reasons for such rejection which is then within the insurer’s knowledge.

 

• If your insurer needs more time to consider your claim, it must give you written notice of the need for additional time, including any additional information the insurer requires in order to make a decision and any reasons for the insurer’s inability to make a determination and provide you with an estimate as to when the determination can be made.

 

• If your claim is accepted, payment must be made within 30 days from the date settlement was reached.

 

• In California, insurance companies have a duty to properly investigate your claim for compensation for loss due to fire. If your insurance company acts unreasonably in the investigation of your claim, you may be able to recover money for losses caused by the delay in paying you fully for your losses.

 

• If your claim is denied or insufficient payment is offered, do not delay in hiring an experienced California lawyer. A lawsuit must be filed within one year of the denial of the payment or you will lose all rights to payment from the insurer.

What Does it Take to Win a Lawsuit Against My Insurance Company?

 

To win your case, a lawyer will have to establish that the insurer acted unreasonably (without a good reason) by failing to properly investigate your claim. What does this mean? To establish this claim against your insurance company, a lawyer will need to prove all of the following:

 

• You suffered a loss covered under an insurance policy;

 

• You properly presented a timely claim to your insurance company;

 

• Your insurance company failed to conduct a full, fair, prompt, and thorough investigation of your claim;

 

• You were harmed by this denial or delay in paying you fully for your claim; and,

 

• Your insurer’s failure to properly investigate your claim was a substantial factor in causing you harm.[vii]

If I Hire a Lawyer, What Can I Hope to Recover in My Claim Against the Insurer for Bad Faith Denial of My Claim?

Depending on the facts of your claim, you may be entitled to recover:

• Full value of your covered losses.
• Out of pocket expenses reasonably incurred because of the insurer’s unreasonable delay/denial of benefits.
• Costs of your lawsuit, including attorney’s fees and court costs
• Damages for anxiety and emotional distress caused by your insurer’s unreasonable delay or denial of benefits.

If you have been denied coverage for your fire loss by your insurer, call an attorney immediately.

MULLIGAN, BANHAM & FINDLEY have successfully battled large corporations and insurance companies seeking to deny just compensation for losses.  Call us or use the contact form on this page today.

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[i]  Cal. Ins. Code Section 2051.5

[ii] Cal. Ins. Code Section 790.03

[iii] Cal. Ins. Code Section 2071 and Cal Code of Regs Section 2695.7

[iv] Mariscal v. Old Republic Life Ins. Co. (1996) 42 Cal.App.4^th 1617, 1620, Jordan v. Allstate Ins. Co. (2007) 148

Cal.App.4th 1062, 1066

[v] Cal. Ins. Code Section Section 790.03

[vi] Cal. Code of Regs Section 2695

[vii] CACI No. 2332. Bad Faith (First Party)—Failure to Properly Investigate Claim Judicial Council of California Civil Jury Instructions (2017 edition)