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Insurance Coverage


California | Colorado Attorneys

1. Do you know what insurance coverage you bought? Is your insurance policy’s coverage different from the coverage you were told you would have?

When selling insurance policies, salespersons describe their carrier’s policies in many ways. Insurance companies use advertisements, “summaries,” lists, brochures, and others writings they directly, or through their agents, provide you to describe the claims they will pay or coverage their policies provide.

Sometimes the advertisements, summaries, lists or brochures describe things that they will pay for, when in fact the policy you are mailed, usually months after your buy it, does not cover or pay for things described in the summaries, lists and advertisements.

Given that insurance is almost never sold by giving you the policy, before you buy it, with an agent or salesperson explanation of what you actually bought, insurance policies often have unpleasant surprises based on coverage that is different from what you were promised or told you were buying.

2. Does your policy contain illegal provisions?

In addition to giving consumers policies that are different from what they were told they were buying, insurance companies sometimes write their insurance policies in violation of state laws. States prohibit certain exclusions and policy restrictions; yet, when an insurance company sells policies in several states there have been situations where their multi-state policy violates the laws of some of the states, in which it is sold.

3. Has your health insurer incorrectly categorized your treatment and thereby eliminated your coverage?

When it comes to health insurance, a policy generally describes what medical care or treatments are covered, but it does not usually describe all possible treatments, illnesses or conditions. The medical industry uses a coding system to describe patient treatment. The codes are linked to whether or not, how much and for how long a health insurer will pay for treatment. Through erroneous or questionable coding of your condition, illness or treatment, you can lose your coverage or have it limited.

4. Property Insurance: If there are covered and non-covered reasons to remove or replace part of your home or building, which did your insurer pick?

The need to remove drywall, tile, natural stones, or to test heating or air conditioning equipment could be because of a non-covered cause or because of covered cause. Has your carrier overlooked the covered cause and just flat-out denied your claim? You may need experienced coverage attorneys to review your policy to sort out the morass of coverages, exclusions and definitions that have to be pieced together to truthfully determine whether your loss is covered.

5. Were you made aware when signing up for insurance that you would receive a “short rate” refund (in truth a penalty) if you cancelled the policy before the end of the policy term?; were made aware of your insurance company’s “short rate” refund policy when you purchased your policy?; were you made aware of your insurance company’s “short rate” refund policy when you called to cancel your policy?

A “short rate” is the insurance premium rate an insurance company charges you when you cancel your policy before it expires. While most insurance companies return to their insured the pro-rated unused portion of the premium, a small group of insurers charge their policy holders a penalty for terminating their policy before its expiration. Those companys refund only the short rate unused portion of the insured’s premium. Farmers’ did not notify the insured that contacted Eppsteiner & Fiorica at the time it sold the policy, when it sent renewal notices, when the insured cancelled his policy, nor even then they sent him his policy refund, that they were only paying him a “short rate” refund. Isn’t this conduct deceptive, misleading and based on withholding material information? Eppsteiner & Fiorica is currently investigating the practices of Farmers Insurance, who has been brought to our attention by a consumer who claims they were not told they would be paid only a “short rate” refund when he cancelled his policy. Please continue for more information regarding this investigation.

At Eppsteiner & Fiorica, our experience is that insurers often do not interpret policies fairly or to favor you. Sometimes you can work out disagreements with your insurer. However, too often you will need a lawyer with expertise and experience in insurance coverage matters who can sort out the tangle of provisions, exclusions and definitions, and put together the pieces needed to perfect your insurance coverage and get your claim paid. When you cannot get a good coverage solution worked out on your own and need legal advice and an attorney:

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