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California Insurance Coverage Attorneys


California Insurance Coverage

  1. Are you certain about your insurance coverage? Does your coverage differ from what you were told about before purchasing?

Insurance sales people explain their company’s policies in numerous ways to potential customers. They use advertising, lists, leaflets and “summaries.” These describe the types of situations the insurance applies to and what it will cover.

Many times customers purchase insurance protection based on these insurance company marketing tools, instead of the policy they are purchasing. After agreeing on a level of coverage from the list or leaflet, they invest in the policy. They are then are mailed a policy, and many times this policy will actually provide less coverage than the one described by the sales person and in the marketing materials.

Because they are not slick looking or easy to understand, the actual insurance policy you are agreeing to is rarely used during the sales and marketing of insurance coverage. For this reason, and to avoid paying for a policy that does not meet your needs, it is important to ask the insurance company representative to explain the policy you have selected in detail to you, and ask questions until you are satisfied that you will receive the coverage you need. In addition, review the policy once it arrives in the mail to make sure it matches what you were promised.

  1. Are all the provisions in your policy legal?

Occasionally, especially in the case of companies that offer coverage in multiple states, insurance companies will include provisions in their policies that violate state laws. Each state has its own insurance exclusions and limitations, and what is legal in California may be against industry regulations in Utah. Ask your insurance company representative about any state laws that may affect your coverage.

  1. Has your health treatment been categorized correctly, or have you lost coverage due to an insurance company error?

Health insurance coverage can be tricky for policyholders to understand, because much of the determination to pay is left up to employees of the insurance company even after the policy is issued. Each health insurance policy outlines the types of medical care that are covered, but does not address specific diseases or treatments. This means that in some cases an insurance company employee must still approve the treatment of a disease before you can receive treatment.

In other cases, a worker in the health care system may have put the wrong code on your file for an approved treatment before it was sent to the insurance company for payment, and your insurance protection is limited because of this.

  1. If your California property insurance claim includes both covered and non-covered causes, did your insurance provider deny the claim entirely?

For example, if both flooding and wind damaged your California home during a recent storm, the wind damage to the roof should be covered by your policy while the flood damage would not be covered unless you had a separate flood policy. In many similar cases, the insurance company will deny both parts of the claim forcing the homeowners to enlist the help of lawyers to gain the insurance protection they paid for.

  1. A short rate refund is a penalty imposed if you elect to drop your coverage before the plan term has expired. Legally, insurance companies must outline this concept clearly to customers. Many companies will simply issue a refund to the customer for months when the coverage was not in effect if the premium was paid in advance. Others, though, charge a cancellation fee to the customer, and refund only a “short rate” instead of the full premium for the cancelled months.

California Protection against Short Rate Premium Fees

Though this practice is legal, the customer must be informed about it. In one example, Farmers’ Insurance gave their clients a short rate refund despite not informing them this would happen at the time the policy was sold, during renewals, or even with the reimbursement check. To many, this seems like fraudulent conduct. The case is still being investigated by Eppsteiner Law, APC, who are representing the policyholder.

At Eppsteiner Law, APC, we specialize in insurance protection law. Our experiences have led us to believe that many insurance companies do not work for the benefit of their policyholders, and are not always forthright about their coverage and their policies. Unfortunately, too frequently attorneys are needed to step in and represent the best interests of policyholders in these cases. If you find that you need the advice of a lawyer experienced in insurance coverage cases, or if you need assistance sorting out the provisions and exclusions of your policy, contact us today:

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