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Is the deck stacked against you in your insurance dispute?

Why you need an attorney when pursuing a contested insurance claim

It is safe to say that everyone is better off never having to file an insurance claim. An insurance claim means that significant injury or damage to your property has occurred. It is our sincere hope you never need to file a claim.

But when an accident occurs, you need insurance benefits: it is what you paid for, after all. Too often, unfortunately, insurers refuse to pay out claims in good faith.

Under the law, refusing to pay legitimate claims, delaying payment unnecessarily or requiring an unreasonable amount of documentation is acting in bad faith, for which the policyholder can recover damages in a lawsuit.

But whether you need to appeal a denied claim, file a bad faith lawsuit against your insurer, or just protect yourself against filing a claim incorrectly or missing deadlines, you need the help of an experienced attorney to guide you through the process.

Unique Travis County arrangement involving insurer draws scrutiny

A recent case out of Travis County, Texas provides a good example of when a sincere effort to recover on an insurance claim resulted in a legal battle. In 2013, an injured worker filed a workers' comp claim for an injury suffered on the job. Travis County prosecutors subsequently charged the man with fraud.

The worker's comp insurer, Texas Mutual Insurance, has an exclusive deal with county prosecutors to cover the costs of pursuing fraud charges. While legal, the arrangement has drawn nationwide scrutiny, with many calling the arrangement a classic conflict of interest for prosecutors.

Ultimately, the case was resolved in the worker's favor. In addition, the insurer had to pay a five-figure settlement to the worker for malicious prosecution. This happened years after the original claim, however, and the worker was required to spend the night in jail and was originally charged with a felony. While the case was dismissed, the stress of the legal battle was significant.

Because Texas Mutual is based in Austin, Travis County prosecutors can pursue claims of insurance fraud involving the insurer statewide.

You need someone who knows the system

While this case involved workers' compensation, allegations of fraud regarding any type of insurance claim are serious. Insurance companies are for-profit entities that will always act with their own financial interests in mind. This includes battling perceived fraud whenever possible, offering low settlements and reading vague contract terms in their own favor.

In addition to its primary purpose of making money, insurance companies are large bureaucracies. In order to get what you deserve, you not only have to prove your claim, but also know how to deal with insurance companies.

This is difficult to do without prior experience handling insurance claims.

At Kustoff & Phipps, LLP, our attorneys are experienced litigators who represent claimants in insurance disputes. Whether your claim involves property damage, an auto accident, or commercial insurance claims, we have the knowledge to help you protect your legal rights. If necessary, we can also help you file a bad faith claim to hold insurance companies accountable and ensure your rights under the law are protected.


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