Do I have a case?
The law strongly favors consumers in their relationship with their insurance company. Hence, if you feel you have been wronged, it usually warrants taking a look to see what, if anything, may be done.
The insurance policy is NOT the last word on coverage.
Keep in mind that insurance policies may contain language that has been superseded by state law or court interpretation of that law. So, do not assume there is no coverage simply because the policy seems to exclude your loss.
Don't take your agent's word for it.
Agents are not trained claims adjusters. Submit your claim regardless of your agents advise on coverage and let the insurance company decide whether they will cover you. (Some agents have a vested interest in seeing that your claim is not reported.)
There is no one test for determining if you have a case against your insurance company or if you should consult with an attorney in that regard. Nevertheless, the following questions may be of some help. When in doubt, it is best to consult with an experienced insurance attorney. (Most attorneys lack a sufficient background in insurance to give an accurate accessment.)
-Is there now or has there been a contractual relationship?
-Are the facts an offense to ones sense of honesty and fair play?
-Can the insured show damages of at least $5,000.00 which resulted directly from the misconduct of the carrier?
-Is the insured clearly free of unclean hands or bad faith on its part? (Has the insured has been fair and honest in all respects?)
-Were the rights of the insured knowingly disregarded by the carrier.
Secondary Questions: All of the preceding questions must generally be answered in the affirmative in order to proceed to these questions. An affirmative answer to any of the following may be a basis for insurance carrier liability?
-Was there an absence of investigation which may have resulted in coverage?
-Did the carrier misrepresent pertinent facts or insurance policy provisions?
-Did the carrier fail to acknowledge and act on communications reasonably promptly?
-Did the carrier fail to affirm or deny coverage within a reasonable time?
-Did the carrier fail to promptly and fairly settle a claim once liability became reasonably clear?
-Have insureds received in litigation substantially more than was offered by the carrier before litigation?
-Has the carrier attempted to settle for less than the amount a reasonable person would have believed he was entitled?
-Did the carrier alter an application or other document?
-Has the carrier made known a policy of appealing arbitration or suit for the purpose of compelling settlement?
-Has the carrier delayed the investigation or payment of claims by requiring the submition of multiple forms or reports containing substantially the same information?
-Has the carrier failed to pay promptly under one portion of the policy (e.g. property damage) in order to influence settlement under another portion of the policy (e.g., personal injury)?
-Has the carrier failed to promptly provide a reasonable explanation of the basis for its denial?
-Was there a course of conduct which was changed without notice or good cause other than to benefit the carrier?
-Was there abuse of a special relationship which the insurer had developed?
-Was there conduct by the carrier which is outrageous or malicious?