Ind. Adjuster 4 insurer has lied, misinformed and delayed investigation for my homeowners claim In Ca. What are my options?

Adjusters' erroneous statements: -He scheduled 2nd investigation for Sept 4 or 5 then never confirmed; When I called a week later he said 1st Expert had heart attack and he would email me next day with new date. He sent email 2 days later. -He agreed to provide me the contract agreement between HOA and roof co. 1 Month later I reminded him and he retracted saying I need to obtain from HOA. -Said he Had to be present for 2nd "expert" investigation then didn't show -Said we can start repairs after expert completed on site investigation. Retracted and denied making statement. Said I can NOT include unpaid work hours in claim Told me that HOA should protect building from further damages, not roofing co. My DAD was present at adj. meeting. initial claim with HOA ins. was filed Aug 1st.

Hermosa Beach, CA -

Attorney Answers (1)

Neil Pedersen

Neil Pedersen

Insurance Law Lawyer - Irvine, CA
Answered

An insurer has responsibilities to an insured which are carried out by its employees like its claims adjuster. If the insurer fails to provide the policy benefits promised in the insurance policy, or as incorporated into the policy by law, the insurer breaches its contract.

If you can prove damages caused by that breach, and those damages were reasonable foreseeable to the parties at the time the policy was issued, then you would be able to recover for those damages.

If it can be proved that the insurer is unreasonably withholding the policy benefit, then you can sue for breach of the implied covenant of good faith and fair dealing, and if you can prove such damages, you can get damages for consequential damages arising out of not getting the policy benefit, and you have the right to seek attorney fees for the expenses to procure the policy benefit. You can also try to seek punitive damages.

The facts you recite suggest frustrating events. Those facts alone probably do not approach a breach of the insurance contract. The Insurance Code requires certain diligent conduct by an insurer to prevent undue delay, and your facts suggest that may be happening. However, before you should consider a lawsuit, far more should really be present to demonstrate more than calendar mix ups and miscommunications.

Keep a log of every action by the insurer that you believe constitutes undue delay of refusals to do what you believe it should do under the policy. If you are really upset with the progress, you have the right to complain to the Department of Insurance. However, I might suggest first trying to elevate your concerns to your adjuster's supervisor.

Communicate your concerns in writing. Don't be rash and unreasonable. Communicate in a manner and style that you would like a jury to later see as you doing your best to get your insurance benefits. Threats and angry statements are unnecessary. The far more scary letter to an insurance company is a polite yet desperate attempt to understand why the insurer is taking so long to resolve the problem in your life.

If you start to incur significant damages, it would be best to visit an insurance coverage attorney. While insurers are inundated with attorney letters and therefore do not see them as a significant event, an attorney can guide you through the final part of the process and commence litigation if that is the right approach for you.

I wish you the best of luck.

This answer should not be construed to create any attorney-client relationship. Such a relationship can be formed... more

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