There are few things that make me want to pull my hair out more than attempting to file a claim through my insurance company. You are “in good hands” right up to the point an accident occurs, and at that point, it is amazing just how many areas of your house, car, etc. are not covered under your policy.
Many people accept the denials for coverage and are forced to pay out of pocket, believing that an insurance adjuster is obligated to process their claim and not try to find a loophole to deny coverage. Often though, this is not the case, and it is helpful to involve an attorney to attempt to submit a claim successfully. If coverage is denied, do not give up! Look at the list below to help navigate through the claims process.
- Submit a letter in writing to the adjuster asking why your claim was denied
- Ask to be provided with your entire policy and declarations page
- If there was an inspection of the subject property done, ask to be provided an inspection report, including the name of the inspector and what their credentials are
- Ask the adjuster to provide the specific area coverage was denied under.
Under Montana law, policy exclusions must be clearly outlined. If a policy is an all-risks policy, which purports to cover all risks of loss not expressly excluded, it is critical that the policy express its exclusions with clarity that leave no doubt in the insured’s mind as to the types of occurrences that are not afforded coverage. See Meridian Leasing v. Assoc. Aviation Underwriters, 409 F.3d 342 (Fed. 6th Cir., 2005).
Insurance contracts are subject to several rules of construction, one being that ambiguities in a contract are construed against the drafter. Ophus v. Fritz, 2000 MT 251, ¶ 31, 301 Mont. 447, 11 P.3d 1192 (citing cases). Moreover, exclusions of coverage in insurance contracts must be interpreted narrowly. Meridian Leasing, 409 F.3d at 353.
What exactly does this mean for you? If your policy is vague, if there is an item not clearly excluded under the policy, you may have an argument that coverage should be granted. Hold your insurance company to its word. If the claims adjuster is not compliant, you do have remedies, one of which is filing a declaratory judgment action or bad faith action in district court. You do not have to go this process alone. The attorneys at diStefano & Mattingley PLLP deal with situations just like this on a daily basis. Contact our office to set up a consultation today.