Frequently Asked Questions

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  • Has Your Claim for Disability Insurance Benefits Been Denied Based on a Preexisting Condition?

    Many disability insurance policies have a "pre-existing condition" limitation that either bars payment of any benefits or limits payment of them to some specific time period, most often 12 months. This bar or limit applies, for instance, where the claimant's disability is "caused by," "contributed to by," or "resulting from" a pre-existing condition. 

    It is not at all unusual for a claimant to find themself disabled due to a number of illnesses and conditions, at least one of which may be a pre-existing condition.  Does this mean that the claim will be barred or payment of benefits be limited on account of the pre-existing condition? Maybe but not necessarily.  

    If the claimant's disability is due to a number of factors including a pre-existing condition the key question will be whether the claimant would still be disabled even if the pre-existing condition did not exist.  Courts call this a "but for"test, as in but for the pre-existing condition the claimant would not be disabled under the terms of the policy.  We have a good discussion of this type of "but for" analysis regarding a case involving a disability insurance policy issued by Reliance Standard, Has Reliance Standard Denied Your Disability Insurance Benefits Claim Based on a Mental Disorder or Condition?

     

  • What Is an Examination under Oath?

    An examination under oath is a device or procedure used by insurance companies that are investigating whether or not to pay a claim. An examination under oath requires a claimant to submit to questioning usually by a lawyer hired by the insurance company and answer the questions under oath. Many insurance policies have provisions in them that require an insured to submit to an examination under oath if the insurance company requests it. If the insurance company makes such a request and the claimant refuses to submit to the examination under oath, the claimant may very well breach the insurance policy and provide the insurance company with grounds for refusing to pay the claim.

    An examination under oath can have a legitimate purpose. Just because one is requested does not mean that the insurance company is being unfair or is trying to get out of paying a claim. If you do not understand how the insurance company is handling your claim, get in contact with an experienced insurance lawyer. You can reach Lexington, Kentucky insurance lawyer Robert Abell at 859-254-7076.

     

  • Can My Insurance Company Require Me to Take an Examination under Oath before It Pays My Claim?

    Probably if not almost surely your insurance policy has a clause or provision in it that says you must submit to an examination under oath if your insurance company requests one while it is considering whether or not to pay your claim. If the insurance company request that you take an examination under oath and you refuse to do so, the insurance company can probably claim that you have breached your responsibilities and obligations under the policy and, on those grounds, refuse to pay your claim.

    If you do not understand your insurance policy, or how your insurance company is handling your claim, contact an experienced insurance lawyer to get some good advice. You can reach Lexington, Kentucky insurance lawyer Robert Abell at 859-254-7076.

     

  • Did Your Disability Insurance Company Turn Down Your Claim Based On A File Review?

    Disability insurance companies sometimes tell a claimant that their claim for disability insurance benefits is being turned down based on a file review by some doctor or other medical professional that the insurance company hired to do the review.  Aside from the fact that this type of ongoing business relationship can, shall we say, compromise the integrity of the reviewing medical professional.  But do the courts recognize the problems and weaknesses of a file review?

    Courts have recognized file reviews raise major issues in a number of situations, two in particular: (1) where the basis for the disability insurance benefits claim is a mental illness or claim; and, (2) where the insurance company disputes the claimant's credibility. Smith v. Bayer Corp. Long Term Disability Plan, 275 F. App’x 495 (6th Cir. 2008) and Evans v. UnumProvident Corp., 434 F.3d 866 (6th Cir. 2006) are court decisions recognizing the problems with file reviews. 

    Don't just allow the disability insurance benefits company tell you that they had your file reviewed and your claim is denied, especially if you have a valid claim.  Insurance companies expect that a certain number of claimants will just go away and forget about their claim. Contact Lexington, Kentucky disability insurance benefits lawyer Robert Abell at 859-254-7076. 

     

  • Who Is An Ambiguous Insuance Policy Read In Favor Of?

    Kentucky law is clear that ambigous terms in an insurance policy must be read in a way that favors the insured not the insurance company.  Here's a couple of key points from Kentucky courts:

    • Kentucky law requires that an ambiguous term in an insurance policy "be liberally construed so as to resolve all doubts in favor of the insured."  Bituminous Casualty Corp. v. Kenway Contracting, Inc., 240 SW 3d 633, 638 (Ky 2008)
       
    • "A contract is ambiguous if a reasonable person would find it susceptible to different or inconsistent interpretations."  Cantrell Supply, Inc. v. Liberty Mutual Insurance Company, 94 S.W.3d 381, 385 (Ky. App. 2002).

  • Can you sue an insurance company for deceptive practices?

    Yes.  The Kentucky Consumer Protection Act allows an insurance company to be sued for deceptive or unfair practices that harm a consumer and/or his or her family. 

  • Is it illegal for an insurance company to delay paying a claim?

    While there is no strict time limit because claims and cases can vary, an insurance company is required by Kentucky insurance law to investigate a claim with reasonable promptness and diligence and to settle pay the claim when liability or coverage is reasonably clear.

    A failure to do either can constitute a bad faith insurance practice and a violation of the Kentucky Unfair Claims Settlement Practices Act.

  • How long can an insurance company take to settle a claim in Kentucky?

    There is no strict time limit on how long an insurance company can take to settle a claim in Kentucky. 

    Kentucky law requires an insurance company to investigate a claim with reasonable promptness and diligence and to pay the claim when liability or coverage is reasonably clear. Obviously what is reasonable in this context can depend on the nature of the claim and the circumstances giving rise to it.  

    On the other hand, a failure to do either can constitute a bad faith insurance practice and a violation of the Kentucky Unfair Claims Settlement Practices Act.

  • Can a car insurance company hold up a settlement offer?

    While there is no strict time limit because claims and cases can vary, an insurance company is required by Kentucky insurance law to investigate a claim with reasonable promptness and diligence and to pay the claim when liability or coverage is reasonably clear.  A failure to do either can constitute a bad faith insurance practice and a violation of the Kentucky Unfair Claims Settlement Practices Act. 

  • Can an insurance company hold up a settlement on one claim to try and force a lower settlement on another claim?

    No. An insurance company can violate the Kentucky Unfair Claims Settlement Practices Act by failing to promptly settle claims where liability has become reasonably clear under one part of the insurance policy in order to influence settlements under other parts of the insurance policy.

    Robert L. Abell, an insurance claims lawyer in Lexington, Kentucky, is an experienced insurance bad faith attorney, who can help you get your insurance claim paid or recover damages caused by an insurance company's bad faith practices.  
     

  • Is an insurance company required to explain why it is denying a claim?

    Yes. An insurance company can violate the Kentucky Unfair Claims Settlement Practice Act if it fails to promptly provide a reasonable explanation of the basis of the insurance policy in relation to the facts or applicable law for denial of the claim.

    Robert L. Abell, an insurance claims lawyer in Lexington, Kentucky, is an experienced insurance bad faith attorney, who can help you get your insurance claim paid or recover damages caused by an insurance company's bad faith practices.  Call Robert Abell Law toll free at 866-578-5302 for a free consultation.
     

  • Is an insurance company required to explain why it will not offer a reasonable settlement for a claim?

    Yes. An insurance company can violate the Kentucky Unfair Claims Settlement Practices Act if it fails to promptly provide a reasonable explanation of the basis of the insurance policy in relation to the facts or applicable law for the offer of a reasonable settlement.

    Robert L. Abell, an insurance claims lawyer in Lexington, Kentucky, is an experienced insurance bad faith attorney, who can help you get your insurance claim paid or recover damages caused by an insurance company's bad faith practices.  Call Robert Abell Law toll free at 866-578-5302 for a free consultation.
     

  • Can an insurance company delay paying a claim and keep making a claimant provide proof of their loss over and over?

    No. An insurance company can violate the Kentucky Unfair Claims Settlement Practices Act if it delays the investigation or payment of a claim by requiring an insured, claimant, or their physician to submit a preliminary claim report and then requiring them later to submit formal proof of loss forms where both submissions contain substantially the same information.

    Robert L. Abell, an insurance claims lawyer in Lexington, Kentucky, is an experienced insurance bad faith attorney, who can help you get your insurance claim paid or recover damages caused by an insurance company's bad faith practices.  Call Robert Abell Law toll free at 866-578-5302 for a free consultation.
     

  • Is an insurance company required to explain the basis or reason for its payment of a claim?

    Yes. An insurance company can violate the Kentucky Unfair Claims Settlement Practices Act if it pays a claim to an insured or the beneficiaries that is not accompanied by a statement explaining the coverage under which the payment is being made.

    Robert L. Abell, an insurance claims lawyer in Lexington, Kentucky, is an experienced insurance bad faith attorney, who can help you get your insurance claim paid or recover damages caused by an insurance company's bad faith practices.  Call Robert Abell Law toll free at 866-578-5302 for a free consultation.
     

  • Can an insurance company attempt to settle a claim based on an altered application when the insured did not know of the alteration?

    No. An insurance company can violate the Kentucky Unfair Claims Settlement Practices Act if it attempts to settle a claim on the basis of an application that was altered without the notice, knowledge, or the consent of the insured.

    Robert L. Abell, an insurance claims lawyer in Lexington, Kentucky, is an experienced insurance bad faith attorney, who can help you get your insurance claim paid or recover damages caused by an insurance company's bad faith practices.  Call Robert Abell Law toll free at 866-578-5302 for a free consultation.
     

  • When is an insurance company liable for a bad faith insurance practice?

    An insurance company can be liable for a bad faith insurance practice where three things are proved: 

    •  The insurance company is obligated to pay the claim under the terms of applicable insurance policy
    •   The insurance company lacks a reasonable basis in law or fact for refusing to pay or denying the claim, and
    •   The insurance company either knew there was no reasonable basis for refusing to pay or denying the claim or acted with reckless disregard for whether such a basis existed


    Robert L. Abell, an insurance claims lawyer in Lexington, Kentucky, is an experienced insurance bad faith attorney, who can help you get your insurance claim paid or recover damages caused by an insurance company's bad faith practices.  Call Robert Abell Law at 859-254-7076. 
     


     

  • Can an insurance company misrepresent insurance policy provisions applicable to a claim?

    No. The Kentucky Unfair Claims Settlement Practices Act makes it unlawful for an insurance company to misrepresent insurance policy provisions applicable to coverages at issue. 

    Robert L. Abell, an insurance claims lawyer in Lexington, Kentucky, is an experienced insurance bad faith attorney, who can help you get your insurance claim paid or recover damages caused by an insurance company's bad faith practices.  Call Robert Abell Law at 859-254-7076. 

  • Is an insurance company required to answer my questions and correspondence about an insurance claim?

    Yes. An insurance company can violate the Kentucky Unfair Claims Settlement Practices Act when it fails to acknowledge and act reasonably promptly upon communication with respect to claims arising under insurance policies. Basically, the insurance company is required to timely and reasonably communicate with an insured about a claim; a failure to do so can be a violation of the Unfair Claims Settlement Practices Act.
     

    Robert L. Abell, an insurance claims lawyer in Lexington, Kentucky, is an experienced insurance bad faith attorney, who can help you get your insurance claim paid or recover damages caused by an insurance company's bad faith practices.  Call Robert Abell Law toll free at 866-578-5302 for a free consultation.

  • Is an insurance company required to promptly investigate a claim?

    Yes. An insurance company can violate the Kentucky Unfair Claims Settlement Practices Act when or where it fails to adopt and implement reasonable standards for the prompt investigation of claims arising under insurance policies.

    Robert L. Abell, an insurance claims lawyer in Lexington, Kentucky, is an experienced insurance bad faith attorney, who can help you get your insurance claim paid or recover damages caused by an insurance company's bad faith practices.  Call Robert Abell Law toll free at 866-578-5302 for a free consultation.
     

     
     

  • Can an insurance company refuse to pay a claim without any investigation?

    No. An insurance company can violate the Kentucky Unfair Claims Settlement Practices Act where it refuses to refuses to pay claims without conducting a reasonable investigation based upon all available information.   

    Robert L. Abell, an insurance claims lawyer in Lexington, Kentucky, is an experienced insurance bad faith attorney, who can help you get your insurance claim paid or recover damages caused by an insurance company's bad faith practices.  Call Robert Abell Law toll free at 866-578-5302 for a free consultation.