Tag: Bad Faith Insurance

Aetna

Insurance Giant Aetna Slammed With $25.5 Million Bad Faith Jury Verdict

Insurance is a critically important financial safety net for most Americans. People pay into a system that will protect them financially in the event of a disaster or catastrophic medical treatment. However, this system only works if insurance companies honor their agreements. When insurers face large claim payouts, they sometimes resort to inappropriate tactics to minimize claims and wrongfully deny payouts. But policyholders were handed a powerful win recently when insurance giant Aetna was slammed with a $25.5 million jury verdict for wrongfully denying coverage for cancer treatment.

In 2014, Orrana Cunningham was denied coverage for treatment of her Stage 4 nasopharyngeal cancer located near her brainstem. Because of the cancer’s location, ordinary radiation therapy would cause blindness, memory loss, and other debilitating side effects. Her doctors instead recommended a targeted form of radiation called proton beam therapy.

Mrs. Cunningham was denied coverage for proton beam therapy because Aetna deemed the treatment “experimental” and therefore not covered under her policy. However, as expert witnesses explained during the recent jury trial, proton beam therapy has been used successfully for decades, hardly making the treatment experimental.

Radiation oncologist Dr. Andrew L. Chang explained it best when he told the jury, “Proton therapy is a well-established treatment for cancer and has been for decades. … Nobody in the oncology community considers proton therapy experimental for the treatment of cancer.” Dr. Chang also pointed out that Medicare covers proton beam therapy, as do most pediatric plans for patients up to 21 years old. If insurance companies covered the cost of this treatment for patients under 21 and over 65, what exactly makes it experimental for those between the ages of 22 and 64?

Nothing does, according to an Oklahoma jury. Mrs. Cunningham died in 2015, and an Oklahoma jury believed it was important to send Aetna a message, awarding $25.5 million in damages to Mrs. Cunningham’s spouse. One might think the verdict would give Aetna a sense of responsibility or remorse. But unfortunately, lesson about bad faith insurance denials, but this is unlikely. Mr. Cunningham reported that after the verdict was read aloud in the courtroom, Aetna’s lead congratulated him on the verdict before telling him he would lose on appeal.

Insurance Companies Prey On Policyholders

Insurance companies rely on uninformed policyholders. Most policyholders are completely unaware of their rights and the actions they can take against insurance companies operating in bad faith. Insurance companies are aware of this, so they often utilize bad faith tactics hoping they don’t get caught – because most of the time they don’t. This is wrong, and every policyholder has a right to stand up to insurance companies that wrongfully deny claims. Whether you own a commercial property insurance policy or health insurance policy, you deserve full coverage.

Fight Back With Raizner Law

At Raizner Law, our experienced insurance lawyers pursue claims against insurance companies that deny cancer treatment. If your insurance company is delaying, undervaluing, or outright denying your claim for medically necessary cancer treatment, contact us today to see how we can help. All of our consultations are free and we work on a contingency fee basis, meaning there is no upfront cost for working with us, and you won’t owe us anything unless we help you recover compensation.

Puerto Rico’s Recovery

This Hurricane Season Could Cripple Puerto Rico’s Recovery

It’s been over a year since Hurricane Maria struck Puerto Rico and caused catastrophic damage. Although the island is rarely in the news these days, life has not returned to normal for many Puerto Ricans. The island is still struggling to rebuild its infrastructure and many are worried the island will not be able to withstand even a small storm.

Hurricane Recovery Is A Long Road

Hurricane season is now at its peak, and Hurricane Maria remains on the minds of many Puerto Ricans. The damage to the island’s infrastructure was catastrophic. The island’s power grid was destroyed and damage to roads and highways prevented FEMA workers and needed supplies from reaching the interior of the island. This has continued to cause problems for rebuilding, and some Puerto Ricans waited over nine months to have power restored. Even for those whose power was restored earlier, the power grid was and still is incredibly fragile. Power outages are a frequent occurrence.

Damaged roads and infrastructure aren’t the only obstacles Puerto Ricans are facing. Insurance companies have been slow to pay out on valid claims. Much of the Puerto Rican insurance market has been sold to foreign reinsurers. These reinsurers have been happy to collect premiums from policyholders, but now that it’s their turn to evaluate and pay out on claims they have gone silent. Puerto Rico’s Commissioner of Insurance has already levied several million dollars in fines, but many of the insurance companies remain recalcitrant.

Puerto Rico Remains Extremely Fragile

There are several storms brewing in the Atlantic that could spell disaster for an already struggling Puerto Rico. The island was drenched last week by Tropical Storm Isaac, which caused power outages across the island. Now more than ever, the island needs help to continue to repair and protect themselves from new threats. Unfortunately, many people have forgotten about the struggles the people of Puerto Rico are still facing and others have blatantly denied the storm’s damage.

President Trump Denies Hurricane Maria Death Toll

For the people of Puerto Rico, the greatest loss experienced on the island was the loss of life. Puerto Ricans know the death toll firsthand because they lost loved ones, but President Donald Trump has consistently denied and refused to acknowledge the enormous loss of life caused by the hurricane. In a series of tweets, Mr. Trump claimed the estimated death toll of nearly 3,000 was a conspiracy by the Democratic Party.

The 3,000-person death toll estimate came from a study by independent researchers at George Washington University commissioned by the Puerto Rico government. Researchers found 16,608 documented deaths on the island from September 2017 to February 2018. This number is 2,975 deaths higher than the predicted mortality rates for Puerto Rico, meaning Hurricane Maria caused the additional 2,975 deaths. Other studies have also found the death toll is much higher than original estimates of 6-18 people.

Raizner Law Is Proud To Help Puerto Rico

Puerto Rico doesn’t deserve to be forgotten. The insurance lawyers at Raizner Law are proud to help Puerto Rican business owners with their Hurricane Maria insurance claims. We understand the island is facing desperate times and are working tirelessly to help policyholders get what they rightfully deserve under their policies. Contact us today to see how we can help.

Commercial Fire Damage Lawyers

Industrial Building Owner Files Lawsuit After Insurance Denial

Our client, an industrial building owner, has filed a lawsuit against Rockhill Insurance Company, International Insurance Company Hannover SE, Antares AUL 1274, Liberty Syndicated LIB 4472, and Vericlaim Inc.

January 2017 Fire

On January 1, 2017, the plaintiff’s property suffered severe damage from a fire that broke out on the property. Immediately upon discovering the damage, the plaintiff filed an insurance claim and asked that the cost of repairs be covered pursuant to the policy.

On February 14, 2017, authorized adjusting representatives from Vericlaim confirmed that the damages were covered under the policy and approved payment for the damage in an official insurance company estimate of damages. On the same day, plaintiffs accepted the estimate of damages creating a binding and enforceable agreement. This should have led to the conclusion of the claim.

Rockhill, Hannorver, Antares, and Liberty are the insurers on the property. In response to the fire claim, the carriers assigned adjusters, consultants, and agents to the plaintiff’s file that were inadequately and improperly trained. In addition, these representatives violated standard insurance practices when directed by the carriers.

Specifically, the claim was assigned to an adjuster who originally prepared the accepted estimate of damages. The carriers refused to honor their coverage representation, and the adjuster failed to stand by the commitment he had made on behalf of the carriers.

Adjusters on the claim failed to perform a thorough investigation of the claim and instead delayed the claim payment and pointed to an approved vendor report in order to reach the non-payment outcome that they desired.

After the February 14 estimate of damages, the carriers and their administrators engaged in deceptive and unfair claim practices by attempting to leverage the claim amount that they knew they owed. The carriers and the adjusters on the claim ignored the promises they made on the claim payment and attempted to invoke appraisal as part of an unlawful negotiating process.

Because the carriers and adjusters confirmed coverage and the undisputed amount owed on the claim to plaintiff on February 14, 2017, they waived any right to later disclaim coverage and put the entire claim in an expensive and wasteful appraisal process.

As a result, the carriers crossly underpaid the claim and the plaintiff has still not been fully paid under the policy. The plaintiff was forced to hire a consultant to properly evaluate the property damage because the carriers refused to do so.

On June 14, 2017, the carriers attempted to place this matter into appraisal, which is in direct violation of the Texas Insurance Code, the common law duty of good faith and fair dealing, and is in breach of their contractual commitments. To put it simply, the carriers chose to act unreasonably in refusing to issue the claim payment their authorized representative confirmed and the plaintiff accepted.

Because of the carriers’ wrongful denials, the plaintiff has been unable to make necessary repairs to the property, which has caused additional damage.

The Carriers Acted In Bad Faith

Our client alleges numerous violations of the Texas Insurance Code, including the failure to effectuate a prompt, fair, and equitable settlement of a claim and misrepresentation of the insurance policies under which it affords property coverage to the plaintiff. The plaintiff also states the carriers are in breach of the insurance contract and have violated the Deceptive Trade Practices-Consumer Protection Act.

Commercial Fire Damage Lawyers

Insurance companies will often do anything to avoid paying out on claims. When an insurance company operates in bad faith, you will need experienced commercial fire damage lawyers to help you get what you are rightfully owed under your policy. If your insurance company is denying, delaying, or under-paying your fire damage claim, contact Raizner Slania immediately.

Hurricane Harvey Insurance Claims

Hurricane Harvey Insurance Claims Misinformation

There is a quite a bit of incorrect information floating around about Hurricane Harvey and notice of an insurance claim, some of it propagated by pseudo first party insurance law experts, or honestly, lawyers who don’t know what they are talking about. Homeowners just trying to help are jumping into the fray, and repeating some of this incorrect information. There’s particular confusion about what the impact of notice on or after September 1, 2017 will be, and even some confusion about the types of policies the new law applies to. Let’s clean some of this up, because the notice requirements differ based on the type of policy. And next to ensuring the safety of your family and friends and protecting your property, nothing is more important right now than understanding the logistics of how and when you should notify your insurance company of a claim.

The new Texas insurance law applies to wind claims, not flood claims. The differences are discussed in more detail below, but here’s the key takeaway: Policies that cover wind claims are governed by state law, so the new rules apply to wind claims. Policies that cover flood claims are governed by federal law and are part of the National Flood Insurance Program, which in turn is part of FEMA, so the new Texas rules do not apply to flood claims.

The impact of notice on or after September 1, 2017 only affects the interest rate on unlawfully delayed claims: Here’s where people are getting the most confused. The new law goes into effect on September 1, 2017 in all its glory. There’s nothing you can do to suspend its application. It applies to any lawsuit filed after that date – which means the new Texas insurance law will impact every lawsuit arising out of Hurricane Harvey. There is one, and only one exception to this. If you file your claim with the insurer before September 1, 2017, then the existing interest rate of 18%, and not the new rate of 10%, applies to unlawfully delayed claims. The information circulating that suggests notice prior to September 1, 2017 can suspend application of the new law in its entirety is just flat wrong. Like it or not, the new law will apply to virtually every single Hurricane Harvey claim. Notice before September 1, 2017 only affects the interest rate, but that’s a pretty big deal.

Why the 18% interest rate matters: Having handled many hundreds of lawsuits arising out of unlawfully handled Hurricane Ike claims, and literally thousands of first party insurance cases over a 25 year period, here’s what I know. The largest stockholders of most of the major insurance companies are massive asset managers like Vanguard, BlackRock, and State Street. They control trillions of dollars in assets, and have more money than many states or countries. And that means you can’t hurt them. You can’t teach them any lessons. The only thing that matters to them is the math. That’s why the interest rate is so important. At an 18% interest rate, an unlawfully delayed claim payment will cost a recalcitrant insurer an additional 50% of the value of the claim over two years, and after four years, they must pay twice the value of the claim. But at 10% interest, they can delay payment for a full ten years before the interest penalty doubles the value of the claim. Time is money, the insurance industry knows it, and the Texas legislature just cut the penalty for insurers who wrongfully delay property damage insurance claims by 45%. Of all the ways in which lawmakers betrayed the communities they represent, including some from the areas most affected by Hurricane Harvey, this windfall to the insurance industry hurts the most.

Let’s go over some specifics about providing notice after Hurricane Harvey:

Notice of a flood claim: In the most general terms, a flood insurance policy covers water rising up from the ground and seeping into a building or home. Much of the Houston area experienced flood damage. Flood policies are usually written through insurance companies, but they are part of the National Flood Insurance Program (NFIP), which in turn is part of FEMA. Not everyone has flood insurance. If you are in certain flood prone areas, a mortgage company will require flood insurance. But if you aren’t in a flood prone area, then flood insurance is completely voluntary and you are limited in what you can buy. You should give your flood insurance company notice of the claim right away, and you have to complete a proof of loss within 60 days of the loss. FEMA often extends the proof of loss date for major natural disasters, but you can’t count on that occurring. Our friends at United Policyholders have posted some valuable information about the flood claims process. A flood claim written on an NFIP backed policy is not subject to the September 1, 2017 time considerations under the new Texas law.

Notice of a wind claim: A standard homeowner’s insurance policy or commercial insurance policy will cover may different perils, including wind damage from hurricanes and tropical storms. If water comes into the home or building through a “storm created opening,” such as roof or window damage, then this type of policy should cover the loss. A wind loss claim is subject to the September 1, 2017 time considerations under the new Texas law. To avoid the 45% reduction in the interest rate, you must get notice of a wind claim loss on file with your insurance company before this Friday, September 1, 2017. And to avoid any miscommunications, it’s best to do this in writing.

What happens if there is both wind and flood damage, or you aren’t sure about the cause?: That’s simple. Give notice of both claims. Sometimes, it takes an engineer or other specialist to determine the cause of a loss, that is, whether it’s from wind, flood, or even non-covered items like wear and tear or manufacturing defects. If you don’t know, that’s ok, but be prudent and provide notice to both your flood insurer and your wind insurer.

Why did this change in the law happen?: Now that’s a great question. There are a handful of reasons, and more than a handful of culprits. We’ll address some of the why’s and who’s in future blog posts, and there’s blame to go around, but here’s some food for thought right now. Some of the biggest proponents of this new law, it’s author and sponsors, the people that overreached and overcorrected a perceived problem and helped the insurance industry grab and take liberties with Texas, some of these scoundrels who betrayed their communities, their friends, their family members, the same ones who are boasting of their efforts on social media right now, some of these state representatives and senators come from districts heavily impacted by Hurricane Harvey. We’ll point them out shortly.

Bad Faith Insurance Lawsuit Attorneys

Homeowners Association Files Bad Faith Insurance Lawsuit

Raizner Slania filed a lawsuit on behalf of a local homeowners association against Mid-Century Insurance Company after its hail damage claim was wrongfully denied.

April 2016 Bexar County Hailstorm

On April 12, 2016, a severe hailstorm swept through Bexar County causing significant damage to the roofs, interiors, and exteriors of condominiums contained in over 50 separate buildings managed by the policyholder homeowners association . Immediately upon discovering the damage, the homeowners association filed a hail damage insurance claim with Mid-Century to cover the cost of the repairs and other damages.

In response to the claim, Mid-Century assigned adjusters, consultants, and agents to the plaintiff’s file that were inadequate and improperly trained. Specifically, the claim was assigned to two adjusters, both of whom were not properly trained to handle this type of claim and failed to perform an adequate evaluation of the damage.

After a haphazard investigation of the property, the adjuster prepared an estimate of damages to the structure that grossly undervalued and ignored obvious damages to the property. Mid-Century relied solely on the adjusters’ investigation to determine what amounts, if any, to pay on the plaintiff’s claim. Mid-Century and the adjusters represented to the plaintiff that certain damages were not covered under the policy when in fact they were.

Mid-Century denied and grossly underpaid the plaintiff’s claim. In addition, Mid-Century continued to deny and delay timely payment of the damages it did accept. This caused the plaintiff to suffer significant economic impact, worry, distress, and continuing economic and physical damage.

Mid-Century Operated In Bad Faith

Our client cites numerous violations of the Texas Insurance Code, including failure to effectuate a prompt, fair, and equitable settlement of a claim, failure to implement reasonable standards for investigation of a claim, and violations of the Deceptive Trade Practices-Consumer Protection Act (DTPA).

Bad Faith Insurance Lawsuit Attorneys

Unfortunately for Texas policyholders, bad faith insurance practices are rampant. For policyholders whose claims have been wrongfully denied by their insurance company, the only way to seek full compensation is with the help of an experienced bad faith insurance lawsuit attorney. At Raizner Slania, our attorneys can help you get what you rightfully deserve under your policy. Contact us today to schedule a free consultation to discuss your case.

Texas Wind Damage Lawyers

Harris County Windstorm Damage Lawsuit

Our client, a local multi-story hotel tower owner, was forced to file a lawsuit against Everest Indemnity Insurance Company and Engle Martin after its commercial property damage insurance claim was wrongfully denied under Texas law.

April 2016 Windstorm

On April 18, 2016, a severe windstorm swept through Harris County and caused substantial damage to the roof, exterior, and interior of the plaintiff’s property. Immediately upon discovering the damage, the plaintiff filed an insurance claim with Everest for the damages caused by the windstorm. In response to the claim, Everest assigned adjusters, consultants, and agents to the plaintiff’s file that were inadequately and improperly trained.

Specifically, Everest assigned the claim to Engle Martin, who in turn assigned the claim to an adjuster. The adjuster and Engle Martin failed to perform a thorough investigation of the claim. The adjuster performed a substandard inspection of the property and failed to prepare any estimates or scopes of damages. The employee and Engle Martin also failed to hire qualified experts to properly assess the damage.

The employee and Engle Martin performed an inadequate, incomplete, and unreasonable investigation of the plaintiff’s claim, which Everest relied exclusively on to determine what amounts, if any, to pay on the claim.

As a result of the haphazard investigation, the plaintiff’s claim was denied. Everest represented to the plaintiff that the damages were not covered under the policy, when in fact they were. The plaintiff was forced to hire its own consultant to independently evaluate the property damage because Everest and Engle Martin refused to do so.

The Insurance Carrier Violated the Texas Insurance Code

Our client cites numerous violations of the Texas Insurance Code, including failure to effectuate a prompt, fair, and equitable settlement of a claim, failure to implement reasonable standards for investigation of a claim, and refusal to pay a claim without conducting a reasonable investigation. Additionally, our client also cites violations of the Texas Deceptive Trade Practices-Consumer Protection Act.

Raizner Slania: Texas Wind Damage Lawyers

If your insurance carrier wrongfully denied or grossly underpaid your Texas wind damage insurance claim, the experienced attorneys at Raizner Slania can help. We’ve helped policyholders across Harris County, throughout Texas, and around the country get the rightful payments they deserve under their insurance policies. Our consultations are free and you won’t owe us anything unless we help you recover compensation. Call us today to schedule your consultation.