Resolving Claim Disputes
Claim disputes are common. You and your insurer may disagree over medical bills, home repairs; what needs to be done and how much it should cost, and whether all or part of your claim is covered. UP offers many resources to help you trouble-shoot specific issues such as depreciation, professional fees, and policy interpretation.
In this section of the UP Claim Help Library, you will find links to publications. They explain the different processes for resolving a claim dispute. You are not on a level playing field when you are dealing with a for-profit insurance company. Claims often involve technical and legal issues. You need to have or develop skills to represent yourself and negotiate a settlement on your own. If you can’t effectively represent yourself, you will get a better settlement by hiring the right professional help.
The best path to resolving a claim dispute depends on the circumstances of the claim and your personal situation. Each dispute resolution process has pros and cons. The main factors that determine which is best for you include:
- how much the process will cost and who will pay for it.
- how long the process will take.
- your settlement goal.
NEGOTIATION (SELF-HELP)
The pros of using our "do it yourself" (self-help) tips are that you won't be paying for professional help. The cons are that you may not have the skills and/or time to get a fair resolution on your own.
- Top Twenty Tips (pdf)
- Speak UP: How to communicate with your insurance company (pdf)
- NAIC Map of State Insurance Departments
- Examinations Under Oath (pdf)
- Statutes of Limitations (pdf)
- Special tips for Californians:
Getting Help From the CA. Dept. of Insurance (pdf),
Your Insurance Legal Rights as a Property Owner in California (pdf)
If you find you are underinsured, visit our Underinsurance Help section
ALTERNATIVE DISPUTE RESOLUTION (ADR)
“ADR” includes different processes for settling disputes without a lawsuit. For an overview of Alternative Dispute Resolution methods, watch UP’s PowerPoint, “Resolving Disputes Out Of Court.”
Appraisal
Most property insurance policies contain wording that allows certain cost disputes to be resolved by a process called "appraisal." An insurance appraisal is different from a real estate appraisal.
- Insurance Appraisal Simplified (pdf)
- Policyholders can win in appraisal (pdf)
- Appraisal - Definition & Use in Insurance - To assist in the resolution of a claim (pdf)
Mediation
Private, voluntary, or court-ordered mediation has become the most common way of resolving claim disputes. Mediation pros are that it can be fast, and relatively cheap compared to a lawsuit. Cons are that claims often get settled for less than full value in mediation.
LITIGATION AND ARBITRATION
Arbitration can be a faster and cheaper way of settling a dispute than litigation and trial. However because arbitration doesn't involve a jury, the results often favor insurance companies.
Litigation means filing a lawsuit, conducting "discovery" (exchanging information with your opponent), and showing evidence and witnesses to a judge and jury. The jury or judge makes a decision (verdict). The verdict often gets reviewed in a process called an appeal.
Although litigation can seem scary, if you have a good, experienced lawyer, it may be the best way to get a fair settlement of an insurance claim, particularly one where there is a lot of money at stake. Filing a lawsuit gives you leverage in negotiations. Most lawsuits get settled before they go to trial. The best scenario for a consumer is to hire an experienced policyholder attorney on a contingent fee basis and the lawyer should advance the cost of the case. The contigent fee and cost advance options may not be available to you, depending on the state you live in and the facts of the dispute.
Visit our Sponsors page to find businesses and individuals in your state that represent policyholders, and are committed to support United Policyholders.
United Policyholders is a non-profit organization founded in 1991 and dedicated to educating the public on insurance issues and consumer rights. UP publishes educational materials and serves as a resource for individual and business policyholders and residents of communities with insurance problems. UP’s Amicus Project provides information to courts of law to support policyholders’ legal rights. UP unites policyholders and their advocates by sharing information. Write to UP at 110 Pacific Ave., PMB 262, San Francisco, CA. 94111, call us at (510) 763-9740, or visit our website at www.unitedpolicyholders.org.
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