Insurance is usually a simple proposition: you pay a money, a “premium,” to a company that promises to pay you a different sum of money if you or your property sustains certain types of damage. In the case of auto insurance, if you have an accident your insurance company will replace your car and pay for certain expenses such as medical bills that you or someone else might have as a result of the accident. Your home insurance will pay for a new house if your current residence is destroyed or home insurance might protect you if someone trips and falls while visiting you.
There are also times when you and your insurance company disagree about who is responsible for what expenses. Most of the time these disputes can be worked out by negotiations or other measures. However, there are other times when the insurance company seems to be stalling on payment of your claim or otherwise acts in a manner that suggests it will not pay what you feel is a legitimate claim that is covered in your policy. In this case you might feel that your insurance company is acting in “bad faith.”
In New York, an insurance company that has agreed to the terms set down in a policy is expected to act in “good faith and fair dealing” with its policyholders. The courts have defined bad faith on the part of an insurance company to be “a deliberate or reckless failure to place on an equal footing the interests of its insured with its own interests when considering a settlement offer.” If a company is acting in bad faith it may be sued in court.
Examples of behavior that the courts have been found to be in bad faith include:
- putting its financial well-being ahead of that of the claimant
- unreasonable refusal to pay a claim
- failing to reach a prompt, fair and equitable settlement when its liability is apparent
- making unfounded accusations of fraud or deceit
There are many other examples of bad faith that have been accepted by the courts. Since many of these are based on legal theory and are better explained by an attorney practicing insurance law.
If you are considering filing a bad faith lawsuit against an insurer, the court will want to be satisfied that you complied with, to the best of your ability, all the provisions that were set forth in your policy such as:
- filing your claim promptly and within the time limits provided for in the policy
- using only the insurance company’s claim forms
- submitting receipts for out of pocket expenses that are reimbursable
- not engaging in fraudulent claims
- providing the agreed-upon number and types of estimates
- participation as required in all reasonable settlement meetings and negotiations
There may be other requirements that the court will set but, as long as you can prove that you have met or have made every possible effort to meet the policy’s stipulations, most courts will be satisfied and the burden will be shifted onto the insurance company to prove that it was not engaging in bad faith activities.
A feature that is present in a bad faith lawsuit that is not always present in other legal actions is that you can also sue for your attorney’s fees and other costs as well as ask for the court to award consequential damages, which are damages to the plaintiff that were a consequence of the defendant’s bad faith in breaching the insurance policy’s terms. This type of request should be made only after consultation with a lawyer who is familiar with insurance law and the civil laws of the State of New York.
As mentioned above, the bad faith concept as it relates to insurance claims is still evolving in the New York courts and the state legislature. Any claim of bad faith should be discussed with an attorney who has experience in all aspects of insurance law.