Insurance Coverage

Our San Jose, California attorneys at Gates Eisenhart Dawson firmly believe that insurance company should be forced to honor their contractual obligations. If you or your business is engaged in a dispute with your insurance company, you need a strong litigation firm in your corner. Josh Borger has extensive experience handling insurance matters. He has represented some of the world’s largest insurance companies in insurance coverage matters. Now, we draw on that experience to represent you and your business and ensure that you receive the coverage you are owed. Based in Silicon Valley, our insurance coverage practice extends throughout California and to other jurisdictions in select matters.

Businesses and individuals rely on insurance coverage to handle a large variety of risks, including lawsuits and property damage. Your insurance policy (the contract) provides that in exchange for the payment of certain amounts, the insurance company will provide you with coverage and pay valid claims. Yet, insurance is also a business. Often, insurance companies improperly deny, limit, or mishandle claims for their own profit. Policyholders are significantly at financial risk when their insurance companies fail to deliver on their contractual obligations. Unfortunately, many people just accept the insurance company’s denial of a claim. The claim and the policy should be evaluated to determine whether the denial was proper and the claim handling was appropriate.

Our lawyers will examine your insurance documents to determine whether the insurance company owes you a contractual obligation. Every insurance policy contains an implied covenant that your insurance company will handle your claim reasonably and promptly. In addition, California has laws prohibiting insurance companies from engaging in certain unfair claim settlement practices, including the following:

  • misrepresenting the relevant facts or insurance policy provisions related to coverage
  • failing to acknowledge and act reasonably promptly after receiving communications about the claim
  • failing to adopt and implement reasonable standards for the prompt investigation and processing of claims
  • failing to accept or deny coverage of claims within a reasonable time period after the insured completed and submitted proof of loss requirements
  • failing to attempt in good faith to reach a prompt, fair, and equitable settlement of the insured’s claim after liability became reasonably clear
  • requiring the insured to file a lawsuit to recover amounts due under the policy by offering substantially less than the amount recovered in the lawsuit, even though the insured made a claim for an amount reasonably close to the amount ultimately recovered;
  • attempting to settle the insured’s claim for less than the amount that a reasonable person would have believed he or she was entitled to, by referring to written or printed advertising material accompanying or made part of the application
  • attempting to settle the claim on the basis of an application that was altered without notice to, or knowledge or consent of, the insured
  • failing, after payment of a claim, to inform the insured, on his or her request, of the coverage under which payment was made
  • informing the insured of its practice of appealing from arbitration awards in favor of insureds or claimants for the purpose of forcing them to accept settlements or compromises less than the amount awarded in arbitration
  • delaying the investigation or payment of a claim by requiring the insured to submit a preliminary claim report, and then also requiring the submission of formal proof-of-loss forms, both of which contained substantially the same information
  • failing to settle a claim against the insured promptly once liability has become apparent under one portion of the insurance policy coverage, in order to influence settlements under other portions of the insurance policy coverage
  • failing to promptly provide a reasonable explanation, based on the provisions of the insurance policy in relation to the facts or applicable law, of the reasons for denying the claim or offering a compromise settlement
  • directly advising the insured not to hire an attorney
  • misleading the insured as to the applicable statute of limitations (the date by which an action against the defendant on the claim must be filed)

When your insurance company violates these obligations, it has committed what is commonly referred to as bad faith breach of an insurance contract. If your insurance company has acted in bad faith, then you may be entitled to damages separate and apart from the proceeds due under your policy, including economic losses, resulting emotional distress, certain types of attorneys’ fees, and in some cases prejudgment interest. If your insurance company is wrongly or unreasonably limiting, denying, or handling your claim, our attorneys can provide you with the necessary representation.

For more information about our insurance practice, we welcome you to contact GED.