Has Your Insurance Company Denied, Delayed, or Undervalued Your Claim?
You paid your insurance premiums. When you need your insurance company to honor its obligations, you expect your claim to be investigated fairly and handled promptly.
But what happens when your insurance company:
- Denies your claim
- Delays investigating your claim
- Offers far less than you believe your claim is worth
- Refuses to explain why your claim was denied
- Disputes coverage
- Questions the extent or cause of your injuries or loss
- Continues asking for repetitive information without resolving the claim
- Fails to communicate with you about your claim
Depending on the circumstances, the way an insurance company handles a claim may raise concerns about unfair claim-settlement practices or insurance bad faith.
You don’t have to assume the insurance company’s decision is the final word.
Gold, Khourey & Turak represents individuals and families in West Virginia and Ohio who are dealing with denied, delayed, underpaid, and disputed insurance claims.
If you’re having trouble with an insurance company, contact GKT for a free consultation. Need help? Get help. Get GKT.
Reviewed by Attorney Michelle Marinacci
Partner, Gold, Khourey & Turak
Michelle Marinacci focuses on insurance disputes and bad-faith insurance claims, including denied, delayed, and underpaid claims. She reviewed this page for legal accuracy and relevance to insurance disputes in West Virginia and Ohio.
View Michelle Marinacci’s Attorney Profile
What Is Insurance Bad Faith?
Insurance bad faith generally refers to an insurer’s failure to act fairly and in good faith when handling a claim or carrying out its obligations under an insurance policy.
An insurance company has the right to investigate a claim and determine whether coverage applies. A disagreement between an insurer and policyholder does not automatically mean the insurer acted in bad faith.
The specific facts matter.
In West Virginia, the law identifies a number of unfair claim-settlement practices, including failing to respond reasonably promptly to claim communications, failing to maintain reasonable standards for investigating claims, refusing to pay without a reasonable investigation, failing to make prompt and fair settlements when liability is reasonably clear, and failing to provide a reasonable explanation for certain denials or compromise settlement offers.
In other words, a denied claim is not automatically a bad-faith claim. But the way the insurance company handled the claim can be important.
What Does an Insurance Company Have to Do When Handling a Claim?
Insurance companies are allowed to investigate claims. They are also allowed to question coverage, liability, damages, and other issues when there is a legitimate basis for doing so.
But West Virginia law addresses certain claim-handling practices.
Depending on the circumstances, potentially unfair practices can include:
- Misrepresenting relevant facts or policy provisions
- Failing to respond reasonably promptly to claim communications
- Failing to maintain reasonable standards for investigating claims
- Refusing to pay without a reasonable investigation
- Failing to make a timely determination regarding coverage
- Failing to make prompt, fair and equitable settlements when liability is reasonably clear
- Offering substantially less than amounts ultimately recovered in certain circumstances
- Failing to provide a reasonable explanation for a denial or compromise settlement offer
These provisions are found in West Virginia’s Unfair Trade Practices Act.
Whether a particular situation constitutes an unfair claim-settlement practice or supports another legal claim depends on the facts and the type of insurance claim involved.
Signs Your Insurance Company May Be Handling Your Claim Unfairly
Your claim was denied without a clear explanation
If your insurance company denies your claim, pay close attention to the reason given for the denial.
Ask for the explanation in writing and review the policy language the insurer is relying upon.
Your claim has been repeatedly delayed
Some claims take time to investigate. A complicated claim may legitimately require additional information.
But unexplained or unreasonable delays may warrant closer attention.
The insurance company isn’t investigating the claim properly
An insurer should have a reasonable basis for its investigation.
If important evidence is being ignored or the investigation appears incomplete, that may be significant.
The insurance company is offering substantially less than you believe your claim is worth
A disagreement over the value of a claim does not automatically establish bad faith. West Virginia law specifically recognizes that a good-faith disagreement over the value of a claim or liability is not, by itself, an unfair claim-settlement practice.
But the circumstances surrounding the offer may still be important.
The insurance company won’t explain its decision
If an insurer denies a claim or makes a compromise settlement offer, the explanation it provides may matter.
West Virginia law addresses an insurer’s obligation to provide a reasonable explanation for certain claim decisions.
What Types of Insurance Disputes Does GKT Handle?
Gold, Khourey & Turak can help clients evaluate a variety of insurance-related disputes, including:
Denied Insurance Claims
An insurer may deny a claim based on coverage, liability, causation, damages, policy exclusions, or other issues.
Delayed Insurance Claims
When a claim remains unresolved, the reason for the delay and the insurer’s communications may become important.
Underpaid Insurance Claims
Sometimes the dispute isn’t whether the insurance company will pay something—it’s whether the amount being offered fairly reflects the claim.
Auto Insurance Claims
GKT represents clients dealing with disputes involving automobile insurance, including claims arising from serious crashes.
Homeowners Insurance Claims
Insurance disputes can arise when homeowners suffer property damage and the insurer disputes coverage or the amount of the loss.
Life and Disability Insurance Claims
GKT also handles certain disputes involving life insurance and disability insurance claims.
Failure to Defend or Indemnify
Insurance policies can impose obligations on insurers to defend or indemnify an insured under certain circumstances. When an insurer refuses to do so, the policy language and circumstances must be carefully evaluated.
What Should You Do If Your Insurance Claim Is Denied or Delayed?
If you’re having trouble with an insurance company, there are several practical steps you can take.
Ask for the reason in writing
If your claim has been denied, ask the insurer to explain the reason for the denial and identify the relevant policy provisions.
Keep your insurance policy and claim documents
Save:
- Your insurance policy
- Claim correspondence
- Denial letters
- Emails
- Estimates
- Medical records
- Medical bills
- Photographs
- Accident reports
- Settlement offers
- Notes from conversations with adjusters
Keep a timeline
Write down when you submitted the claim, when the insurer contacted you, what information was requested, when you provided it, and what happened afterward.
Be careful about signing documents
Before signing a release or accepting a settlement, make sure you understand what rights you may be giving up.
Consider having the claim reviewed
If you’re unsure whether the insurance company’s position is reasonable, an attorney can review the policy, the claim history, the evidence, and the insurer’s communications.
First-Party vs. Third-Party Insurance Claims
One of the most important questions in an insurance dispute is whose insurance policy is involved.
What is a first-party insurance claim?
A first-party claim generally involves a person seeking benefits under their own insurance policy.
Examples can include certain:
- Auto insurance claims
- Homeowners insurance claims
- Life insurance claims
- Disability insurance claims
What is a third-party insurance claim?
A third-party claim generally involves a person seeking compensation from an insurance policy belonging to someone else—for example, an injured person making a claim against another driver’s liability insurance.
The distinction matters because West Virginia law treats third-party unfair-claims-settlement allegations differently from first-party claims.
Under current West Virginia Code §33-11-4a, a third-party claimant does not have a private cause of action under that section for an unfair claims-settlement practice or bad-faith settlement of a claim. The statute instead provides for an administrative complaint process with the West Virginia Insurance Commissioner, subject to the statute’s requirements.
This is an area where the specific facts and type of claim matter greatly.
If you’re unsure what type of insurance claim you have, talk with an attorney before assuming what legal remedies are available.
How West Virginia Law Addresses Unfair Claim Settlement Practices
West Virginia’s Unfair Trade Practices Act identifies specific practices that may constitute unfair claim settlement practices when the statutory requirements are satisfied.
The law addresses conduct such as:
- Unreasonable delays in responding to claims
- Inadequate investigation of claims
- Refusing to pay without a reasonable investigation
- Failing to make prompt, fair settlements when liability is reasonably clear
- Failing to provide reasonable explanations for certain claim decisions
- Certain practices involving the handling and payment of claims
The law also makes clear that a good-faith disagreement over the value of a claim or liability does not, by itself, constitute an unfair claim-settlement practice.
Because insurance law can be complicated—and because the rules can differ depending on whether you’re making a first-party or third-party claim—it’s important to evaluate the actual policy, claim, and circumstances.
How GKT Can Help With Insurance Disputes and Bad Faith Claims
When you’re dealing with an insurance company, it can feel like you’re at a disadvantage.
The insurance company has adjusters, claims representatives, investigators, and attorneys.
You may simply be trying to get your claim paid.
Gold, Khourey & Turak can help you understand your rights and options.
Our attorneys can review:
- Your insurance policy
- The history of your claim
- Communications with the insurer
- The reason for a denial
- The basis for a delay
- Settlement offers
- Medical records and other evidence
- Other documentation relevant to your claim
See examples of GKT’s results in insurance disputes and bad-faith claims.
Meet Michelle Marinacci
Michelle Marinacci is a partner at Gold, Khourey & Turak who focuses on insurance disputes and bad-faith insurance litigation, along with personal injury, medical malpractice, and wrongful-death matters.
Her insurance-related experience includes denied claims, delayed investigations, underpaid settlement offers, failure to defend or indemnify, unfair claim-settlement practices, life insurance disputes, disability insurance denials, homeowners’ insurance disputes, and auto insurance bad-faith claims.
If your insurance company isn’t treating your claim fairly, Michelle and the GKT team can help you understand what options may be available.
Frequently Asked Questions About Bad Faith Insurance Claims
What is insurance bad faith?
Insurance bad faith generally refers to an insurer’s failure to act fairly and in good faith when handling an insurance claim or fulfilling its obligations under a policy. Whether conduct legally constitutes bad faith depends on the circumstances and applicable law.
Is every denied insurance claim a bad-faith claim?
No. An insurance company can have legitimate reasons for denying a claim. A denial by itself does not establish bad faith.
What if my insurance company delays my claim?
Some claims require additional investigation. However, unreasonable delays or failures to communicate or investigate may raise concerns depending on the circumstances.
What if the insurance company offers me less than I think my claim is worth?
A disagreement over the value of a claim does not automatically constitute bad faith. However, the circumstances surrounding the valuation and settlement offer may be important.
Can I sue an insurance company for bad faith?
The answer depends on the type of insurance claim and the specific legal theory involved. In particular, West Virginia law currently treats third-party unfair-claims-settlement allegations differently from first-party claims. Generally, you are limited to suing your own insurance company for bad faith, but exceptions may exist in certain circumstances.
An attorney can evaluate your specific situation.
What evidence can be important in an insurance dispute?
Important evidence may include the insurance policy, claim correspondence, denial letters, photographs, medical records, estimates, claim notes, settlement offers, and records of communications with the insurance company.
How long do I have to pursue an insurance claim?
Deadlines can vary depending on the type of claim, policy language, and applicable law. Don’t assume you have unlimited time to act. In West Virginia, the statute of limitations for filing a bad faith claim is one year, while breach of contract claims may be subject to different time limitations.
Should I talk to a lawyer before accepting an insurance settlement?
If you have significant injuries, substantial losses, a disputed claim, or concerns about the insurance company’s handling of your claim, it may be worthwhile to have an attorney review the situation before you sign a release or accept a settlement.
Insurance Company Denied, Delayed, or Undervalued Your Claim?
You don’t have to figure it out alone.
Gold, Khourey & Turak helps individuals and families throughout West Virginia and Ohio with serious personal injury and insurance-related matters.
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Need help? Get help. Get GKT.
Attorney Review
This page was reviewed by Michelle Marinacci, Partner at Gold, Khourey & Turak, for legal accuracy. Information about insurance claims and bad-faith disputes can vary depending on the facts, insurance policy, and applicable law.
