insurance

Insurance Coverage: Understanding Triggers

If you have owned one or more insurance policies for a long period of time, you may have been lucky enough never to have to use it or worry about insurance coverage—but on the other hand, you may also wonder if it has been worth it to pay out so many premiums for what could seem like virtually nothing; after all, in many ways insurance is just a concept. After you meet with the insurance agent, discuss options, purchase coverage, and go on your way, you may feel a bit let down to find out all you feel like you received in exchange for your money was a stack of paper that may be difficult to understand.

Of course, the major goal in purchasing insurance is to procure protection in the case of a car wreck, an injury to a third party at your business, a disaster that affects your home—and so much more. Any such incidents could be debilitating to the person filing the claim, but also catastrophic to your finances. There are many reasons that coverage can be triggered, but it all comes down to one thing: the insurance claim.

If you have an occurrence policy, the claim may be that a third party was injured at your business, or their property was damaged. That triggers the coverage as long as the incident for the claim occurred during the time the policy was in force. With a claims-made policy, coverage is triggered if the policy was in force at the time the claim is made, or during an extended reporting period (also known as the tail).

In some cases, there may be a dispute with the insurer over the claim. You may have done everything right, from filling out all of your paperwork clearly and honestly, to paying every premium without fail, and making sure to keep all your policies reviewed and updated on an annual basis. To have a claim not paid promptly after you have held up your end up the bargain faithfully can be extremely disappointing. Seek advice from an experienced bad faith insurance attorney if you are worried about the following, whether it is regarding an injury claim, property claim, or professional liability that could threaten your business or livelihood:

  • An offer from the insurance company that is exceedingly low
  • Lack of investigation from adjusters
  • Delaying in payment for the claim
  • Outright denial of the claim

If you need help reviewing your insurance policy, or if you suspect your insurance company may be denying your claim in bad faith, contact the attorneys at the Bolender Law Firm.  If a dispute over a claim cannot be easily resolved through a call or written communication, our attorneys will advocate on behalf of policyholders through litigation, arbitration, or non-binding mediation. Our attorneys are experienced in representing clients in state and federal courts, at both the trial and appellate level. Call us at 310-320-0725 now or submit an easy consultation request online. We are here to help!

malpractice tail coverage

Malpractice Tail Coverage: Is it Necessary for Physicians?

The particulars involved in taking on insurance can be often be complex. This could apply to any type of policy, but if you are trying to protect your business or professional livelihood with liability insurance, there are many facets to consider financially and for the long-term. If you are sued due to an injury affecting a third party or if property is damaged, without insurance you could be responsible for an astronomical sum. The proper insurance may also protect you against libelous claims.

Although insurance is critical for many different types of professionals, doctors are often under legal fire, and while some malpractice suits may be solid, there are many frivolous ones too. This means that medical professionals must dedicate a significant amount of their income to protecting themselves from a devastating malpractice suit. Without it, they could experience a financial catastrophe that would send them reeling back despite all their many years of hard work in the hospital, private practice, or both.

Malpractice insurance is almost always required, and the claims-made policy is common, often including a short-term extended reporting period or ‘tail.’ Needs may vary, but it is crucial to understand the differences in the policies available and make sure there is an ERP if necessary. A basic 30- to 60-day tail included with malpractice insurance certainly would not be enough if, for example, the medical professional is thinking about retiring but wants to be smart about covering themselves for the possibility of a claim arising even afterward.

While previously there were not a lot of options regarding tail coverage, malpractice insurers offer physicians a much wider range of extended reporting periods today, with varying rates in premiums. The need for such specialized insurance is there especially for doctors who may not receive notice of a pending claim or lawsuit until long after the insurance policy was canceled or terminated for whatever reason. Cost can play a major role in whether tail coverage is purchased though, and what kind. Medical facilities often cannot afford to provide doctors with the extended coverage, but they may be required to provide it for themselves. This could even be written into a contract regarding their departure from a facility, requiring the tail to be purchased then so that the hospital or office is not held liable.

If you need help reviewing your insurance policy, or if you suspect your insurance company may be denying your claim in bad faith, contact the attorneys at the Bolender Law Firm.  If a dispute over a claim cannot be easily resolved through a call or written communication, our attorneys will advocate on behalf of policyholders through litigation, arbitration, or non-binding mediation. Our attorneys are experienced in representing clients in state and federal courts, at both the trial and appellate level. Call us at 310-320-0725 now or submit an easy consultation request online. We are here to help!

claims made

Claims Made Policy: Consider This Before Terminating

While the insurance industry gets a bad rap—and sadly all too often with good reason—you probably usually feel good about knowing you have coverage in place in case something goes wrong, resulting not only in injury but sometimes opening you up to enormous liability too. There is also the possibility that expenses for such a loss could be catastrophic to your finances. Because of that, most of us are relieved to have insurance and the accompanying peace of mind, despite high premiums and the long list of complexities that accompany many policies.

Getting educated about what you need is critical. Although your insurance agent may be able to explain all the details to you, researching different types of coverage and features included in varying policies will benefit you greatly; for example, you may not understand the differences between the occurrence policy and the claims-made policy. The occurrence policy protects you with coverage even if a claim is made later after your policy has been terminated—as long as the claim is regarding an incident that occurred while your policy was in force.

And although you may be tempted to cancel your claims-made policy due to issues such as the need for broader coverage or better service from your insurance company, keep in mind that there are benefits to the claims-made policy that you may miss out on later; for instance, although the claims-made policy usually states that any claim must have happened during the time the policy was in effect only, there is exception to this with the extended reporting period.

Commonly referred to in the insurance industry as a ‘tail,’ you can purchase an ERP as an endorsement with your policy that may last anywhere from one to five years, or sometimes even as long as ten—and although it may be more expensive than the basic policy, it can be extremely effective for professionals like doctors in the case that a malpractice suit or other claims are brought forth after the policy expires. The ERP may also be referred to as optional or supplemental or be listed as a ‘discovery period.’ They may also be included in your original policy, but only for the very short term such as 30 to 60 days.

If you need help reviewing your insurance policy, or if you suspect your insurance company may be denying your claim in bad faith, contact the attorneys at the Bolender Law Firm. If a dispute over a claim cannot be easily resolved through a call or written communication, our attorneys will advocate on behalf of policyholders through litigation, arbitration, or non-binding mediation. Our attorneys are experienced in representing clients in state and federal courts, at both the trial and appellate level. Call us at 310-320-0725 now or submit an easy consultation request online. We are here to help!

Insurance topics

Insurance Topics: Attempts to Rescind Policies Are Not Always Successful

As we age and take on more and more in life, financial responsibilities just continue to grow, and insurance topics figure into many conversations. Along with all the typical consumer household expenses (and debt) such as the mortgage, student loans, auto payments, and credit cards that keep us beholden to a range of ongoing payments, insurance is another critical purchase that must be made and then maintained financially; in fact, in some cases—like auto insurance—it is required. But even if law doesn’t force you to purchase other types of insurance, they are critical for financial protection, as well as peace of mind.

Once you have explored all your options regarding an insurance policy, discussed different coverages with your agent, and taken the plunge to buy a policy that seems like a good fit for your needs, you probably feel in control and able to go on about your business knowing that your future is protected in the case of a catastrophe. Other times though, you may feel like you are at the mercy of the insurance company, even when you fulfill everything asked on your end—which mainly means filling out all paperwork truthfully and signing on the dotted line—and paying those premiums (which often may be hefty!) on time.

Frustration usually sets in if you have had a car accident or had a claim for property damage or professional liability, and the insurer is delaying payment or even denying it altogether for a policy that was in effect. And while it is always your option to terminate an insurance policy, you may be surprised to find out that the insurance company can actually attempt to rescind a policy from their end. Usually when something like that happens, the insurance company is claiming that there was incorrect or fraudulent information in the original application for insurance. They may even accuse you of lying or hiding information so that you could have the advantage of seeing a policy go into effect that might otherwise have been rejected.

A successful rescission of your insurance policy by the insurer means that essentially, it is as if it was never put in place to begin with. Your premiums should be refunded, and you should be notified quickly regarding the process. Such activity can be extremely disturbing if a rescission takes place after you filed a claim, and especially if you know you were honest in filling out your application. While the onus is on the insurer to check out your information before putting the policy in place, all too often they may perform investigations after a claim has been filed and rescind a policy to avoid paying out.

If you suspect your insurance company may be attempting to rescind your policy simply to avoid paying for the claim, contact the attorneys at the Bolender Law Firm.  If a dispute over a claim cannot be easily resolved through a call or written communication, our attorneys will advocate on behalf of policyholders through litigation, arbitration, or non-binding mediation. Our attorneys are experienced in representing clients in state and federal courts, at both the trial and appellate level. Call us at 310-320-0725 now or submit an easy consultation request online. We are here to help!

claim denied

Claim Denied Due to the Assault & Battery Exclusion

The purpose of insurance is very clear, and it is a financial one. In exchange for paying premiums that could be considered nominal in the long run should there be a major claim, you have the security of knowing that you are ‘covered.’ You may sleep better at night too like so many other policyholders do, dealing with all the stresses of home and business, but knowing that if there were an accident, a fire, a negligence claim, or even a major catastrophe, that the insurance company has agreed to take care of you.

The insurance policy can be complicated though, and one or more of yours may be so full of legalese that you feel like you are mired in trying to understand a different language upon reading it. Not only are there the usual basics such as your personal information and general coverage details, but insurance policies are often also full of a wide range of differing explanations of limits, conditions, riders, and endorsements which add extra protection. And although the individual who sold you the insurance policy may be experienced and knowledgeable, the rules of the insurance industry change so often that it is possible they may not even understand the policy fully.

Exclusions are common in insurance policies, spanning nearly every type; for instance, your homeowner’s policy may exclude damage from earthquakes or construction defects, while your automobile policy excludes other limitations regarding traffic accidents. Business and professional liability insurance may be even more complicated though, and there may be exclusions you never think you would have to worry about such as those pertaining to issues like assault and battery.

Assault and battery exclusions may arise in general liability, but usually such a policy is expected to pay claims for any type of bodily injury or property damage. Some insurance policies may clearly state, however, that they will not cover the insured if an assault and battery claim is filed asking for damages due to injuries. While it may seem understandable that the insurance company would want to exclude themselves from paying legal fees and damages for what could clearly be a criminal act, in many other cases the claim could be complicated and the terms ‘assault and battery’ could be used only technically, or as a complete stretch.

If you need help reviewing your insurance policy, or if you suspect your insurance company may be denying your claim in bad faith, contact the attorneys at the Bolender Law Firm.  If a dispute over a claim cannot be easily resolved through a call or written communication, our attorneys will advocate on behalf of policyholders through litigation, arbitration, or non-binding mediation. Our attorneys are experienced in representing clients in state and federal courts, at both the trial and appellate level. Call us at 310-320-0725 now or submit an easy consultation request online. We are here to help!

comprehensive insurance

Comprehensive Insurance and Collision: Know the Details

Car insurance (comprehensive insurance, for example) is usually a necessity, and one of the typical financial responsibilities most of us take on as soon as we purchase our first car. Not only can it be expensive in some cases, it can also be hard to understand as you wade through trying to figure out which details you need in a sea of different coverages, deductibles, limits, and so much more. While not every state asks you to carry insurance by law, California does require you to have the following:

  • Bodily injury liability
  • Property damage liability
  • Uninsured motorist bodily injury coverage

And while both collision and comprehensive insurance are optional, most of us have at least one or both; in fact, if you have financed a car they may require that you carry ‘comp and collision’ until the balance of the vehicle loan has been paid off.

No matter what types of insurance you are purchasing, it may be tempting to get the bare minimum with the lowest premiums—and as we all know, even that can be high! Collision insurance is not hard to understand, just based on the term itself. If you collide with someone or something—in an accident—your collision coverage (assuming your policy is in force and there are no other extenuating circumstances) will kick in whether you hit another car, an inanimate object, or even a pothole. Deductibles vary. You may not have one at all, but of course that raises the rate of your premium. If you have a $500 deductible in the case of a collision, you would have to pay that before the insurance kicked in to have your car fixed.

Comprehensive insurance covers collisions with different types of obstacles such as animals or falling objects. Along with that, you also have coverage for theft, vandalism, natural disasters, and more. There are limits as to how much it will cover, and again, you may or may not have a deductible—depending on how much you want to pay for a premium.

If you aren’t sure about what types of coverage are best for you, have an in-depth discussion with your insurance agent and consider how much your car is worth, how much time you really spend on the road, and what your budget can realistically afford, whether you pay your insurance by the year, quarter, or month.

Are you concerned about a recent accident, or are you trying to understand your insurance policy? If a dispute over a claim cannot be easily resolved through a call or written communication, the Bolender Law Firm will advocate on behalf of policyholders through litigation, arbitration, or non-binding mediation. Our attorneys are experienced in representing clients in state and federal courts, at both the trial and appellate level. Call us at 310-320-0725 now or submit an easy consultation request online. We are here to help!

ERISA

History: The Employment Retirement Income Security Act (ERISA)

The Employee Retirement Income Security Act of 1974 (ERISA) was enacted, plain and simple, to protect employees. This came about long after egregious acts by employers who mismanaged pensions and retirement plans—leaving long-term, hardworking employees with nothing in some more extreme cases such as that of Studebaker leaving thousands out in the cold in the early ‘60s. Pension reform was needed, but it did take time.

Throughout the years, ERISA has been amended several times as lawmakers work to refine it further to protect individuals in the US looking forward to the benefits they have been promised. And while pensions were not offered or expected by most before 1900, today they are a benefit many individuals seek—looking toward security in their later years. ERISA originally administered to a range of different tax and labor issues for employees and their retirement plans, but over time it has been expanded to include requiring minimum standards for other benefits like health and disability insurance, scholarship programs, training programs, and more.

“ERISA requires plans to provide participants with plan information including important information about plan features and funding; provides fiduciary responsibilities for those who manage and control plan assets; requires plans to establish a grievance and appeals process for participants to get benefits from their plans; and gives participants the right to sue for benefits and breaches of fiduciary duty,” states the U.S. Department of Labor.

Over time, ERISA has grown through critical amendments as well, such as the:

  • Consolidated Omnibus Budget Reconciliation Act (COBRA)
  • Health Insurance Portability and Accountability Act (HIPAA)
  • Newborns’ and Mothers’ Health Protection Act
  • Mental Health Parity Act
  • Women’s Health and Cancer Rights Act

Today three different entities administer ERISA: the IRS, the U.S. Department of Labor, and the Pension Benefit Guaranty Corporation. Whether you are an employer or an employee, you may have numerous questions about the complexities of ERISA and how it applies to you. If your benefit plan has been disrupted or denied, you may also need skilled legal advice form a law firm experienced in both insurance law and business law.

Contact the Bolender Law Firm. If a dispute over a claim cannot be easily resolved through a call or written communication, our attorneys will advocate on your behalf through litigation, arbitration, or non-binding mediation. Our attorneys are experienced in representing clients in state and federal courts, at both the trial and appellate level. Call us at 310-320-0725 now or submit an easy consultation request online. We are here to help!

delay tactics

Delay Tactics: Is Your Insurance Company Using Them?

Dealing with insurance companies can be challenging even in the best of times. The laws are complex, coverage requirements can be difficult to understand, and the policy you end up with may seem like it is written in a different language altogether—especially if there are exclusions, riders, endorsements, and more to sift through. And then there are the premiums (rarely on the inexpensive side) that you must keep up with faithfully, fearing cancellation if even one is missed or late. Purchasing and maintaining coverage may seem like an odious task but as consumers in the US, we usually fulfill these responsibilities to protect our families, ourselves, our possessions, livelihoods, and more.

The insurance industry rakes in billions of dollars each year, but they don’t always have a happy following of clients, and many are outspoken and critical to say the least. Most of us don’t enjoy buying a product that is intangible for the most part—and may feel like it is a complete waste of money to pay for years on end when you never even have to file a claim. If that has been your experience, you may be extremely frustrated when the time does come to file a claim and your insurance company is giving you the runaround. Undoubtedly, you are comparing their millions or billions of dollars in net worth with what you have and wondering why they feel the need to treat faithful customers so poorly—you included.

Insurance companies may use delay tactics such as disputing enormous bills that you need paid in the claim; for example, if you were in a car accident and the insurance company for the negligent party is supposed to pay out, they may dispute medical bills or scrutinize how long it took you to get treatment—eventually using that as a reason to drag their feet on even deny the claim altogether.

The reason they do so is built on a simple, but extremely profitable, business model: put as little time and effort into claims and investigations as possible and pay out as little as possible. Nearly everyone working in the insurance industry is enticed by bonuses and additional compensation—and this goes for adjusters too, who understand that the less the large corporations have to pay out, they more they can make too. Knowing that they are completely in the driver’s seat if you do not have legal representation, the insurance company may also delay just to wear you down into accepting a smaller settlement.

In the midst of such delays, remember that the adjustors are not your friends. They are there to save the insurance company as much as possible regarding claims. Beware of their attempts to speak to you instead of your attorney, as well as requesting access to medical records and asking if they can tape your conversations. They may also tell you to relax when it comes to hiring an attorney—why would you need one when you can work out a settlement with them all on your own? The fact is that you do need legal representation to see that you receive the compensation you deserve. Don’t try to go it alone, and especially if you think the insurance company might be acting in good faith.

If you need help reviewing your insurance policy, or if you suspect your insurance company may be denying your claim in bad faith, contact the attorneys at the Bolender Law Firm.  If a dispute over a claim cannot be easily resolved through a call or written communication, our attorneys will advocate on behalf of policyholders through litigation, arbitration, or non-binding mediation. Our attorneys are experienced in representing clients in state and federal courts, at both the trial and appellate level. Call us at 310-320-0725 now or submit an easy consultation request online. We are here to help!

claims made policies

Claims Made Policies and Occurrence Policies: The Differences

If you own an insurance policy (or two or three…), chances are it is either an occurrence or claims made policy. And as a business owner or a professional, when you begin working with an insurance agent to explore different policies, it is extremely important to know the differences and understand which will work best for you in terms of liability protection so that your livelihood is protected.

Protect Yourself as a Business Owner or Professional

Being in business for yourself offers so many rewards. You have the freedom to follow your dreams, control to develop your own products and services and innovations, create the schedule you want for yourself (and your team too), and perhaps even make a significant impact within your own industry. Along with that, you may have daily contact with the public and a growing client base. While that can be incredibly rewarding—and especially if you feel like you are making a difference in their lives—there may also be instances where you need protection; for example, if someone is injured on your property and you do not have the proper liability insurance in place, you could be completely drained financially trying to pay for the damages yourself.

Occurrence Policies

With an occurrence policy in place, coverage is provided as long as the incident happened while your policy was in force—and even if it is reported later (yet still establishing a date within the policy coverage period), you should still be covered. That applies even if once the incident that occurred during the policy period has later been canceled when the claim is made. To be clear, let’s say you had a policy in force from 2015-2016. Obviously, it has since been canceled, but a claim was just brought forth regarding a liability issue from 2016. The occurrence policy should cover it—and most general liability is written this way.

The Claims-Made Policy

The claims-made policy introduces some other nuances, however. You must have been continually insured when a claim was brought forth, and although the incident may have occurred outside of the coverage period, it is covered if the claim is brought forth while your policy is in effect. It is also possible to buy further insurance referred to as a ‘tail.’ This offers extended coverage is a claim is reported after the claims-made policy has been terminated. While this type of coverage is helpful for many professionals, and often for doctors, it is not available to everyone. Dealing with claims could be complex later too.

Contact Us for Help Now

If you need help reviewing your insurance policy, or if you suspect your insurance company may be denying your claim in bad faith, contact the attorneys at the Bolender Law Firm.  If a dispute over a claim cannot be easily resolved through a call or written communication, our attorneys will advocate on behalf of policyholders through litigation, arbitration, or non-binding mediation. Our attorneys are experienced in representing clients in state and federal courts, at both the trial and appellate level. Call us at 310-320-0725 now or submit an easy consultation request online. We are here to help!

business owners

Business Owners: Are You Covered for Workplace Injuries?

No matter what type of business you own, there is always the possibility of an injury in the workplace. While some sites are more prone to one or more of your team having an accident over the years while they work for you—whether you oversee a large construction crew, operate a restaurant, or any other type of company—it is critical that you have sufficient worker’s compensation insurance; and in fact, it is the law in California according to California Labor Code Section 3700.

Many different types of accidents can occur, and employees may be out of work for a range of different time periods—receiving either temporary or even permanent disability. The most common injuries that result in payments from workers’ compensation tend to be strains; for example, employees may pick up boxes or other materials at work that are too heavy and then sprain their backs or other areas such as the arms or wrists. Unfortunately, many of these injuries occur even after so many businesses have instituted their own injury and illness prevention programs as recommended by the Occupational Safety & Health Administration (OSHA).

Offering the proper education, information, and training to your employees regarding how to avoid injuries on the job can be critical to cutting down on incidents, and also helps promote a stable and safe atmosphere:

“Injury and illness prevention programs are not new, nor are they untested. Most large companies whose safety and health achievements have been recognized through government or industry awards cite their use of injury and illness prevention programs as their key to success,” states the OSHA website. “Convinced of the value, effectiveness, and feasibility of these programs, many countries around the world now require employers to implement and maintain them. These countries include Canada, Australia, all 27 European Union member states, Norway, Hong Kong, Japan and Korea. This initiative also follows the lead of 15 U.S. states that have already implemented regulations requiring such programs.”

The OSHA website also points out that “California began to require an injury and illness prevention program in 1991. Five years after this requirement began, California had a net decrease in injuries and illnesses of 19 percent.”

Even with programs available and heightened awareness though, accidents sometimes cannot be avoided—and that is where insurance comes into play (in so many other areas of coverage too for individuals and businesses in the US). Not only does workers’ compensation protect your employees by providing them with medical coverage as well as compensating them for wages, but as they accept it they also give up the right to sue you regarding the injury, making it indispensable coverage all around.

Your insurance agent will be able to inform you of California’s laws and requirements regarding worker’s compensation and you should be able to purchase your coverage through them. It is also available through the State Fund.

If you are having difficulty with workers’ compensation, contact the attorneys at the Bolender Law Firm.  If a dispute over a claim cannot be easily resolved through a call or written communication, our attorneys will advocate on behalf of policyholders through litigation, arbitration, or non-binding mediation. Our attorneys are experienced in representing clients in state and federal courts, at both the trial and appellate level. Call us at 310-320-0725 now or submit an easy consultation request online. We are here to help!