{"id":892681,"date":"2017-08-03T11:47:26","date_gmt":"2017-08-03T17:47:26","guid":{"rendered":"https:\/\/www.myconstructionexpert.com\/blog\/?p=892681"},"modified":"2017-08-03T11:47:26","modified_gmt":"2017-08-03T17:47:26","slug":"insurance-bad-faith-can-also-found-insurer-fails-properly-investigate-claim","status":"publish","type":"post","link":"https:\/\/www.myconstructionexpert.com\/blog\/insurance-bad-faith-can-also-found-insurer-fails-properly-investigate-claim\/","title":{"rendered":"Insurance Bad Faith Can Also Be Found When an Insurer Fails to Properly Investigate the Claim"},"content":{"rendered":"<p>Denise Sze | <a href=\"http:\/\/www.propertyinsurancecoveragelaw.com\/2017\/07\/articles\/bad-faith\/insurance-bad-faith-can-also-be-found-when-an-insurer-fails-to-properly-investigate-the-claim\/\" target=\"_blank\">Property Insurance Coverage Law Blog<\/a> | July 31, 2017<\/p>\n<p>Insurance Codes are regulated by each state, but ask any insurance company representative in any state and they will tell you it is an insurance company\u2019s duty to place the insured\u2019s interest ahead of the insurance company\u2019s interests; and the proper way to handle a claim is to find coverage wherever possible.<\/p>\n<p>Many of my clients have sought legal help because they feel that the insurance company has specifically failed in their duty to properly investigate their claim and put its own interests before the insured\u2019s. My clients tell me that their insurers have taken every opportunity to ignore the numbers provided by their contractors or evidence presented and gone out of the way to find a way to underpay or deny the claim. In these instances, it\u2019s important to scrutinize the insurer\u2019s claims handling practices to see if they properly investigated the claim.<\/p>\n<p>In California, \u201cWhen investigating a claim, an insurance company has a duty to diligently search for evidence which supports its insured\u2019s claim. If it seeks to discover only the evidence that defeats the claim it holds its own interest above that of the insured.\u201d<sup>1<\/sup><\/p>\n<p>What comes to mind are cases where insurers send their insureds to the Special Investigations Unit (SIU). An SIU claim is one where the insurance company believes specific factors are suspicious, such as a \u201ctheft occurring when an insured is not home\u201d. The insurance company then sends the claim to the SIU division which \u201cinvestigates the claim\u201d rather than \u201cadjust\u201d the claim. The SIU Investigator\u2019s job is then to report the claim to the California Department of Insurance within a certain timeframe if fraud is suspected and to \u201cinvestigate\u201d each suspicious factor that sent the claim to SIU. Judging by the number of inquiries I receive, more often than not these claims sent to SIU are denied because the investigation yielded by the insurer goes to show that the insured somehow could not overcome these suspicious factors. The most common reason for denial issued by the SIU team is that the insured misrepresented something that the insurer deems \u201cmaterial\u201d and the insurer denies the claim and voids the policy.<\/p>\n<p>Strangely, each factor that cited as\u00a0<em>suspicious<\/em>\u2014such as a \u201ctheft occurring while an insured is not home\u201d\u2014is often common sense:\u00a0<em>Burglaries happen more often than not when an insured is away<\/em>. Another suspicious factor that an insurer indicated was cause to send a claim to SIU was that the insured tried to settle the claim quickly. It\u2019s been my experience most insureds want to get a claim over with so they can move on after the loss.<\/p>\n<p>When litigating a lack of a proper investigation by an insurer in California, there is a jury instruction (CACI 2332) on point that deems it bad faith when an insurer fails to properly investigate the claim. CACI 2332 reads:<\/p>\n<blockquote><p>[<em>Name of defendant<\/em>] acted unreasonably or without proper cause if it failed to conduct a full, fair, and thorough investigation of all of the bases of the claim. When investigating [<em>name of plaintiff<\/em>]\u2019s claim, [<em>name of defendant<\/em>] had a duty to diligently search for and consider evidence that supported coverage of the claimed loss.<\/p><\/blockquote>\n<p>Policyholders must remain vigilant as to why claims are denied and whether their claim has been diligently and properly investigated by an insurer. Finding out and seeking help to see whether their insurer really looked to evidence that supports the insureds claim or if the insurer put the insurer\u2019s interests ahead of that of the policyholder may tell you whether your claim is subject to a bad faith cause of action in California.<br \/>\n_________<br \/>\n<sup>1<\/sup>\u00a0<em>Mariscal v. Old Republic Life Ins. Co.<\/em>\u00a0(1996) 42 Cal.App.4th 1617, 1620 [50 Cal.Rptr.2d 224].<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Denise Sze | Property Insurance Coverage Law Blog | July 31, 2017 Insurance Codes are regulated by each state, but ask any insurance company representative in any state and they will tell you it is an insurance company\u2019s duty to place the insured\u2019s interest ahead of the insurance company\u2019s interests; and the proper way to&hellip; <a class=\"more-link\" href=\"https:\/\/www.myconstructionexpert.com\/blog\/insurance-bad-faith-can-also-found-insurer-fails-properly-investigate-claim\/\">Continue reading <span class=\"screen-reader-text\">Insurance Bad Faith Can Also Be Found When an Insurer Fails to Properly Investigate the Claim<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[3],"tags":[9895,3],"class_list":["post-892681","post","type-post","status-publish","format-standard","hentry","category-insurance-claims","tag-advise-consult","tag-insurance-claims","entry"],"jetpack_publicize_connections":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Insurance Bad Faith Can Also Be Found When an Insurer Fails to Properly Investigate the Claim - Advise &amp; 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