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Insurance · Claim assistance
Denied, delayed or underpaid insurance claims
If your insurer has denied a claim, sent a reservation-of-rights letter or offered less than the loss is worth, you can push back before anyone files a lawsuit. Fernald & Zaffos reviews the policy and the insurer’s position, builds a documented response and files suit when the insurer will not do the right thing. We handle claims in California and Nevada.
Leads this practice
Brandon C. Fernald · Founding Partner
Founded the firm in 2009 after seven years at Norton Rose Fulbright. Admitted in California, Nevada, North Carolina and Illinois.
What we do before a lawsuit
Many disputes can be resolved before a lawsuit is filed. We help clients evaluate a denial or a low offer, review the policy and the insurer’s file, and push back with a well-documented position. That work can include:
- Reviewing your policy, endorsements and the denial or reservation-of-rights letter
- Finding coverage under every policy that may apply, including commercial general liability, property, professional liability and D&O policies
- Tendering claims and demanding a defense or indemnity
- Negotiating with adjusters and coverage counsel
- Filing suit when the insurer will not do the right thing
Reading a denial letter
A denial letter should name the policy provisions the insurer relied on. Put it next to the full policy, including every endorsement, and check each reason it gives. In California, an insurer that denies a claim must explain the reasons in writing and refer to the specific policy provisions and facts it relied on (Cal. Code Regs., tit. 10, § 2695.7(b)(1)).
A reservation of rights is not a denial
A reservation-of-rights letter means the insurer is handling the claim, or defending you, while keeping the option to deny coverage later. In a liability case, a reservation of rights can entitle you to independent counsel paid by the insurer when the coverage question could be controlled by how the case is defended (Civ. Code § 2860).
Claim-handling deadlines in California
The Fair Claims Settlement Practices Regulations set the pace an insurer must keep. Among other rules, an insurer must:
- Acknowledge a claim, provide forms and begin its investigation within 15 days of notice (§ 2695.5(e))
- Accept or deny the claim within 40 days of receiving proof of claim, or explain in writing why it needs more time (§ 2695.7(b), (c)(1))
- Pay an accepted claim within 30 days (§ 2695.7(h))
A missed deadline does not by itself win a case, but it is evidence of how the claim was handled. Nevada sets its own timing rules, including NRS 686A.310 and the Nevada Administrative Code.
Deadline
Don’t sign a release before getting advice
Accepting a final payment or signing a release can end the claim. Talk to an attorney first, especially if a deadline in the letter or the policy is coming up.
Common questions
Don’t see yours? Call (323) 410-0300.
My claim was denied. What should I do first?
Write down the date you received the letter, collect the full policy and every letter from the insurer, and don’t sign a release or accept a final payment until you have had advice.
What is a reservation-of-rights letter?
A letter in which the insurer says it is handling the claim or defending you while keeping the right to deny coverage later. It is not a denial, but it signals a coverage dispute.
Can you help before I file a lawsuit?
Yes. Much of our claim work happens before suit: reviewing the policy, tendering the claim, answering the denial and negotiating with the adjuster or coverage counsel.
What if the insurer offered less than my loss?
We compare the offer with the policy and your documentation of the loss. Depending on the policy, the dispute may go to appraisal, negotiation or suit.
Does more than one policy cover my loss?
Sometimes. A business may have coverage under general liability, property, professional liability or D&O policies. We look at every policy that may apply.
How long does the insurer have to decide my claim?
In California, generally 40 days from receiving proof of claim, unless it explains in writing why it needs more time. See our guide on how long an insurer has to pay a claim.
Related
Practice page
Commercial property and lost income after a covered loss.
The information on this page is general and is not legal advice. Contacting the firm does not create an attorney-client relationship. Prior results do not guarantee a similar outcome.