Policyholders trust that their insurance companies will have their backs when disaster strikes. Unfortunately, these for-profit businesses often work against their customers. Insurers routinely deny, underpay, and drag their feet on legitimate claims in hopes that the policyholder will give up. The motive is clear: the less these companies pay out in claims, the greater their profits.

It does not have to be this way. Just because your insurance company has rejected your claim or made an unreasonably low offer does not mean that it is the last word. You can fight back by retaining a dedicated insurance dispute lawyer. Wallace Law works hard to help clients better understand how insurance claims work so they can receive the payouts they deserve.

Insurance Dispute Attorney Near Me

You can reach Wallace Law by phone or email. Our office is conveniently located at:

1414 N Taylor Drive
Suite 200
Sheboygan, WI 53081

You can find us just off Interstate 43 and Highway 23 near HSHS St. Nicholas Hospital and Taylor Drive Dental Care. If you need help getting here, just call and speak with our friendly staff.

How Do Insurance Claims Work?

An insurance claim is a policyholder’s request for the insurer to pay for damages that are covered under the policy. The request is, at least initially, straightforward: something has happened that causes damage or loss, and the policy (which is a contract with the insurance company) should require the insurer to pay for it. The policyholder will want to review their insurance policy and make sure the incident is covered.

There is typically a phone number that the policyholder must call to alert the insurer to the damage and begin the claims process. Notifying the insurer as soon as possible is essential to prevent further damage and to keep the insurance company from denying or underpaying the claim.

As soon as you initiate the claims process, you should start documenting everything. This includes:

The time, date, and subject of all phone calls with the insurer
Any written correspondence the insurance company sends you
Photographs and video recordings of the damage
Any police and accident reports concerning the incident
Any purchases you make to mitigate the damage (e.g. placing a tarp on a damaged section of the roof to prevent rain from coming into the property)

An insurance claims adjuster will be tasked with investigating, evaluating, and ultimately settling the claim. This may be done, for instance, by asking a series of questions and visually inspecting damage to the property. The policyholder should promptly respond to all communications and comply with all requests from adjusters and others.

Ideally, the process will result in an insurance claim payment that fairly compensates the policyholder for their losses. Of course, this does not always happen, and it may be necessary to hire an insurance claim dispute lawyer.

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Types of Insurance Claims

There are many different insurance claim types, with some common examples being:

Life insurance: A life insurance policy provides financial support to loved ones after the policyholder dies. Pursuing the life insurance claim process will help beneficiaries receive money for expenses, funeral and burial costs, and more.

Health insurance: You probably have either an employer-provided health insurance policy or one that you pay for yourself. Either way, a health insurance claim can help offset the cost of medical expenses for injuries, illnesses, and routine medical needs.

Property insurance: There are two main types of property insurance: homeowners insurance and renters insurance. Homeowners insurance pays for losses to your home due to various disasters like storms. Renters insurance covers personal losses when the dwelling in which you rent is damaged or destroyed.

Commercial property insurance: Similar to residential property insurance, commercial property insurance pays for damage done to commercial property. If you own an office, for example, you will want to make sure items you own inside the building are covered.

How Do I Submit a Claim to Insurance

If damage occurs that your insurance policy covers, it is your responsibility to report it to the insurer and start the claim process. An attorney can explain in detail how to submit a claim to insurance and assist you with the process. In general, the steps are:

Documentation: For property damage claims, and as soon as it is safe to do so, take as many pictures and record as many videos of the loss as possible. For other claims like life or health insurance, obtain important documents like the death certificate or copies of medical bills.

Mitigate the damage: This is a vital step for property damage claims. You should make reasonable efforts to prevent further damage, including by covering windows that have been broken, placing a tarp on damaged areas to keep rain out, and removing excess water from flooded areas. Document any expenses you make to do this and take pictures or record video of your mitigation efforts.

Review your policy: Take a close look at your policy and note the sections that pertain to your specific loss or claim. Pay special attention to your insurance claim deadline, as some policies will give you only a short amount of time to make a claim. Be mindful of the instructions outlined in the policy to initiate the claims process.

Submit the claim: Finally, you need to submit the claim per the rules and guidelines of your policy. Usually, it starts with a phone call to an insurance representative who will get you started. Follow their instructions and be responsive to requests for additional information.

Avoiding unreasonable delays, following the procedures outlined in your policy, and making complete and accurate submissions will improve your chances of receiving a fair payout and not having your insurance claim denied.

How Long Do You Have To Report a Claim To Insurance?

You must follow any deadlines or timelines stipulated in your insurance policy, or you will risk receiving an insurance claim denial. In general, you should report the incident as soon as you have taken the above steps such as documenting and mitigating the damage. If you are unsure what your policy requires, call the company and speak to a claims representative. You can also call our firm to speak with an insurance dispute attorney.

Who Handles Insurance Claims?

Every insurance policy differs, but in general, insurance representatives, agents, and/or adjusters handle claims. The person who is responsible for your claim will vary depending on what stage of the claim you are at. Your first contact with the insurance company may be with an agent or representative, who will open your file and then pass it off to someone else like an adjuster. Staying in constant contact with your insurance company, and requesting status updates if you have not heard from anyone in several days, is the best way to ensure prompt and efficient handling of your claim.

What Does an Insurance Claims Adjuster Do?

The primary job of an insurance adjuster is to investigate policyholder claims. This stage of the process is essential to resolving the matter, hopefully in the policyholder’s favor by way of a reasonable payout. You are most likely to deal with an insurance company adjuster fairly early in the process. Some more of their specific duties include:

Assessing the nature and amount of damage
Determining who was at fault or who should be held liable
Documenting how much damage was done and comparing it to what the policyholder reported
Negotiating a fair insurance claim settlement

As part of their investigation, adjusters must obtain information from the policyholder by asking questions about:

How the accident or loss occurred
Your role in the accident or loss
Whether anyone else was responsible for the accident or loss
The damage done to your property to anyone else’s property
Any injuries that you or others suffered

Although you should not lie to the adjuster, you should be mindful that the adjuster may use any information you provide to deny or underpay your claim. If you are unsure what to tell the adjuster, call our office before they visit and read our detailed page about how insurance companies pay out claims.

How Does the Insurance Claim Process Work?

Before you file your claim, you must get everything in order and prepare to begin the process. We recommend taking the following steps:

Inventory: Make an inventory of all items damaged, destroyed, or missing after the incident in question. If you can, find receipts or proofs of purchase to show that you owned these items and what their values may be. Keep a detailed list and update it as needed.

Proof of damage: Taking photos and recording videos of the damage is arguably the most important step in your insurance claim. If possible and if it is safe to do so, you may want to capture the damage as it is happening. But if not, then take photos and videos as soon as you can. Show the damage from different angles and err on the side of more rather than fewer pictures and videos.

Review your coverage limits and deductibles: As part of examining your insurance policy, you will want to focus on two important terms: coverage limits (the maximum amount the insurance company will pay for a covered loss) and deductibles (any out-of-pocket amounts you must pay before insurance pays). If you do not understand these, speak with an insurance claims lawyer.

Once you have taken care of the above, the claims process will go as follows:

You file the insurance claim with your insurance company: Following the steps listed in your policy, you will formally initiate the claim by filing.

The insurer will assign an adjuster to your case: You can expect the adjuster to inspect the site where the loss occurred, interview witnesses, and ask you insurance claim questions like the ones described above. Try to develop a friendly relationship with the adjuster to keep the process moving forward.

The adjuster will determine how much insurance claim money to pay: The adjuster will examine the policy limits, decide how much the loss is worth, and make a settlement offer if the loss is under the limits. The renter’s insurance claim process provides a good example of this. For instance, the renter’s policy may cover $20,000 worth of damage. If the value of the items in your apartment is determined to be $10,000, that amount is within the limit and will be paid. However, something more valuable like a rare piece of art may be outside the limit and not be covered.

You can negotiate the insurance claim payout: If you do not agree with the claim offer, you have the right to negotiate it. However, it is more beneficial to retain an insurance claim denial attorney at this point. Your attorney will review your policy, assess the damage, and determine the basis of the adjuster’s decision. If the adjuster undervalued your damage or made an unreasonably low offer, your lawyer will request a higher amount. But this step must be taken early to avoid complications with your payout.

You may appeal a claim denial: There are steps you can take with your insurer to file an insurance claim appeal internally. But beware of deadlines to do so. You should also be prepared to submit a detailed explanation of why you disagree along with supporting documents.

You may need to file a lawsuit against your insurance company: Ultimately, if the insurance company refuses to make a reasonable settlement offer in violation of your policy, you will need to file an insurance claim lawsuit. Our insurance dispute lawyers are ready to assist you.

How Long Do Insurance Claims Last?

Wisconsin state law establishes some important time frames that will affect your claim:

Prompt acknowledgment: Your insurer must act promptly on your claim by acknowledging it within 10 days of receipt. Regulations require that insurers promptly provide all necessary claims forms, instructions, and reasonable assistance to policyholders and claimants.

Prompt response: The insurance company must also respond promptly (which again is 10 days) to any communications you send which would normally require a quick response.

Investigating with all reasonable dispatch: The same regulations mentioned above require insurers to initiate and conclude a claims investigation with all reasonable dispatch. This phrase is not defined, but state law also requires that insurers pay claims within 30 days unless they can prove they do not have to pay. Generally, the insurer must notify you if your claim is being accepted or denied within a reasonable time after you have proven that a loss has occurred.

Why Do Insurance Companies Drag Out Claims?

Insurance companies know that time is of the essence when it comes to claimants getting the money they need to make repairs, pay bills, and receive what they are owed under the policy. Unfortunately they often take advantage of claimants’ desperation and deliberately drag out the insurance claim investigation process and other steps. The hope is that the claimants will simply give up, especially if they do not know the law or their rights as policyholders.

Although there may be legitimate reasons to delay the process, many times this is simply a stalling tactic. There are some steps you should take if you believe your insurer is taking too much time.

Insurance Claim Denied: What To Do?

If your insurance company denied your claim or otherwise failed to pay it, you may have the right to file a lawsuit. Insurance litigation involves these steps:

Understanding why you were not paid: Common reasons for denial include that the policy lapsed, that the policy does not cover the loss, errors with the application, damage that occurred before the claim was filed, failure to file on time, and alleged insurance fraud.
Finding out whether you have a case: Simply disagreeing with the insurance company is not a sufficient reason to file a lawsuit. However, if the insurer engages in bad faith practices (e.g. denying a claim without a good reason) or tries to drag out the process, you might be able to sue. Talk to our insurance claim litigation team to learn more.
Documenting everything about the claim: Start with a copy of your insurance policy, all correspondence and records exchanged between you and the insurer, receipts of anything you paid for to mitigate damage, appeals letters, and (for health and life insurance) medical records and the death certificate.
Contacting an experienced lawyer: We can review your case to determine if you have a valid insurance claim dispute. Once you retain our firm we get to work immediately to attempt to resolve the matter in your favor.

When Should I Consider Taking Legal Action?

Hiring an attorney early is the best way to protect your rights and maximize your payout. Doing so will avoid unnecessary delays and deadlines while making it easier to obtain the evidence you need to support your claim. Even if you are unsure whether you have a legal case, you should reach out to our team to discuss it.

Different types of claims require different considerations. For instance, health insurance is complicated and many claim denials turn on whether the policyholder requested coverage for something in-network or out-of-network. Knowing the intricacies of these terms, and the insurance laws and regulations that govern policies, is important. Our firm has experience litigating all types of insurance claims.

Fight Bad Faith Insurance: Tips to Help Increase Your Chances of Maximizing Your Insurance Claim Settlement

Improving your chances of winning a favorable insurance claim settlement starts with understanding bad-faith insurance practices. Bad faith is a term that refers to unethical insurer conduct such as unreasonably dragging out claims, denying valid claims without justification, lying to policyholders about their policies and coverage, and other attempts by the insurer to refuse to fulfill its obligations under the policy. Examples of bad faith include:

Making changes to your policy without notifying you
Undue delays in handling your claim
Inadequate or delayed investigation of your claim
Requesting excessive or unusual documentation
Illegal or fraudulent practices (e.g. making unlawful threats or misrepresenting the policy or the law)
Denying a legitimate claim without a good reason
Using false statements or outdated legal arguments to deny payment
Refusing to make a reasonable insurance claim settlement offer

An insurance claim lawyer can help you take the most advantageous legal course, which includes these options:

Arbitration: The terms of your policy may require that you first arbitrate the dispute, which means that a third-party arbitrator will hear arguments from you and the insurer and render a decision.

Litigation: Bad faith insurance litigation means filing a lawsuit against the insurer to compel it to do what was agreed under the policy.

Mediation: This is an out-of-court procedure, typically used after a lawsuit has been filed, by which a neutral third-party mediator attempts to facilitate a settlement but (unlike arbitration) does not make a decision.

Key Elements of an Insurance Dispute Lawsuit

The outcome of an insurance dispute turns on a few essential issues, which include:

Which forum is appropriate: Sometimes arbitration is the starting point for a lawsuit, but other times the matter can go straight to court. The issue then becomes whether state or federal court is the appropriate forum.

When the cause of action began: Understanding when the cause of action began (when the claimant had the right to sue) is critical for purposes of the insurance claim statute of limitations discussed below.

Procedural and strategic considerations: Your lawyer will consider questions such as which causes of action you should bring to court, how and when discovery should be used, and whether other parties should be named as defendants.

Interpreting the insurance policy: Whether there are amendments to the policy (e.g. endorsements) will affect the underlying claim. So, too, will the method by which the court resolves ambiguities in the policy or endorsements.

Available remedies and damages: The key considerations here are whether the insurance company will be required to pay for the loss, in what amount, and whether other damages (such as contractual or punitive damages) are appropriate.

From start to finish, a claimant who has filed an insurance dispute lawsuit can expect:

Both parties to hire lawyers, conduct investigations, and file and serve pleadings (e.g. the complaint) and motions (which request the court to take specific actions)
Discovery, which could be drawn out and may involve taking depositions
Retaining expert witnesses, who are professionals with scientific or technical knowledge who can explain complex subjects to a jury or mediator
The use of mediation or arbitration, as appropriate or as required under the policy
Ongoing settlement negotiations and discussions apart from mediation
Communications and updates from your lawyer
A trial date and dates for hearings on litigation-related matters like court motions

Things to Keep in Mind While Navigating the Insurance Claim Settlement Process

Most civil lawsuits, including those that involve insurance claim litigation, eventually settle. To make the most of the insurance claim settlement process and improve your chances of the best possible outcome, we suggest you:

Develop a negotiation strategy: Your lawyer should be prepared before the negotiation session begins with things like making an opening demand, knowing the range of acceptable settlement offers, understanding the key issues, responding to the insurer’s counter-arguments, and other factors.
Stay organized: Organization of all your insurance records, including written communications between you and the insurer, is key to making the best possible case during negotiations.
Don’t despair: Initial insurance company offers usually say very little about what you deserve or what a skilled insurance dispute lawyer may be able to negotiate for you. While no attorney is permitted to make false or misleading statements, they might use “half-truths” as permissible negotiation tactics to lowball you; the key is to let your attorney do their job and not get discouraged.
Remain patient: A good insurance dispute lawyer can help you get a fair settlement amount by staying patient and presenting strong arguments based on the facts of your case and the applicable law. You should resist the impulse to get to the bottom line quickly and let your attorney go to work for you.
Focus on a fair settlement value: In many negotiations, defendants typically compare percentages while plaintiffs are focused on the dollar amount. Your lawyer must have a clear strategy to calculate your fair settlement value and focus on getting you there.
Don’t leave critical non-economic damages until the last minute: Non-economic damages include claims like emotional distress which are more difficult to quantify in terms of a dollar amount. If the insurance company’s bad faith actions triggered anxiety, depression, and other psychological and mental health issues, you may have the right to sue the insurer for emotional distress.
Be clear about key issues and wary of preconditions or other bad faith negotiation tactics: Your lawyer should have an idea of the key issues in dispute between you and the insurance company, and should vigorously address these during negotiations. Some insurers attempt to use bad-faith negotiation tactics like attaching preconditions to the discussions, so be wary of these strategies and consult privately with your lawyer if you have questions about them.
Do not waste time: Discussing irrelevant topics, attempting to argue invalid points, or allowing the insurance company’s lawyers to antagonize you will simply waste time. The worst thing you can do is get upset and lash out at the other side’s attorneys, who are only doing their job by representing the insurer.

Things to Keep in Mind While Navigating the Trial Process

As you go through the trial process, keep these points in mind:

Develop a trial strategy: Work with your lawyer to develop a trial strategy and alternative strategies that will keep your response flexible. These may include tactics for selecting the right jury members, using discovery tools wisely, and knowing whether to mediate or move forward with litigation.
Don’t despair: Again, it is important to understand that sometimes negotiations do not work out, but it does not mean that you cannot get a fair outcome through the trial process. An experienced trial attorney can help present your case in court strongly and convincingly.
Understand the litigation process: Your attorney should be able to answer all questions you may have about the process, including estimated timelines and expected damages. Your lawyer must know and understand your goals thoroughly.
Avoid surprises: One of the main purposes of discovery is to prevent surprises at trial by obtaining as much information as you can about, for instance, the insurance company’s rationale in denying your claim. Your lawyer should have as much information as possible at all stages of litigation to represent you effectively.
Identify and prepare your key witnesses: Work with your lawyer to identify and prepare your key witnesses. These may be lay witnesses such as yourself and neighbors who can testify about facts (e.g. how the property damage in question occurred) as well as expert witnesses who can discuss more complicated topics with a jury.
Focus on key facts and legal arguments: To win an insurance dispute lawsuit, you need to get to the core of the dispute: it does not matter whether “you are right” or “the insurance company is wrong”; it matters whether your attorney can efficiently present your case to convince the court why the insurance company should compensate you for your damages.
Discuss post-trial actions: If you lose at trial, you may have the right to appeal. The insurance company may also appeal or it could decide it is not worth the fight and simply pay what the court orders.

What Is the Statute of Limitations on Insurance Claims?

In general, a claimant has only one year after the date that the loss occurred to file a bad faith insurance lawsuit. This deadline is known as the insurance claim statute of limitations. You may also be able to find this deadline described in your insurance policy. Some policies extend this deadline to two years, depending on the circumstances.

Regardless, it is imperative that you file your lawsuit within the applicable statute of limitations. If you do not, the insurance company and other defendants can ask the judge to dismiss your case. As a general rule, you should act sooner rather than later anyway to preserve evidence and present a stronger case. Read our page on Wisconsin insurance laws to learn more about the statute of limitations and other rules pertaining to specific types of insurance claims.

How Can an Insurance Dispute Attorney at Wallace Law Help Me?

When you retain Wallace Law, Attorney Justin Wallace, and his team will take care of all aspects of your insurance case from start to finish. More specifically, we will:

Communicate with the insurance company on your behalf
Work to reverse a claim denial so your loss gets covered
Fight for a higher claim payout if your insurer has underpaid you

Have Questions About Navigating the Insurance Claims Process? Contact Wallace Law To Learn More

You may have suffered a loss and are not sure how to file a claim. Perhaps you have initiated your insurance claim but you have run into a dead end. Or you may simply have questions about your legal options, including litigation and mediation. The good news is you do not have to take on the insurance company by yourself. To take legal action on your claim or to learn more about the claims process, contact Wallace Law today.

A Comprehensive Guide to Navigating the Insurance Claim Process: FAQs

Can I Submit a Claim to My Insurance?

To find out how to submit an insurance claim, check your policy. If you are unsure, you can call the company directly and ask for guidance. However, if your insurance company is refusing to handle your claim in a timely and professional manner, you can file a complaint with the Wisconsin Office of the Commissioner of Insurance.

How Many Insurance Claims Can You Make In a Year?

While there is generally no limit on the number of insurance claims you can make in a year, you may exhaust the total dollar amount of coverage if you make enough claims during the policy period. Check your policy for details.

What Are Health Insurance Claims?

Health insurance claims cover:

Inpatient medical services (requiring patient admission into a hospital or clinic)
Outpatient medical services
Emergency claims
Planned surgeries
Cashless claims (no upfront patient payment required)
Reimbursement claims (the patient pays upfront and requests insurer reimbursement)

Our firm can help with any disputes related to the health insurance claim process.

Can You File a Lawsuit Against an Insurance Company?

Yes, you can file a lawsuit against your insurance company for bad faith practices, for unreasonably delaying or denying a claim, for underpaying a claim, and for other illegal and unethical conduct. Learn more about how we can represent you.

Who Is the Claimant In an Insurance Claim?

The claimant is the policyholder who files a claim pursuant to the policy. Sometimes the claimant is a personal injury accident victim, but there are differences between insurance and personal injury attorneys you should know about.

What Can You Sue an Insurance Company For?

You can sue an insurance company for denying a health insurance, life insurance, or property insurance claim. The objective is to compel the company to pay what is owed under the policy. You can also sometimes seek other damages as well as attorney’s fees and court costs.

Why Does Insurance Go Up After a Claim?

Rate increases or surcharges are common after filing a claim. They can happen because the insurer views you as a higher risk or because the cost of doing business, in general, has gone up. A higher number of claimants in a given period will also likely cause rates to increase.

Which Is a Common Reason Why Insurance Claims Are Rejected?

A rejected claim has yet to be processed for payment because of a mistake. Clerical errors as well as missing or incorrect claimant information are often to blame for this.

How Much Can You Sue an Insurance Company For?

The amount of money you can sue for will depend on the type of policy, how exactly the insurance company breached its policy with you, and the consequences you suffered as a result. Talk with our legal team for more information.

How Much Does it Cost to Sue an Insurance Company?

With Wallace Law, you pay nothing unless you win. It is part of our commitment to serving those whose rights have been violated by unprofessional insurance companies. Reach out to us to get started today.

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Can Insurance Adjusters Lie to You?

No one likes to be lied to, especially by a professional who is responsible for determining whether your insurance claim is valid. If you have been injured in an accident and have a sizable claim, you may find the tactics used by an insurance adjuster to be accusatory, shrewd, and downright dishonest.

December 26, 2024

What to Do if Insurance Denied Roof Claim

You can navigate the challenges of dealing with an insurance company by understanding your policy and gathering compelling evidence to support an appeal. For more insights into handling insurance disputes, visit the Wallace Law guide on Wisconsin insurance disputes.

December 24, 2024

Our Results

We’ve recovered hundreds of thousands of dollars for clients who faced denied or underpaid insurance claims. Don’t leave money on the table: Hire Wallace Law today.

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$1,500,000

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Secured after insurance initially offered $200,000 for extensive hail damage.