Insurance companies have a duty to investigate all claims submitted by policyholders and employ claim representatives to investigate and resolve such claims. Claims representatives are the people responsible for fulfilling the insurance company’s promise of Good Faith and Fair Dealing.

In every contract there is an implied covenant of good faith and fair dealing that neither party will do anything which impairs the right of the other to receive the benefits of the agreement. This principle is applicable to policies of insurance.

The insurance company’s claims department is where the insurer’s promise of good faith and fair dealing is most exposed to allegations of negligence and/or bad faith conduct. Insurance claim disputes often arise out of allegations and issues such as:

• Wrongful interpretation of insurance coverage:

• Wrongful declination of insurance coverage

• Unsupported defenses; asserting a litany of boilerplate in Denial or Reservation of Rights (ROR) letters

• Waiver of policy provisions

• Failure to establish conflict screens in coverage disputes

• Late notice of claim and prejudice

• Negligent supervision and training

• Improper behavior or conduct (bad faith)

• Violation of Unfair Claims Practices Statute (Unfair Trade Practices)

• Reasonable expectations of the policyholder

• Unreasonable delayed payment

• Failure to perform a prompt and thorough investigation

Insurance companies have a duty to investigate all claims submitted by policyholders and employ trained claim representatives to investigate and promptly resolve such claims.