Insurance Claims in California

What Are Insurance Claims?

Filing an insurance claim in California can be a stressful process. Every policy is different, and insurance companies may not pay you what you deserve. In many cases, hiring an insurance claim lawyer is necessary. This page breaks down the nuances of different types of insurance claims.

What Is a Property Insurance Claim?

A homeowner’s insurance policy is an agreement to protect the home from damage under specific occurrences. When you as a policyholder suffer a loss, you should find a dedicated California property insurance lawyer. Your legal advocate works on your claim to ensure that you receive the benefits necessary to repair or rebuild your California property.

If the insurer denies coverage or delays, policyholders should consult a property insurance attorney about a bad faith claim. If your claim goes to court and you win, you can often recover your court costs, attorney fees, and coverage benefits. There is also the possibility of recovering more money depending on the state laws under which you file your claim.

What Types Of Damage Claims Apply to Property Insurance?

Specific geographic regions impact the design of insurance policies. For example, Florida property insurance policies have more provisions for hurricanes versus earthquakes. 

California residents don’t generally have to worry about tornadoes or the other severe weather that impacts people in other states. According to Hippo, this means that California residents often pay lower premiums for their homeowner’s insurance. However, standard insurance policies do not cover several of the potential threats to your California property. These include floods, earthquakes, and wildfires. Additionally, the increase in wildfires over the last few years has led some insurers to raise rates or even cancel their fire policies. In fact, Cal Matters reports that new legislation was necessary to prohibit cancellation of policies immediately following a wildfire. In addition, homeowners who cannot find private fire coverage may be eligible for fire insurance through the California FAIR plan.

How to File a Property Insurance Claim in California

After you suffer a loss, you must contact your insurer as soon as possible. Taking this step begins the insurance claim process and gets things moving along. You need to notify your insurance company in writing or over the phone. From there, your insurer appoints a claim representative.

What to Expect Afterwards

Under California regulations, when you contact your insurance company to make a claim, several deadlines automatically kick in. First, the insurer has 15 days to acknowledge the claim, provide you with all necessary forms and assistance, and begin their investigation. Once you submit your proof of claim form, the insurer has 40 days to accept, deny, or notify you that they will need additional time. During this period, adjusters and other professionals may inspect the damage and estimate costs.

If the insurance company accepts your claim, they will offer you a settlement amount. Ideally, this will cover your repair or replacement costs, depending on your policy. However, sometimes the offer is much lower than you are expecting. If the insurer denies your claim or offers you an insufficient settlement, you may need to take further action. The California Department of Insurance recommends that you speak with the insurance company’s claims manager about your concerns. You can also contact the Department of Insurance through their phone hotline. In some cases, litigation may be necessary to resolve your claim.

What Is an Auto Insurance Claim?

Auto insurance claims involve requesting compensation from an auto insurer after an accident. Car accidents are incredibly stressful, especially if there are uncooperative responsible parties. However, your insurer’s job is to work on your behalf to secure compensation for repairs, injuries and other expenses.

What Do You Do After a Car Accident?

According to the Accident Guide from the California Department of Insurance, you may have several reporting requirements after an accident. First, you must notify the police. If there are any injuries, call 911 from the scene. For minor accidents, you have 24 hours to report the incident to either California Highway Patrol or the local police department. In addition, if there was damage of $1,000 or any injuries, you must also file a report with the California Department of Motor Vehicles. You have 10 days after the accident to submit this form.

In most cases, the next step will be a call to your insurance company. According to Wallethub, California is one of the 38 states that follows the fault model for insurance claims. This means that the at-fault driver’s insurance will pay for the damages. In some cases, you can file the claim with your own insurance, and they will seek reimbursement from the other party. However, you may have to file directly with the other driver’s insurance company. If the case ends up in litigation, California courts will apply a pure comparative negligence standard. Under this theory, you can collect damages even if you were mostly at fault. However, the court will decrease your award by the percentage of your fault.

Auto Claims Adjuster

Your auto insurance company will assign a claims adjuster to your claim report. Your adjuster acts as your representation in any mediation between you and all other involved parties. This insurance representative bears responsibility for investigating the claim and seeing that you receive compensation for any repairs or injuries.

Whether there are repair claims, personal injury claims, or you are dealing with someone who does not have insurance, your auto insurance adjuster should see you through the process. Your claims adjuster may recommend a garage to handle your vehicle repairs. They may also make arrangements for a rental vehicle if required. The most important thing to note is that your auto claim adjuster is your primary point of contact regarding the status of your claim in California.

Health Insurance Claims

California policyholders file health insurance claims when they seek reimbursement for medical services or treatments. When you obtain a medical service from a provider, your health insurance carrier should be notified directly. If there are any discrepancies in your claim, consider hiring a health insurance claim specialist attorney.

How Do You File a Health Claim in California?

There are two ways to file a health insurance claim on your behalf. The first is the medical facility notifies your insurer for you. You may be able to walk out of the facility without spending anything, but that depends on your policy. The other way is to file a health insurance claim yourself. Taking this route can occur when a health provider you use is not in your provider network. The facility may still file the claim on your behalf, but you may need to file it yourself.

Many people mistakenly assume that if their doctor recommends a treatment, their insurance will cover it. Unfortunately, this is not always the case. However, even if your health insurance company denies your claim, you do have some options. The L.A. Times reports that a surprisingly small percentage of patients appeal their denials. On the other hand, for those that do appeal, around 40% result in a reversal of the denial. If the appeal process does not resolve the issue, you may want to consider filing a consumer complaint with the California Department of Insurance.

Work with an Experienced Local Insurance Lawyer in California

If your health insurance provider refuses to honor a claim, seek out a qualified California insurance claim attorney’s help. An insurance claim attorney can help if you have been improperly denied coverage or sent a bill for a service you never received. We can even help you connect with an attorney across California state lines.

Submit a request online or call us today at (866) 345-6784 to get in touch with an experienced lawyer in your area!

How It All Works

Call us or answer the questions on this site. Your category, location, and additional information will help us connect you to a legal professional and we’ll send you the results instantly.

Which Areas of Law?

We have attorneys in over 20 legal categories to choose from.

How Much Does This Cost?

We don’t charge you to be connected. Some legal categories require upfront fees while others do not. The legal professional will determine this with you before you commit to anything.