When you submit an insurance claim, you expect the insurer to make a reasonable effort to determine what happened, review the available evidence, and fairly evaluate whether coverage applies. Problems can arise when an insurer reaches a decision without obtaining important records, interviewing relevant witnesses, inspecting damage, or meaningfully considering evidence that supports the policyholder.
At Pribila and Fields, we represent Colorado Springs policyholders in disputes involving insurance bad faith. If an insurer fails to properly investigate a claim, the policyholder may have options for challenging the insurer's conduct and pursuing benefits that should have been paid.
There is no single investigation process that applies identically to every Colorado insurance claim.
A relatively straightforward property claim may require different investigative steps than a complex claim involving significant injuries, business losses, or disputed coverage.
Generally, an insurer should make a reasonable investigation based on the available information and circumstances of the claim.
Depending on the case, that investigation could involve:
The insurer's ultimate decision should be based on a meaningful evaluation of the claim rather than assumptions or an incomplete factual record.
Policyholders do not always know what an insurance company did behind the scenes before making its decision.
However, certain circumstances can raise questions about whether the investigation was adequate.
For example, an insurer may deny a Colorado Springs property damage claim without inspecting the damaged property. An adjuster might disregard photographs provided by the policyholder or rely on an expert opinion without considering conflicting evidence.
Other warning signs can include:
An unfavorable claim decision does not automatically mean the investigation was improper. The issue is whether the insurer reasonably investigated the facts before reaching its conclusion.
Colorado regulates how insurance companies handle claims.
Insurers generally cannot simply ignore relevant information and make arbitrary coverage decisions. Colorado law provides protections when insurers unreasonably delay or deny covered benefits, and claim-handling practices can become important when determining whether an insurer acted improperly.
A failure to conduct an adequate investigation may be significant because an insurer cannot reasonably evaluate a claim if it has not gathered enough information to understand what occurred.
Our Colorado Springs insurance bad faith attorneys can review the insurer's handling of a claim and determine whether an inadequate investigation may support further legal action.
Policyholders frequently provide insurers with documents they believe support their claims.
Depending on the type of loss, that evidence might include photographs, estimates, receipts, medical records, contractor reports, witness statements, or expert evaluations.
An insurer does not necessarily have to agree with every piece of evidence a policyholder provides. However, disregarding relevant information without reasonable consideration can raise concerns about the fairness of the investigation.
If you believe evidence was overlooked, keep a record of what you provided and when.
Email confirmations, upload receipts, letters, and other documentation can help establish that the insurer received the information.
If possible, communicate important matters in writing so there is a record of the claim-handling process.
Insurance companies often use experts when investigating claims.
For example, a property insurer may retain an engineer to determine what caused structural damage. Other claims may involve medical professionals, accident reconstruction specialists, accountants, or other experts.
Using an expert does not itself indicate bad faith.
Questions can arise, however, if an insurer selectively relies on an opinion while ignoring significant contrary evidence, provides the expert with incomplete information, or uses an investigation designed primarily to support a predetermined outcome.
The quality and independence of an expert's work can therefore become relevant in a disputed Colorado Springs insurance claim.
Policyholders may also obtain their own qualified professional opinions when appropriate.
If you believe an insurer has overlooked important evidence, begin by organizing the claim file.
Keep copies of the policy, claim correspondence, estimates, photographs, reports, and other materials related to the loss.
You may also consider:
Avoid relying exclusively on telephone conversations. Written records can be particularly valuable if a disagreement later develops over what the insurer knew and when it knew it.
Depending on the circumstances, a policyholder may be able to provide additional information and ask the insurer to reconsider its position.
This may be appropriate when the insurer made a decision based on missing or inaccurate information.
For example, suppose an insurer denies a Colorado Springs property claim because it believes the damage existed before the policy period. The policyholder may possess photographs, inspection reports, or repair records contradicting that conclusion.
Submitting that evidence could give the insurer an opportunity to reevaluate the claim.
However, repeatedly sending the same information without receiving a meaningful response may indicate that a different approach is necessary.
In some disputed claims, an independent expert can provide valuable evidence.
Whether hiring an expert makes sense depends on the type and value of the claim.
A construction professional might evaluate property damage. An engineer could address causation. A medical professional might provide an opinion concerning an injury or treatment. An accountant may be appropriate for certain business-related losses.
The objective is not simply to obtain someone who disagrees with the insurer.
A useful expert should be appropriately qualified and able to provide a well-supported opinion based on the available evidence.
An attorney can help determine whether expert analysis is likely to strengthen a particular Colorado insurance dispute.
Not every imperfect investigation establishes insurance bad faith.
Insurance claims can involve legitimate disagreements about coverage, causation, value, or the meaning of policy language.
However, an insurer's investigation can become important evidence when determining whether its conduct was reasonable.
For example, an insurer may have difficulty justifying a denial if it failed to gather readily available evidence that was necessary to evaluate the claim. Similarly, refusing to consider information contradicting the insurer's preferred explanation may raise questions about whether the investigation was genuinely designed to determine the facts.
Bad faith cases are fact-specific. The entire claim-handling record may need to be examined rather than focusing on one isolated mistake.
An insurer's claim file can provide important information about how the claim was investigated.
Depending on the litigation and applicable rules, relevant materials may help establish what information adjusters reviewed, what investigative steps were taken, how decisions were made, and whether important evidence was overlooked.
The timeline can be particularly revealing.
For example, records may show that a coverage decision was made before a critical inspection occurred or before requested documents were received.
Comparing the insurer's internal handling of the claim with the explanation provided to the policyholder can sometimes identify inconsistencies that deserve further examination.
The remedies available depend on the facts and legal basis of the claim.
A policyholder may seek payment of benefits owed under the insurance policy. When an insurer's conduct satisfies the requirements for additional claims under Colorado law, other remedies may potentially be available.
Determining what can be recovered requires examining the policy, the insurer's conduct, the benefits at issue, and the losses caused by the claim-handling practices.
Policyholders should not assume that every investigation error automatically results in additional damages. The conduct must be evaluated under the applicable legal standards.
You do not necessarily need to wait until every internal conversation with an insurer has failed before seeking legal guidance.
An attorney can review the policy, correspondence, investigation, and explanation for the insurer's decision.
Early review can be particularly useful when substantial benefits are at stake or when the insurer appears to be relying on an incomplete investigation.
It may also help you avoid inadvertently giving up rights or accepting a resolution without understanding the full value of the claim.
An insurance company does not have to agree with every policyholder, but it should reasonably investigate a claim before deciding whether benefits are owed. When an insurer ignores important evidence, relies on incomplete information, or fails to take reasonable investigative steps, its claim-handling practices may warrant closer examination.
If you are dealing with an insurance company that failed to properly investigate your claim in Colorado Springs, our attorneys are here to help. Call Pribila and Fields today or connect with us online to schedule a consultation.
Pribila and Fields, P.C. has successfully handled thousands of personal injury cases and tried scores of cases where an insurance carrier refused to pay fair compensation for injuries, losses or damages.
18 E. Monument Street
Colorado Springs, CO 80903
reception@pribila.com
Phone: (719) 888-3720
Fax: (719) 473-2542
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