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Lawyer vs. Insurance Company: When Do You Need an Attorney?

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When it comes to insurance, there are few limits to what you can insure. Personal property, events, and even weddings have all been insured in the past. According to the California Department of Insurance (CDI), the state of California has the largest insurance market in the United States, with annual premiums of more than $340 billion.

That doesn’t mean that insurance (or the insurance industry itself) is without limits, however, and unfortunately these limits often don’t become clear until after you make a claim – especially when it comes to claiming the maximum amount. The good news is that California has more laws than any state in the country when it comes to protecting insurance policy holders. It’s also not uncommon for an insurance claim with legal representation to result in a larger pay out.

How much do insurance companies pay for personal injury claims?

How much insurance companies pay for a personal injury claim varies, dependent on different factors, which is why it’s important to read the fine print before signing an insurance policy. For example, if your car insurance premium covers up to $1 million in damages and personal liability, that does not mean you’ll get the full amount.

Insurance claims are also often capped by annual limits. According to, these caps can include access to services like hospital visits or prescription plans, and are defined by either a dollar amount or the number of visits. Once an annual limit is reached – and it doesn’t matter if it’s a new claim – then it’s your responsibility to cover the remaining costs. 

What happens when my car accident settlement exceeds the limit?

From an insurance perspective, one car accident counts as a single incident even if there are multiple injuries. If your insurance coverage only covers up to $1 million, then the amount for that single claim is divided among all of the parties injured and the cost of damages.

Each state mandates the minimum amount that insurance companies must cover. For the state of California, the minimum is one of the lowest in the country, at $15,000 for each person injured or killed in an accident, and $5,000 for property damage. It’s important to purchase additional insurance coverage to avoid paying out-of-pocket.

What does full insurance coverage look like?

Full coverage (including comprehensive and collision coverage) includes a $500 deductible, $100,000 for injuries you cause in an accident, up to $300,000 per accident, and $100,000 for property damage. This is often referred to as 100/300/100.

Insurance adjustor inspects car for damage - learn when you need a lawyer vs insurance company

What to do when an insurance company denies your claim

There are several reasons why insurance companies might deny a claim. One of the most common reasons occurs when taking too long to file the claim. Insurance companies legally have 15 days to respond after you submit a claim, but it’s your responsibility to make the claim in the first place.

Not providing enough evidence is also a reason to deny a claim. When submitting a claim, it’s important to include as much information and evidence as possible. Take pictures and record any personal information from the parties involved.

Not paying premiums on time – even one missed payment – is also a valid reason for an insurance company to deny your claim.

If your claim is rejected you can either appeal it, hire a public adjuster, or seek legal representation. Research your options to compare what a lawyer vs. insurance company can do for your claim. Although both professions are experts in understanding complex contracts and deciphering the fine print, a lawyer can provide you with more legal opportunities that insurance companies don’t have to disclose.

When do you need a personal injury lawyer?

It is against the law for an insurance company to unreasonably deny a claim (Cal Code of Regs 2695.7). However, unless there is evidence and a legal case to pay the full amount of a policy, it is likely that an insurance company will only pay what they deem as fair. Without a legal case supporting an insurance claim, however, there is little incentive for an insurance company to pay what you think is fair. With a valid case and skilled representation, this is when a lawyer vs. insurance company situation can be successfully resolved in your favor.

Avrek Law is here to help you understand your legal options when it comes to making your insurance claim. The consultation is free, and you’ll get expert advice from a law firm with $1 Billion recovered in over 45,000 cases. Contact us today – we want to hear more about your case!

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