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10550 Independence Pointe Pkwy, Ste 200
Matthews, NC 28105
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(704) 759-6110

Semirog Law Firm, pllc is a personal injury and auto accidents law firm located in Charlotte and Matthews, North Carolina.   We are committed to providing quality legal services in a dedicated and cost-effective manner to all members of our community, regardless of race, gender, or national origin.

We have handled complicated litigation in the areas of personal injury, car wrecks, truck accidents, family and business law.  In addition, we have experience in real estate law and short-sale negotiations.

We offer standard and flexible billing arrangements for our clients, such as flat fee billing, hourly billing, and contingency fee billing depending on the type of legal matter.

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Read our blog where we post recents news in developments in the personal injury and car and auto accidents law in North Carolina.  Learn interesting facts and legal concepts that will help you in your daily life.

Unfair Claims Settlement Practices

Serge Semirog

Insurance companies and their representatives have one job: make money.  In the end, no matter how nice the representative may act, he or she is acting within the limitations of the practice so as to retain as much money as possible for the company.  Most adjusters are kind-hearted people that do want to help, but you should still be aware of possible unfair claims settlement practices. 

North Carolina Unfair Claims Statutes and Regulations fall under Unfair Trade Practices. The tactics can be put into three main groups: misrepresentation, time pressure, and unreasonable offers.

Misrepresentation

Have you ever heard an insurance policy that is just too good to be true?  If an ad has any claims that are untrue, the company is misrepresenting the offer.  If an insurance agent tells you lies about your policy, the company is misrepresenting the offer. And if an adjuster omits or excludes pertinent facts about your coverage regarding the issue, the company is misrepresenting the offer.  It is important that you read your policy to know exactly what you are entitled to, otherwise you must depend on the word of the adjusters.  For example, take a look at Pearce v. American Defender Life Co. Ins. where a pilot asked if his policy would cover accidental death while flying for the US Air Force when the representative responded affirmatively.  When he died, the beneficiary did not receive the money because it was not technically in the policy.  Thus, the suit came about for misrepresenting the terms and conditions of the contract.

Time Pressure

Adjusters will use time to dwindle your resolve, to wear you out and make you ready to accept the next offer, even if it may not be adequate nor reasonable.  Lynch and Associates, P.C. have made a wonderful table explaining the time frames NC Insurance Companies must abide by: see here. The main issue is that most of the limits are simply stated as "promptly," while in other states there is a strict number of days.  The only definition appears in the Prompt Pay Law which limits several of these actions to 30 days. Therefore, insurance companies cannot wait to acknowledge claims, communicate with the claimant, affirm or deny coverage, or settle for an extended period of time; doing such would be a delay of service and therefore an unfair trade practice. As a result, as seen in Mohr vs. Dix County Mutual Ins. Co., the claimant can pursue the company for unreasonable and vexatious delay. 

Unreasonable Offers

"Attempting to settle a claim for less than the amount to which a reasonable man would have believed he was entitled" is an unfair trade practice according to NC statutes ( § 58-63-15(11h) ). Naturally, the debate comes down to one question: what would a reasonable man believe?  On this, research shows that it is, naturally, on a case by case basis and determining that the offer is unreasonable is more difficult that one would think.  Quite often, an unreasonable offer is accompanied by a breach of other NC General Statutes such as unwillingness to properly communicate or investigate a claim.

Remember, the purpose of the insurance claim is to recover what you lost in an accident.  You are entitled to return to your original condition before the loss. Should you find that an insurance company is practicing any of the aforementioned unfair claim settlement practices, the NC Department of Insurance has a complaint form on their website. That being said, the Department of Insurance cannot act as your representative like an attorney.  For proper representation, feel free to give us a call so that we can FIGHT and you can WIN. 

 
tags Insurance Company, Settlement
By Serge SemirogGoogle +