What is an insurance policy?
Well, OK, no one really asks that question - but they should, and they should have done it a long time before they call an attorney, and specifically to their insurance agent. A policy holder has an affirmative duty to read, and understand, his insurance policy. If he doesn't understand it, or any part of it, he must question either the agent or the company representative, as "immediately" as possible.
To simplify, an insurance policy has many different parts, and though there are many different types of insurance policies, generally speaking they all have the same or similar "parts." And, they are interrelated and frequently confusing.
The process starts with an application, and once completed the application is submitted to the insurance company, and underwriting begins. There are some policies which do not require underwriting, but for purposes of this question, lets presume that underwriting takes place. "Underwriting" is the process where the insurance company reviews the application and makes a determination whether the risk to be insured is something which it would undertake to insure. Depending upon the type of policy, and the amount, the insurer may obtain medical records, financial records, contact physicians, conduct a private medical examination if the applicant, obtain comparable evaluations of the property involved, and so forth. If the policy is issued, the application generally becomes part of the policy.
At the beginning of most policies is the "declaration page(s)." The "dec page," as it is sometimes called, identifies the insurance coverages provided by the policy, and the amounts of both the benefit to be provided or the risk to be insured, and the price.
Behind the dec pages is the policy "jacket," or text, which is actually the portion which explains the coverages identified in the dec pages. Generally speaking, there will be a list of definitions, and another list of exclusions. Beyond the jacket, there may be endorsements which modify the policy terms and conditions, or riders which amplify the text and endorsements. And, all must be read as one.
When a claim is made, a representative of the insurer's claims department will review the claim and the policy and decide if the claim is covered and, if so, to what extent. The claims representative may, then, issue a Reservation of Rights letter which explains the company's position on the claim and coverage -- or not.
It is sound practice to consult an attorney at the time the claim occurs, and have him assist you in the claims process, which begins with the first notice to the insurer. A smart approach is to consult with counsel and let him assist in making the claim. Whether a reservation of rights letter is issued or not, whether there is a prompt decision or not, the sooner you obtain the advice of counsel, the better.
If you have any questions, please contact Barry M. Feldman or submit an online form. He can assist you in understand your policy and the process. So, don't wait!