How to Resolve an Insurance Dispute

How to Dispute an Insurance Claim

Dealing with an insurance company after an accident is often the most stressful part of the recovery process. You pay your premiums with the expectation of protection, but insurance coverage disputes are incredibly common. Whether the insurer is lowballing your payout or refusing to pay a claim entirely, you have legal rights in North Carolina to challenge their decision.

At Paul Robinson Law, P.L.L.C., we help clients in Raleigh, Durham, and Chapel Hill navigate insurance claims and disputes. This guide outlines how to protect yourself and ensure the insurance company plays by the rules.

What is an Insurance Coverage Dispute?

An insurance dispute occurs when there is a fundamental disagreement between you and the carrier regarding the terms of your policy or the value of your losses. Most insurance claims and disputes fall into three categories:

1. Denial of Coverage: The insurer claims the accident or damage isn't covered under your specific policy.
2. Underpayment: The insurer acknowledges the claim but offers a settlement that doesn't cover your actual medical bills or repairs.
3. Bad Faith Delays: The insurer uses "stall tactics," failing to acknowledge your communications or dragging out the investigation without cause.

Your Rights Under NCGS § 58-63-15

North Carolina law provides strict protections against "Unfair Claim Settlement Practices." Under N.C.G.S. § 58-63-15(11), insurance companies are prohibited from committing acts that indicate a general business practice of unfairness.

Prohibited practices in North Carolina include:

• Misrepresenting pertinent facts or policy provisions.
• Failing to acknowledge and act reasonably promptly upon communications.
• Refusing to pay claims without conducting a reasonable investigation based upon all available information.
• Not attempting in good faith to effectuate prompt, fair, and equitable settlements where liability has become reasonably clear.
• Compelling insureds to institute litigation to recover amounts due by offering substantially less than the amounts ultimately recovered.

If your insurer has engaged in these behaviors, they may be in violation of North Carolina law, which can significantly improve your odds of winning an insurance appeal.

How to Dispute an Insurance Claim: A Step-by-Step Guide

If you find yourself in a situation where the insurance is refusing to pay a claim, follow these steps to build your case:

1. Request a Written Denial Don't accept a "no" over the phone. Demand a written explanation that cites the specific policy language the insurer is using to justify the denial or low offer.
2. Gather Comparative Evidence If the dispute is over value, get independent estimates. For property damage, get quotes from two or three reputable contractors. For personal injuries, ensure your medical records clearly link your treatment to the accident.
3. File a Formal Internal Appeal Most companies have an internal appeals process. Use your gathered evidence to write a formal letter. Be persistent and professional, and always keep a log of who you spoke to and when.
4. Escalate to the NC Department of Insurance (NCDOI) North Carolina residents can file a formal complaint with the NCDOI. While they cannot always force a company to pay, their intervention often prompts a more serious review of the file.

Frequently Asked Questions About Insurance Disputes

How do you negotiate an insurance settlement? 

Negotiation is about leverage. You provide the adjuster with "new information,” such as a secondary medical opinion or a more detailed repair estimate. That makes it harder for them to justify their low offer. Never accept the first check; it is almost always a baseline offer.

Do insurance companies prefer to settle out of court? 

Yes. Litigation is expensive and unpredictable for insurance companies. They generally prefer to settle out of court to avoid the costs of defense attorneys and the risk of a high jury verdict. However, they may wait until you hire a lawyer to offer a truly fair amount.

What are the odds of winning an insurance appeal? 

The odds increase significantly when you can point to a specific misinterpretation of policy language or a violation of N.C.G.S. § 58-63-15. Insurers are more likely to settle when they realize the policyholder understands their legal protections.

Why You Should Consult a Raleigh Insurance Dispute Attorney

Insurance companies have teams of lawyers dedicated to protecting their bottom line. You deserve the same. An experienced attorney can spot "bad faith" practices that a layperson might miss and can compel an insurer to settle fairly.

If you are struggling with insurance coverage disputes in Raleigh, Apex, or Cary, don't walk away from the money you are owed. At Paul Robinson Law, we understand the intricacies of North Carolina insurance statutes and how to hold carriers accountable.

Contact us today for a free, no-obligation consultation. Let us help you resolve your dispute and get the compensation you deserve.