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Austin Insurance Law Blog

Insurance adjusters are not your friends

While there are many advantages to owning a home in Texas, there are also many significant issues that can arise in the wake of a catastrophic event. If your home becomes damaged or destroyed due to fire, plumbing leaks or severe weather, your insurance company will send an adjuster to assess the damage and determine the eligibility of your claim. You may assume that the insurance adjuster is working with your best interests at heart, but unfortunately, we at the law office of Jon Michael Smith have observed that the opposite is more often the case.

According to The Law Dictionary, the job of an insurance adjuster is to minimize the amount of money the insurance company has to pay out to you for damages to your home. In other words, they work for the insurance company, not for you, and though they may appear pleasant enough when interacting with you, they are not your friends. 

What does it mean to be an underinsured driver?

Being struck on a Texas road by a driver who does not possess insurance can be a true burden for the driver who was wronged, as the other motorist’s lack of coverage can make receiving compensation harder. But what does it mean if a driver is underinsured? While a driver that has been struck by an underinsured driver can still receive compensation, it will not be up to the level the injured party would receive if the other driver had adequate insurance.

Esurance explains that some motorists, while they do carry car insurance, may possess liability limits that are too low to fulfill the medical or repair bills of an injured party. When an underinsured driver hits your vehicle, you can expect the other driver’s insurance policy to pay out to the policy’s limit and no more. You would end up with only a partial payment for your damages and injuries.

Understanding your health plan’s internal appeals process

As a Texas resident with a health insurance policy, you have the right to question your insurer’s decisions if the company denies you coverage or decides to terminate your relationship. The first step in the process involves requesting what is known as an “internal review.” Attorney Jon Michael Smith is well-versed in the methods health insurers often use to deny claims, and he has helped many clients facing similar circumstances pursue appeals and other solutions to meet their needs.

According to HealthCare.gov, your health insurer may deny your claim for any number of different reasons, but you are within your rights to question, and if necessary, appeal, your health insurance company’s decision to deny you coverage. Your insurer may, for example, deny your claim if you had what it considered to be a “preexisting condition,” meaning you had the issue before your insurer started covering you. It may do the same if it considers certain treatments not medically necessary or experimental in nature, among other reasons.

What should you know about long-term disability insurance?

As a Texan resident, you may have considered the uses of long-term disability insurance before. If you are suffering from an injury or ailment, you may be wondering how to make a claim. Jon Michael Smith, attorney, is here to help you through your journey with this type of insurance.

First of all, long-term disability insurance differs from regular insurance in one important way. Rather than covering one-time accidents that you eventually recover from, it is meant to cover chronic conditions or long-term injuries that may be with you for a long time. For example, if you get into an accident and become paralyzed, this could be covered by long-term disability insurance. The same goes for those who have an illness with an extremely long recovery period, or a condition that will be with you for life.

Your rights under ERISA

Employers typically present group healthcare plans as important employee benefits during the hiring and contract negotiation processes. Unfortunately, Texas insurers are not always enthusiastic about paying up — even when the people make claims for benefits that are well within the scope of the policies.

For those who come up against resistance while filing a claim, it is often important to realize that an important federal law protects the rights of employees. This often helps relieve some of the stress that comes from going against large, powerful institutions, such as insurance providers and employers.

Pros and cons of opting out of uninsured motorist coverage

The upside of rejecting uninsured motorist insurance in Texas is obvious to many people: it would likely reduce monthly auto insurance bills. The disadvantages of opting out are probably greater in most cases, although they could prove somewhat more difficult to enumerate and explain.

Many people see underinsured or uninsured driver coverage as supplemental to standard insurance policies: this is true, legally speaking. However, despite the fact that these insurance products are not mandatory, injured drivers routinely benefit from their coverage. 

Choosing a life insurance policy

Protecting your family financially is an important consideration. That is why, at the legal practice of Jon Michael Smith, our team does everything possible to hold Texas insurers to their promises. However, our ability to secure benefits or damages is limited by the scope of internal insurance company negotiations and courtroom proceedings. Choosing the right insurance policy could go a long way towards securing your family's future.

You might also want to look beyond insurance. Our life insurance dispute clients often suffer from an immediate lack of funds due to delayed or denied claims. While it may seem redundant, you might avoid this issue by keeping an emergency savings account to tide family members over until they resolve their insurance issue.

Holding insurance companies accountable for their promises

At our law offices here in Austin, we are proud to be part of the team supporting Jon Michael Smith in providing representation for people who are struggling with insurance companies' failures. Our goal with our clients from across central Texas and beyond is to guide them efficiently and compassionately through complex, frustrating appeals and trial processes.

Big insurance companies do not scare us away. When we take a case — regardless of the size of our opponents — we represent the interests of our clients patiently and tenaciously, always with an eye towards obtaining the compensation necessary to deal with disabilities and maintain reasonable standards of living. 

What is a life insurance contestability period?

Life insurance is an important precaution that can be of immense help to beneficiaries at a difficult time in their lives. The last thing you want to hear when you are in the position of having to make a claim is that the insurer is delaying or even flat-out denying your claim.

One common situation when insurers conduct a close investigation into a policy's documentation is when the death occurs within Texas' contestability period. The law allows insurers to investigate and contest claims that beneficiaries submit within two years after the policy takes effect.

What to do if your long-term disability claim is denied

If you have been diagnosed with a chronic condition that makes it difficult for you to continue working, you may rely on your long-term disability benefits to make ends meet. When you file a claim for long-term disability, the claim administrator over your case will determine whether there is sufficient evidence indicating that you suffer from a disability and truly deserve benefits. However, there are incidents where long-term disability claims have been denied, even when medical documents show that there is an actual case of disability. What do you do when your claim has been denied?

The Employee Retirement Income Security Act gives you the right to appeal your denied claim. First, you may want to request your file from the insurance company. This shows all of the evidence, such as doctors’ files, memos, charts and reviews, the administrator used to make his or her decision to deny the case. Now you can check for any incomplete information or miscommunication that may have occurred in your files. You can also get detailed medical letters from your physicians indicating your chronic condition and how it acts as a disability in your life. You can also include notes from your employer and people in your life who witness your struggle on a daily basis.

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Jon Michael Smith Attorney

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Austin, TX 78731

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