A Client came to me for help help on a problem.
Through his work, he had purchased a small accident policy that was supposed to pay $10,000 in medical expenses and a small disability benefit for 6 month. He also insured his long-haul Kenworth tractor with the same company. Following a one vehicle accident that the Client believed was caused by faulty repairs leaking carbon monoxide into the cab, the Insurer denied all benefits, saying that the accident must have been caused by some unknown illness or disease. The same Insurer was unresponsive on the Client's claim for the total loss of his tractor leaving a voice mail with no further explanation that all proceeds would be paid to the lender.
I can remember the meeting where the Client shared his frustrations in how he had purchased the insurance to protect himself in case of an accident and how it had turned out to be worthless. Convinced that his problems were due to misunderstandings and a failure of communication, my recommendation was that he file a Complaint with the Alaska Division of Insurance. The Client's even more frustrated response was to say that he had!
With the Client having given the Insurer every opportunity to perform as it had promised, a lawsuit was filed for insurance bad faith. After a year, the Insurer finally paid the promised benefits in full, plus interest, plus additional damages.
The playing field between an insurer and its insured is not level. You have to play your hand smartly. See www.Junelawyer.com