An insurance policy is, basically, a contract, by which one party (the insurance company) in consideration of the payment to it of a certain amount of money (premium) by a person or party (the insured) agrees to take on certain risks of the insured, and to pay to him or some other person or party a certain amount of money upon the happening of an insured event.  Most people are familiar with the more common forms of insurance, such as automobile insurance, homeowners insurance, and life insurance.  However, there are numerous other types of insurance contracts (policies) the interpretation and performance of which affect the insured, or a third party.  Other types of insurance policies include business liability, workers’ compensation, director’s and officer’s liability, professional liability, health benefits, and disability policies.

Each policy attempts to define the particular subject matter of the insurance, and the circumstances or events by which benefits can be claimed.  Also set forth in the contract of insurance are exclusions from coverage, by which the insurance company seeks to limit its obligations to certain categories or situations, and exclude all others.  It is, therefore, important for a person buying insurance to understand clearly what types of risks or situations are covered by the insurance, and which are not. 

Most insurance claims are paid according to the understood terms of the policy, and without incident.  However, because insurance policies are contracts, and like all contracts, are subject to interpretation and potential disagreement as to meaning, it is not uncommon for disputes to arise between a party insured, or one to whom benefits are due, and the insurance company which potentially must pay those benefits. 

When a dispute arises between an insurance company and a party seeking benefits, the dispute is usually of sufficient importance either financially or because it might act as a precedent for future claims of benefits, for it to be wise to seek legal advice or assistance.  There is a vast body of legal case law which has interpreted all sorts of insurance contracts under a variety of factual settings.  The language of an insurance policy is not always easy to read, to say nothing of understand.  Occasionally, insurance companies attempt to write their policies in “plain language” in an effort to make them more “user friendly.”  However, even in those situations, there are often disputes that arise as to what the policy really means. 

Attorneys who are experienced and familiar with the wording of the many types of insurance policies, and the manner in which these policies have been interpreted can counsel insureds, or potential beneficiaries of an insurance policy as to their rights, and if necessary, can seek to enforce those rights through legal proceedings in court.  Our law firm has several attorneys with decades of experience in insurance law both in the representation of insurance companies, as well as those making claims for benefits from an insurance company.