What is Insurance Coverage Law?

Daphne Mallory

Insurance coverage law deals with disputes about coverage that arise between policy holders and insurance companies. The subject matter of the conflict is any type of insurance policy that the policy holder pays for with the expectation of receiving certain benefits. When those benefits are not paid out by the companies after insurance claims have been filed, the policy holders may initiate lawsuits or hire attorneys for counsel on how to proceed. Some of the insurance policies that give rise to disputes include liability, health, and omissions insurance. Insurance coverage law sometimes overlaps with other areas of law, such as intellectual property and employment law, and it often includes contract law because insurance policies are written agreements.

A courthouse.
A courthouse.

Insurance claims are first handled by the insurance adjuster. The adjuster determines whether the claims should be paid by the insurance company according to the policy. If the adjuster declines to pay, he often forwards it to the attorney who represents the company in insurance coverage disputes. The policy holder may then pursue the matter with an attorney who practices insurance coverage law with the hopes of seeking a legal remedy in civil court.

Insurance claims are first handled by the insurance adjuster.
Insurance claims are first handled by the insurance adjuster.

Many lawyers who work in the area of insurance coverage law are litigators. They often try to negotiate with the other party, whether it’s the policy holder or insurance company, to resolve the matter. If both sides cannot reach a resolution, then the attorney represents her client in court, either providing litigation defense to the insurance company or litigation representation to policy holders who initiate the lawsuit. The attorneys on both sides have to review the insurance policy and prepare their case to argue that the policy holder’s rights should be protected in the case of the plaintiff’s attorney, or that the insurance company is not liable for coverage payments in the case of the insurance defense attorney. Judges and attorneys use regional and national laws to interpret insurance agreements and to determine their limits.

Insurance coverage law consists of transactional-based work in addition to litigation. Attorneys often analyze policies for clients prior to them signing agreements or when they have to file claims. Attorneys often interpret the legal language in the agreement and explain the rights and legal principles that pertain to the agreement for their clients. The goal is to determine whether a present or future claim is covered by the policy and what exclusions apply.

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