We are personal injury attorneys who have achieved results for our clients in Joplin for over 40 years.
Insurance claims can involve property damage, car accidents, personal injury, or other losses covered by insurance policies. The insurance claim attorney’s job is to ensure that the insurance company honors its agreement and pays what is fair under the policy’s terms.
This is important because dealing with insurance companies can be overwhelming and confusing, especially when stressed by an accident or unexpected loss. Policies are often filled with legal terms and fine print, making it hard to understand your rights.
In a busy city like Springfield, where people rely on timely resolutions, having someone who can manage the process can help reduce stress and protect one’s financial well-being.
At Buchanan, Williams & O’Brien—Springfield, we help clients navigate insurance claim issues by reviewing policies, negotiating with insurance adjusters, and advocating for their rights when claims are delayed, underpaid, or denied.
We understand how insurance companies operate in Springfield and work closely with our clients to pursue the compensation they’re owed. Whether it’s property damage, personal injury, or other losses, we handle the details so our clients can focus on moving forward.
Understanding Insurance Claim Disputes
Dealing with insurance claim disputes can be stressful and complicated, especially when claims are denied after years of paying premiums. In Springfield, common disputes arise from auto insurance, homeowners’ policies, commercial property insurance, and business interruption coverage.
In addition, third-party claims, such as workers’ compensation subrogation or liability claims, can add further legal challenges.
Why Do Disputes Happen?
At the heart of most insurance disputes is how the policy language is interpreted. Insurance policies are detailed legal contracts with terms, exclusions, and conditions. Disagreements often happen when insurers deny claims based on unclear wording, alleged false statements, or exclusions within the policy.
Missouri law favors policyholders when the language in a policy is ambiguous (Ritchie v. Allied Property & Cas. Ins. Co., 307 S.W.3d 132, Mo. banc 2009). However, legal action may still be needed to enforce this principle.
Common Reasons for Claim Denials
Here are some common reasons insurers deny claims:
- Alleged false information on the policy application
- Filing the claim too late or missing proof-of-loss deadlines
- Disputes over the value of damages or coverage limits
- Exclusions for things like wear and tear, negligence, or natural disasters
Insurance adjusters work for the insurance company and assess damages and coverage. Sometimes, they undervalue claims or interpret the policy to minimize payments. If this happens, policyholders may need legal help to ensure adjusters follow Missouri’s Unfair Claims Settlement Practices Act (RSMo § 375.1000–375.1018), which prohibits tactics like unjustified delays, lowball offers, or improper investigations.
What Happens When Disputes Escalate?
When attempts to resolve disputes fail, legal action may be necessary. Most disputes are handled in Missouri state courts, but federal courts may get involved if the parties are from different states (diversity jurisdiction) and the claim exceeds $75,000 (28 U.S.C. § 1332). Our legal team is skilled in navigating state and federal courts to protect client rights effectively.
Third-Party Claims
Third-party claims, like workers’ compensation subrogation or liability disputes, often involve multiple parties, including employers, insurers, and third-party wrongdoers. These cases require careful handling to ensure our clients recover what they are entitled to under Missouri’s comparative fault and liability laws.
Legal representation is essential if your insurance claim is denied or underpaid. At Buchanan, Williams & O’Brien in Springfield, we advocate for fair interpretation of your policy and ensure the insurer follows Missouri’s regulations.
Bad Faith Insurance Practices
In Missouri, insurance companies must act in good faith and deal fairly with their policyholders. When they fail to uphold this duty—for example, by denying valid claims, delaying payments without justification, or conducting inadequate investigations—they may be acting in bad faith. Missouri law treats bad faith claims as separate from breach-of-contract claims, allowing policyholders to seek additional damages.
Examples of Bad Faith Conduct
Bad faith by an insurer can take many forms, including:
- Unreasonable delays in investigating or processing claims.
- Denial of valid claims without proper investigation or justification.
- Failure to communicate key information, such as policy exclusions or claim status updates.
- Unfairly low settlement offers, even when liability and damages are clear.
These issues can arise in various claims, including auto accidents, wrongful death, premises liability, and medical malpractice. When insurance companies act in bad faith, the financial and emotional impact on policyholders can be severe, especially when medical bills or property damage go unpaid because of insurer misconduct.
Legal Protections for Policyholders in Missouri
Missouri law gives policyholders specific protections under RSMo § 375.420. This statute allows policyholders to recover additional damages and attorney’s fees if an insurance company is guilty of a vexatious refusal to pay. This law penalizes insurers for delaying or denying payment without a reasonable cause or excuse.
To prove bad faith, policyholders generally must show:
- The insurer had no reasonable basis to deny the claim.
- The insurer knew or should have known that no reasonable basis existed.
- The insurer failed to act with the fairness and diligence required by the policy.
Missouri courts have upheld these principles in cases like Overcast v. Billings Mutual Insurance Co., where it was affirmed that policyholders can recover damages for emotional distress and other harm caused by bad faith conduct.
At Buchanan, Williams & O’Brien, we fight for clients in Springfield and across Missouri who insurance companies have mistreated. We thoroughly investigate claims, hold insurers accountable, and pursue litigation when necessary to ensure policyholders get the compensation they deserve.
Steps to Take When Your Insurance Claim Is Denied
A denied insurance claim doesn’t have to be the final answer—it’s your opportunity to act. Review the denial letter carefully to understand why your claim was rejected. Under Missouri law, insurers are required to provide clear reasons for their decision.
Here’s how to move forward:
- Request a Detailed Explanation: Ask your insurer for a written explanation that directly references your policy. This can help clarify their reasoning.
- Gather Supporting Documents: To strengthen your case, collect relevant paperwork, such as medical records, repair estimates, or incident reports.
- Submit a Formal Appeal: Write a formal appeal addressing the specific reasons for the denial. Include all supporting documents to back up your argument.
If your appeal is denied or the insurer doesn’t respond, you can file a consumer complaint with the Missouri Department of Commerce & Insurance (DCI). The DCI investigates claims of unfair practices under Missouri law (RSMo § 375.1000 et seq.) and may help resolve disputes without going to court.
If the issue persists, legal action may be necessary. At Buchanan, Williams & O’Brien, we help clients build strong appeals and explore legal options to fight unfair claim denials.
How Buchanan, Williams & O’Brien – Springfield Can Help
When your insurance claim is delayed, underpaid, or denied, having skilled legal support can be the key to getting the compensation you deserve. At Buchanan, Williams & O’Brien in Springfield, we have over 40 years of experience helping clients resolve insurance disputes quickly and effectively.
Free Case Review
We start with a free consultation to review your insurance policy, the reason for the denial, and all related documents. We identify any potential coverage issues, compliance problems, or signs of bad faith by the insurer. Acting quickly helps us preserve vital records, meet deadlines, and build a strong case for your claim.
Focused Legal Support
Our insurance claim attorneys provide personalized support, whether filing appeals, negotiating with insurance adjusters, or pursuing litigation if needed. We handle many claims, including denied homeowners’ insurance, underpaid auto coverage, and disputed business interruption claims. Our approach is tailored to fit your unique situation and Missouri insurance laws.
Clear Communication Every Step of the Way
We prioritize clear and consistent communication with our clients. You’ll receive regular updates on your case, honest advice, and answers to your questions. We ensure you’re informed and supported throughout the entire process.
Contact Our Experienced Insurance Claim Attorneys Today
Choosing the right insurance claim attorney stems from experience and dedication to client rights. At Buchanan, Williams & O’Brien, we leverage over 40 years of experience to fight for policyholders in Springfield, ensuring just compensation in personal injury and insurance claims. Our office is known for its strategic location and deep understanding of regional laws.
Our team stands ready to support clients whose claims have been delayed, denied, or undervalued. We offer a compassionate and ethical approach, underscored by our client testimonials, which highlight our commitment to achieving favorable outcomes.
Whether dealing with personal injuries or disputes with insurance companies, reaching out to us for a free consultation can make a critical difference in reclaiming what you deserve.
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