Insurance policies are intended to provide financial protection when an unexpected loss occurs. However, coverage disputes can arise over exclusions, policy wording, reporting requirements, the cause or value of a loss, and whether the policy was properly arranged in the first place.
Our Vancouver insurance claim lawyers routinely assist individual and commercial insureds in navigating the claims process, particularly where coverage is denied, delayed, or disputed. We have extensive experience dealing with insurers of all kinds, from multinational companies to regional and specialized groups.
We have also acted for insurance companies on a wide range of issues, including defending insurance claims, providing coverage opinions and representation, acting as conflict counsel, and handling subrogation matters.
If you need help with a denied, delayed, or underpaid insurance claim, contact our Vancouver insurance claim lawyers today.
Key Takeaways: Insurance Claim Disputes in Vancouver
An insurer’s decision to deny a claim is not necessarily final. The policy, denial letter, application, endorsements, exclusions, and claims record should be reviewed carefully.
Insurance disputes may concern whether coverage exists, the amount of the covered loss, compliance with policy conditions, or an insurer’s interpretation of an exclusion.
A claim may also arise against an insurance broker where requested or appropriate coverage was not obtained.
Insurance policies and legislation may impose strict notice, proof-of-loss, dispute resolution, and limitation requirements.
Our Vancouver insurance claim lawyers act for insureds and insurers, providing a practical understanding of the issues that can arise on both sides of an insurance dispute.
Types Of Insurance Claims We Handle in British Columbia
Our Insurance Claims team advises and represents clients in matters involving:
- Insurance coverage
- Denied or disputed claims
- Fire and flood losses
- Broker negligence claims
- Conflict counsel
- Policy interpretation
- Property and business interruption losses
- Subrogation matters
- Negotiation and alternative dispute resolution
- Insurance litigation
- And more
Understanding Insurance Law in B.C.
Insurance policies are contracts. The wording of the insuring agreement, definitions, exclusions, endorsements, statutory conditions, and declarations can determine whether a loss is covered.
The British Columbia Insurance Act establishes rules that apply to insurance contracts and claims in the province. However, the outcome of a particular dispute will depend on the type of insurance, the policy wording, the facts of the loss, and the conduct of the parties.
Our Vancouver insurance claim lawyers can review the full policy and claims record, identify the central coverage issues, and advise on negotiation, dispute resolution, or litigation.
Legal Assistance With Insurance Coverage Disputes
Determining whether insurance coverage extends to an incident, or the extent of coverage for an incident, is a common source of disputes in the insurance world.
Our insurance claim lawyers in Vancouver have experience providing opinions to insurers and insureds on the extent and application of coverage. We also represent parties in litigation, mediation, arbitration, and other dispute resolution processes involving coverage issues.
What Can Cause An Insurance Coverage Dispute?
Coverage disputes may involve:
- The interpretation of policy wording
- Whether the event falls within the insuring agreement
- The application of an exclusion
- Alleged misrepresentation or non-disclosure
- A material change in risk
- Late notice of a claim
- Failure to provide requested information
- Compliance with statutory or contractual conditions
- The cause of the loss
- The amount necessary to repair or replace property
- Business interruption and loss calculations
- Whether more than one policy responds
- And more
The insurer and insured may agree that a loss occurred but disagree about whether the policy covers it or how much should be paid.
Can An Insurance Claim Denial Be Challenged?
Yes, in some cases. A denial may be challenged where the policy has been interpreted incorrectly, an exclusion does not apply, relevant evidence has been overlooked, or the insurer’s factual conclusions are unsupported.
The first step is usually to obtain and review the complete policy, including all endorsements and schedules. The denial letter, application, broker communications, adjuster reports, expert reports, and proof-of-loss materials may also be important.
Read more about denied insurance claims and broker negligence.
Fire And Flood Insurance Claims
A fire or flood can cause extensive damage to a home, commercial property, inventory, equipment, and business operations. The claims process may involve emergency repairs, remediation, temporary accommodation, replacement costs, business interruption losses, and disputes over the cause or extent of the damage.
Our fire and flood insurance claims lawyers in Vancouver assist with issues such as:
Property Damage Valuation
Insurers and insureds may disagree about the cost of repair, whether property can be restored, the appropriate replacement materials, depreciation, or whether the property is a total loss.
Additional Living Expenses
A homeowner may have coverage for reasonable additional expenses incurred while the residence is uninhabitable. Disputes can arise over the amount, duration, and type of accommodation covered.
Business Interruption Losses
Commercial policies may provide coverage for lost income and continuing expenses after an insured event. These claims can require accounting evidence and careful interpretation of waiting periods, indemnity periods, limits, and exclusions.
Cause Of Loss Disputes
Coverage may depend on whether damage was caused by fire, flood, sewer backup, overland water, faulty workmanship, gradual deterioration, or another peril.
Expert engineering, environmental, accounting, or restoration evidence may be needed.
Broker’s Negligence Claims
Insurance is often obtained through a broker. On occasion, a broker may provide inadequate recommendations, fail to renew a policy, misunderstand the client’s instructions, or neglect to obtain the requested coverage. This can leave property, individuals, or businesses uninsured or underinsured.
If that occurs, a claim may be available against the broker for the difference between the coverage obtained and the coverage that should reasonably have been arranged.
Our Vancouver broker negligence claims lawyers have experience litigating these claims and assisting individuals and businesses after fires, floods, and other losses.
When Might An Insurance Broker Be Considered Negligent?
Potential concerns may arise where a broker:
- Fails to follow clear instructions
- Recommends insufficient coverage
- Does not explain a significant exclusion or limitation
- Fails to identify an obvious gap in coverage
- Does not submit an application or renewal on time
- Provides inaccurate information about the policy
- Fails to communicate a cancellation or expiry
- Does not make reasonable inquiries about the client’s insurance needs
A disappointing claim outcome does not necessarily mean that the broker was negligent. The broker’s obligations depend on the instructions, the nature of the relationship, the information provided, and the standard reasonably expected in the circumstances.
Providing Conflict Counsel to Clients in B.C.
An area of law unique to insurance is the dual-client nature of the relationship that defence counsel may have with an insurer and the insured.
In a liability claim, an insurer may appoint a lawyer to defend the insured. Although the insurer usually funds the defence, the insured remains a client. A potential conflict may arise when the interests of the insurer and insured diverge, including where certain allegations may fall outside the policy.
Our Vancouver insurance claim lawyers have experience advising when possible conflicts arise and acting as conflict counsel where separate representation is appropriate.
When May Conflict Counsel Be Needed?
Separate counsel may be considered where:
- The insurer has issued a reservation of rights
- Some claims are covered and others may not be covered
- The insurer and insured disagree about litigation strategy
- The claim may exceed the policy limits
- The insurer alleges misrepresentation or breach of a policy condition
- Settlement decisions may affect the insurer and insured differently
Whether separate counsel is required depends on the particular facts and the nature of the potential conflict.
Negotiation And Alternative Dispute Resolution
In many contexts, an insurance issue may require arbitration, appraisal, mediation, or another alternative dispute resolution process before or instead of litigation.
Our Vancouver insurance claim lawyers are experienced in representing and advocating for clients’ interests in these processes and can assist outside of court as well. We can assist with:
- Negotiation: A negotiated resolution may be possible after the parties exchange documents, expert opinions, repair estimates, accounting evidence, or legal submissions regarding coverage.
- Mediation: Mediation allows the parties to explore settlement with the assistance of a neutral mediator. It can be useful where the dispute involves several coverage, valuation, or factual issues.
- Statutory Dispute Resolution: Section 12 of the British Columbia Insurance Act provides a dispute resolution process for certain disagreements about matters such as the value of insured property, the amount of a loss, or the adequacy of repairs or replacement. The availability and suitability of this process will depend on the nature of the dispute.
- Litigation: Court proceedings may be necessary where the parties cannot resolve a dispute involving coverage, policy interpretation, broker negligence, damages, or another substantive issue.
Our Litigation and Dispute Resolution team represents clients in complex disputes and works toward efficient, practical, and cost-conscious resolutions.
What Should You Do If Your Insurance Claim Is Denied?
Request a written explanation identifying the policy provisions relied upon. Obtain a complete copy of the policy, including the application, declaration pages, endorsements, exclusions, and renewal documents.
You should also:
- Keep all letters and emails exchanged with the insurer or broker
- Preserve photographs, video, damaged property, and repair records
- Retain receipts and invoices
- Keep notes of conversations with adjusters and representatives
- Obtain copies of expert and adjuster reports where available
- Review all deadlines stated in the policy or denial letter
- Seek legal advice before signing a release or accepting a final payment
Continue taking reasonable steps to protect the property from further damage, where it is safe to do so. Document those steps and retain the related invoices.
Are There Deadlines For Insurance Claims In BC?
Yes. Insurance policies and the British Columbia Insurance Act may impose deadlines for reporting a loss, providing a proof of loss, participating in dispute resolution, and starting legal proceedings.
The applicable deadline can vary by policy and type of insurance. The general Limitation Act may also be relevant in some disputes, including claims against brokers or other professionals.
Do not assume that negotiations or an ongoing adjustment have suspended a limitation period. Obtain legal advice promptly if a claim has been denied or a deadline may be approaching.
Frequently Asked Questions About Insurance Claims in British Columbia
Why Was My Insurance Claim Denied?
An insurer may rely on an exclusion, alleged non-disclosure, late notice, insufficient documentation, a material change in risk, or a conclusion that the loss was caused by an uninsured peril.
A denial letter reflects the insurer’s position, but it does not necessarily determine the legal outcome. The decision should be assessed against the complete policy and the available evidence.
What Is A Reservation Of Rights Letter?
A reservation of rights letter advises that the insurer is investigating or defending a claim while reserving the right to deny some or all coverage later.
The letter should be reviewed carefully because it may identify a potential coverage dispute or conflict between the insurer and insured.
Can I Accept A Partial Insurance Payment And Still Dispute The Balance?
That depends on the terms attached to the payment. Before accepting or depositing funds, determine whether the insurer requires a release or treats the payment as a full and final settlement.
Legal advice from an insurance claim lawyer may help preserve the right to pursue the disputed balance.
Can I Sue My Insurance Broker Instead Of The Insurer?
A claim may be available against the broker where the insurer correctly denies coverage because the required policy was never obtained or an important gap was left in place.
In some cases, claims may be advanced against both an insurer and a broker in the alternative. The appropriate approach depends on the policy, the broker’s instructions, and the reasons for denial.
Does An Insurer Have To Pay Every Claim Made Under A Policy?
No. Coverage is governed by the policy’s terms and applicable law. An insurer may deny a claim that falls outside the insuring agreement or within a valid exclusion.
However, insurers must assess claims based on the policy and the available evidence. A disputed interpretation can be reviewed through negotiation, dispute resolution, or litigation.
How Do Vancouver Insurance Claim Lawyers Help?
Our lawyers can interpret the policy, assess the denial, organize the evidence, obtain expert opinions, communicate with the insurer or broker, provide a coverage opinion, negotiate a resolution, and represent the client in mediation, arbitration, or court.
Speak With Our Vancouver Insurance Claim Lawyers Today
Insurance disputes can involve dense policy language, technical evidence, significant financial losses, and strict deadlines. Early advice can help clarify the issues and prevent steps that could affect your rights.
Our Vancouver insurance claim lawyers advise individuals, businesses, insurers, and other parties on coverage, broker negligence, conflict counsel, subrogation, negotiation, alternative dispute resolution, and litigation.
Contact Watson Goepel or call (604) 688-1301 to discuss your insurance claim and learn more about your legal options.
