Legal expenses insurance – what happens when insurance coverage is refused?
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If the legal expenses insurance does not cover the costs
Legal expenses insurance is designed to protect policyholders from the high costs of legal disputes. Anyone who gets involved in a private or professional conflict relies on the insurance company to cover lawyer and court fees. It is therefore all the more distressing when legal expenses insurance is suddenly denied or only partially covered.
In practice, it frequently happens that legal expenses insurance companies reject coverage for various reasons. Sometimes they cite allegedly insufficient prospects of success, other times waiting periods, exclusions of risk, or a supposedly uninsured matter. Policyholders then face the question of whether the insurance company's decision is lawful.
Rogert & Ulbrich represent policyholders nationwide in insurance law and examine whether the rejection of legal expenses insurance is valid and how insurance coverage can be enforced.
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3When does legal expenses insurance provide coverage?
Whether insurance coverage exists depends on the specific contract and the agreed-upon legal protection modules. A typical distinction is made between private legal protection, professional legal protection, Legal expenses insurance for traffic law matters or legal protection for tenants.
The decisive factors are whether the claim is covered by the agreed insurance policy and whether the legal dispute arose within the insured period. Furthermore, waiting periods may apply, which limit the duration of the insurance coverage.
Legal expenses insurance cannot arbitrarily refuse coverage. It is bound by the contractual agreements. Whether a Rejection Whether something is lawful often requires a precise legal analysis.
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Rejection due to lack of prospects for success
A common reason for rejection is the alleged lack of sufficient prospects of success for the intended legal action. However, the insurance company cannot arbitrarily decide on the prospects of success.
If legal expenses insurance refuses to cover costs on the grounds that the case has no prospect of success, it must be examined whether this assessment is justifiable. In certain circumstances, insured parties are entitled to a so-called tie-breaking or expert arbitration procedure.
This is precisely where the legal arguments of an experienced lawyer become apparent, as they can be crucial.
If your insurance company is causing problems – talk to lawyer Dario Kovac
Is your insurance company refusing to pay or delaying the settlement? Lawyer Dario Kovac He has been assisting clients with disputes with insurance companies, particularly legal expenses insurers, since 2019. His previous work at ARAG He is familiar with typical rejection strategies from practice.
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Cost coverage and scope of legal protection
Legal expenses insurance generally covers the statutory costs of a lawyer, as well as court fees and, if applicable, expert witness fees, within the agreed coverage limit. Nevertheless, disputes over individual items frequently arise.
Disputes can arise regarding whether multiple matters are involved, whether deductibles apply, or whether certain types of proceedings are covered by the insurance. Out-of-court costs can also be a point of contention.
A differentiated interpretation of the insurance terms and conditions is required here.
Obligations of the policyholder
Insured persons are obligated to report the legal dispute immediately and inform the insurance company of any significant circumstances. Furthermore, no costly measures may generally be initiated without the consent of the legal expenses insurance provider.
If the policyholder violates contractual obligations, the insurance company may, under certain circumstances, refuse or reduce coverage. Whether such a reduction is lawful depends on the degree of fault and the specific terms of the contract.
Practical examples from legal expenses insurance
In one case, the legal expenses insurance refused to cover the costs of an employment law lawsuit, arguing that the conflict had already begun before the policy started. However, after a thorough analysis of the facts, it was demonstrated that the relevant breach had only occurred after the insurance coverage had commenced. The insurance company then granted coverage.
In another case, the insurer refused to cover the costs, claiming there was insufficient prospect of success. However, a well-founded legal opinion demonstrated that the intended lawsuit had a reasonable chance of success. The legal expenses insurance ultimately covered the costs of the proceedings.
These examples illustrate that a rejection does not automatically represent the insurance company's final word.
Experience in insurance law – nationwide representation by our law firm
Rogert & Ulbrich specialize in insurance law and represent policyholders nationwide in their dealings with legal expenses insurers. Our firm reviews rejection letters, analyzes policy terms, and consistently enforces legitimate insurance claims.
We support clients in their private lives as well as in professional disputes and develop a clear strategy for enforcing cost coverage.
10 Questions & Answers about Legal Expenses Insurance
Have your coverage denial legally reviewed now.
If your legal expenses insurance refuses or limits coverage, you should not accept the decision without review. A legal assessment is particularly advisable when significant costs are involved.
Have your case reviewed by an insurance lawyer to determine if you are entitled to insurance coverage. Schedule an initial consultation to gain clarity about your options.
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