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Month: April 2014

What are the Steps in Filing a Complaint for Unfair Insurance Practices?

Evil insurance agent being glad of palming off a contract to with intention to uphold it to his clients
Evil insurance agent being glad of palming off a contract to with intention to uphold it to his clients

In California, the insurance codes have laws established that apply to car insurance companies. Many are designed to punish companies that have engaged in unfair practices. The Department of Insurance is unable to force insurance companies to pay claims that are deserved by claimants. But the individual does have the ability to file a DOI complaint, assuming they are not already represented by an attorney.

The DOI will claim you are not without a remedy since you have an attorney. So this really only applies to people who are trying to battle their case with no outside counsel. In any event, this is good stuff to know. And we recommend that every consumer facing an insurance company peruse through this document to familiarize themselves with the rights, duties, and obligations of both insurers and claimants.

What are Unfair Claims Practices?

First, what the heck is an unfair practice? Well, unfair practices by insurance companies may involve misrepresentation of insurance policy provisions related to coverage and claimants. Insurance companies can be acting in bad faith when they attempt to put off, deny or delay settling a fair claim. So when the objective requirements have been met they cannot escape paying. One example would be when the insurer fails to acknowledge or act within a reasonable amount of time. So upon the communications of the damaged party, when a claim has been filed against an insurance policy. they must act.

Also, it applies if the insurer fails to settle when it is clear that there is compelling evidence they are liable, or offers a paltry amount. If it shocks the conscience and is far from similar case payouts, it may trigger action.

What is the Insurance Code for Unfair Practices?

The California Insurance Codes that apply for unfair practices is Insurance Code 790.03 (h), which is the Unfair Practices Act. This act details various actions by an insurance company. These are actions considered unfair practices against policy holders and claimants. The Department of Insurance is responsible for enforcing the standards insurance companies must practice being within the law.

What are Other Unfair Insurance Practices?

The failure to settle claims promptly, when it has become apparent under the insurance policy coverage there is liability under the ACT, it applies. Also, it comes into play when it influences settlements under portions of the policy coverage. If they fail to promptly to provide a reasonable explanation for the denial of a claim or offer a settlement, they are on the hook. If an insurer or adjuster directly tells a claimant not to involve the services of a lawyer it may also apply.

How Do I File a Complaint with the California Department of Insurance?

Filing a complaint with the California Department of Insurance should not be done prior to contacting the insurance company. You must first attempt to resolve the problems that exist in the claim process. So if this is not successful, the claimant can file a request for assistance. Or a victims may file a complaint form with the Department of Insurance.

Along with this request there should be documentation. Also, if supporting documentation is not included with the complaint or request it could result in a delay. Documents that should be included are the declaration page from your insurance policy, if you are bringing a claim against your own insurance company. Also, any cancelled checks, the denial letter and any other documents that pertain to proving the claim or communications must be sent.

Original documents should not be sent with the complaint or request. And original photos should not accompany either of these documents. After all, they are evidence.  And it most likely will not be possible to get them back. Copies are important to send of evidence and photographs to help in the review of the insurance company practices by the Department of Insurance.

When a request or complaint is filed with this agency, a copy of the request is generally provided to the insurance company, broker or agent. But not if the person who files the complaint requests that they do not want a copy forwarded. Attorneys usually suggest that a copy of the request or complaint get forwarded to the insurance company by the plaintiff.  Here is a copy of the fill-able PDF complaint form.

The California Department of Insurance can be contacted at:

California Department of Insurance Consumer Communications Bureau
300 South Spring Street, South Tower
Los Angeles, Ca. 90013

They can be contacted between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday at:
1-800-927-HELP (4357) or 213-897-8921.

Night Club Bouncer Assault and Unsafe Building Hazards

Negligent Unshaven Security Guard - Bouncer
Negligent Unshaven Security Guard – Bouncer

Gatherings at night clubs or bars are thought of as a way to have fun with a friend or group of friends. People do not expect to be hurt when visiting these types of establishments. In fact, they expect the bouncers to keep order and the building to be safe. But consuming alcohol diminishes inhibitions, and this can lead to problems. The other way injuries can occur when the building itself is unsafe.

Slip and fall injuries are the most common type of harm that patrons often suffer, which can include head trauma, broken bones or sprains. These types of incidents happen due to a defect or failure by the property owner or management to maintain the building properly. The other types of harm that can occur may include criminal conduct in the form of assault, battery or rape, and rare cases death.

What is The Function of Security Guards?

Patrons of a nightclub or bar are not concerned with criminal danger. After all, these establishments usually have security guards that are referred to as bouncers to protect them. The function of these employees is to ensure patrons are safe while they are in the establishment. If so, should the situation arise they must peacefully try to diffuse the situation? They are usually large men with presence enough to keep patrons from misbehaving. So the bouncer is usually the employee who will have contact and cooperate with the police in situations where the police are involved.

As part of their employment even when defusing a situation, the bouncer is expected to refrain from using emotions when dealing with patrons who may behave badly. In some instances, the security the establishment has hired step over the line of their intended functions in controlling dangerous situations. If so, when it crosses the line between crowd control and assault of patrons liability attaches.

What Are Bouncer Assaults?

There have been reported incidences and arrests made in situations where bouncers have assaulted patrons of nightclubs or bars. One occurred in Worcester Massachusetts where a security guard was arrested for armed robbery, kidnapping, along with assault and battery. In this incident, a video went viral on the internet, of the security guard/ bouncer was seen punching the patron and then robbing the person in the bathroom of a strip club. The bouncer later said he believed the man was dealing drugs in the club.

An incident occurred in Muhlenberg Township, Pennsylvania in a night club saw a bouncer kick a person out of the club. This resulted in the patron hitting his head on the sidewalk. The man required emergency surgery. The bouncer was arrested and charged with assault and endangerment.

In Lawton Kansas, a veteran was attacked by a bouncer in a night club, with the soldier being beaten to the point that his face was fractured. He required facial reconstructive surgery after being injured by an improvised explosive device before this beating. Police suspected this bouncer of two other assaults that occurred at the same club.

In Henderson Kentucky, a patron ended up dead after complaining about his drink. Police observed a photo that was taken the same night as the altercation, where one of the security team can be seen holding a baton. Police believe it is the same baton that witnesses claim was used to strike the man who had complained about his drink. The bouncer was arrested, charged with murder and released on $50,000 bail.

In the event a bouncer harms a patron, they can be criminally charged, and the patron who was hurt may be able to bring a lawsuit against the bouncer and the night club or bar. The bar or night club owner can be held liable for negligent infliction of emotional distress, negligent entrustment, negligent retention, dram shop and in the event of death they can face a wrongful death.

What is Security Negligence?

Negligent security can occur when the bouncer does not perform his or her functions they were hired for properly. So the result is a patron being harmed. Most of all, this is one of the most common claims by visitors to these establishments. Namely, the security guard or bouncer failed to take action. Because of this, the patron was not protected from being harmed. This can also be used when a bouncer attacks a patron.

What is Owner Premises Liability?

When a guest of a nightclub or bar is hurt, under the legal theory of premises liability the individual has a claim against the owner. Premises liability in the state of California outlines that the owner of a property has a duty to provide reasonable safe conditions and prevent any foreseeable harm to any visitor to the business.

Negligent actions by the employees of a bar or nightclub owner in the performance of their duties, which their actions cause injuries to a patron, the owner may be held liable. This could be as simple as security being alerted by a patron of a spill and it is not cleaned up but results in another patron having a slip and fall incident that causes harm. Then the owner of the establishment could be held liable for negligent premises liability.

How Do Dram Shop Laws Apply?

Dram shop laws are on the books in 42 states and the District of Columbia, which hold the owner of the establishment and servers responsible if a patron injured another person within their establishment. In the case of a bar or nightclub, the owners and servers may be held liable if they permit a patron to become visibly intoxicated at the establishment.

What are the Wrongful Death Dangers?

When there is an incident at a nightclub or bar that result in the passing of a patron, this will mean that negligence or wrongdoing of another person. Wrongful death claims in California are brought by the spouse, children, grandchildren, domestic partner, other dependents or personal representative of the deceased individual. The heirs will be awarded damages in a wrongful death lawsuit that will be based on two things. The pecuniary loss, which involves the financial support the victim, would have provided had they lived and this will also include funeral and burial expenses.

The other damages that will be awarded are non-pecuniary damages, which are the loss of moral support, comfort, companionship, assistance in maintenance and other damages caused by the loss of the individual. The one damage that heirs will not recover in a wrongful death lawsuit is punitive damages, though if the person who died was hospitalized and has medical expenses the decedent’s estate may bring a wrongful lawsuit on behalf of the deceased victim.

What About the Rights of Patrons?

It is important for the person who is a patron at a bar or night club to understand their rights since an incident resulting in harm can have life changing consequences. If you have been hurt or suffered the loss of a loved one due to an incident in one of these establishments it is essential to consult an experienced personal injury attorney in order to be educated about your legal rights and the best course of legal action to take.

Ehline Law Firm Personal Injury Attorneys, APLC
201 Wilshire Blvd. FL 2
Santa Monica, CA 90401

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Why is a Competent Expert So Important in Your Personal Injury Case

A speedometer or gauge tracking your progress in learning a skill, going from the level of amateur or novice to expert
A speedometer or gauge tracking your progress. Learning a skill, going from the level of amateur or novice to expert

Expert testimony is essential in almost all criminal and civil cases brought before a trial by judge or jury. This is because the attorney has a moral and legal duty to present the best possible case on behalf of their client. The one way to do this is to provide the court with clear analyses of the evidence by an expert in the field of whatever type of proof is their specialty. In many cases, experts are required to prove elements of certain cases.

Beyond that, an expert can be invaluable when it comes to honing a case for trial. For example, an expert can assist in preparation for the cross-examination of defense experts in their field. The functions of this type of specialist can make a claim stronger, by helping explain the evidence in a manner that is understandable and ultimately proves the plaintiff’s side of the case, over the event of the defendant.

In particular, the personal injury lawyer has a big responsibility to ensure that the expert they choose has a flawless record within their field of expertise, they have not had any issues with their licensing or been punished by the licensing board. Injury cases are already often viewed as suspicious by the public. This is due to harmful insurance company ads, as well as bad apples in the injury law field itself historically.

After all, the terms “scumbag” and “PI Lawyer” go hand in hand with a lot of lawyer jokes, and in passing conversations in the halls of court. Any issue with the background of the person specializing in a certain area of expertise will be used by the defense against the plaintiff’s case. Obviously, hiring the wrong expert only serves to further disparage the already shady reputations of many trial lawyers in the eyes of everyone in the courtroom. Hiring the right expert conversely, can make the plaintiff and their case in chief shine.

There are questions the legal advocate should ask any expert they plan to use in a civil lawsuit, including:

  • How long they have held a license in the field they specialize.
  • Have they published any peer review articles or papers and how were they received.
  • How many cases have they testified in and has their testimony been limited or thrown out.

These are just a few questions that should be asked, along with others that will prove they are the person who will be able to strengthen a lawsuit and the evidence. It is up to the lawyer to do their homework in choosing the right individual specializing in providing testimony on evidence in a case. The already tarnished image of injury cases and lawyers, in general, makes it especially important to obtain experts who are above reproach. Doing so is one of the most important aspects of managing a case.

Let’s work

Ehline Law Firm
Personal Injury Attorneys, APLC

633 W 5th St #2890
Los Angeles, CA 90071

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