If you are in dispute with an insurance company over the exact meaning of a policy document then the last resort is to take the company to court. Before doing this you will obviously need to get legal help, but the following 5 facts might help you to decide whether this is worth doing:
1. Ambiguous Clauses
An insurance policy is a contract between the insured and the insurer. A general principle of contract law is that if the terms of the contract are ambiguous then the dispute is settled against the party that created the contract (the insurance company).
2. The Expertise Used to Decide on the Meaning of the Policy
The interpretation of the policy document is considered from the point of view of a person of average intelligence, not an insurance expert or attorney.
3. Conflicting Clauses
If the policy document contains two clauses that are inconsistent then the one that gives the most protection to the insured will be considered instead of the one that gives the most protection to the insurance company.
4. Avoiding an Absurd Result
The court will not enforce either the policy as written or as interpreted if this would cause a ridiculous result.
5. Policy Endorsements
Insurance companies will often use endorsements to limit cover. If an endorsement is attached to the policy when it is purchased it then becomes part of the policy. If the policy and the endorsement are in conflict then the endorsement is considered to be correct.
Conclusion
A disagreement over the terms of an insurance policy is a serious and complicated issue. You do really need to get legal help to resolve it. Hopefully the above facts will help you understand the issues if you do seek legal advice.
Tags: Life Insurance, life insurance disputes, policy interpretation
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