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Ely, Counselor at Law
Category: Legal
Satisfied Customers: 99416
Experience:  Private practice with focus on family, criminal, PI, consumer protection, and business consultation.
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Insurance company ran their own investigation to determine

Customer Question

Insurance company ran their own investigation to determine the origin of fire that claimed our house. After over 5 months they finally admitted that the fire was an accident. They have refused all medical expenses originating from the fire, even though the policy states medical would be paid. The lease on the house the insurance company put us in ends 07/29/2013. During this entire time, State Farm has only issued $3,000.00 in emergency funds. The policy is in my mother's name. However my wife and I lived in the house also and lost all of our personal property. Would my mother be able to make a settlement with State Farm without them receiving the fully completed Persona Property Inventory Forms from us? I was severely injured in the fire and my wife suffers from a previous injury. I have kept in touch with State Farm and have been completing the forms as fast as possible. During this time State Farm was trying to come after me due to allegations made by other family members, which were proven false some time ago. It has been since January 3, 2013, and we have yet to receive either a denial or acceptance of the claim in writing. State Farm did tell my mother that they would pay her $57,000.00 as long as she used their contractors to rebuild the house as it was. State Farm has paid her $17,000.00 for her Personal Property lost. She is 82 years old and fears that she will have no assistance and that my wife and I will be left with no where to live, as she was told at the time of receiving her Personal Property check that it could be another tweo years before anything further is done.
Submitted: 3 years ago.
Category: Legal
Expert:  Ely replied 3 years ago.
Hello friend. My name is Ely, and welcome to JustAnswer. Please note: (1) this is general information only, not legal advice, and, (2) there may be a slight delay between your follow ups and my replies.

I am sorry for your situation. Please understand that this matter may be divided into two, separate issues - (1) your claims and (2) your mother's claims. But to discuss this, we need to also discuss how insurance works.

The insurance company agrees to cover any possible damage in the event of a fire. But, understand that this is a CONTRACT. An insurance company does not really want to pay out, and will avoid a payout based on any reason it can. To force the issue, you and/or your mother may have to go to Court.

You and your wife may have a claim against your mother, technically. Understand that aside from paying out the insured for a loss, the insurance company is often liable for the judgment that you'd get against the INSURED (i.e. your mother) if you sue her. Ergo, to avoid paying out huge sums from a judgment where their insured (again, your mother) is likely responsible, the insurance company likes to settle the claim to avoid litigation. Once an agreement is reached, you sign a release and waive your rights to sue in exchange for the payout.

Someone in your situation may wish to claim a legal fiction of possibly suing your mother unless they pay out. The company may wish to pay out rather to have to pay for her attorney and for any judgment. While you may have no intention of actually suing, of course, it may be in your best interest to claim that you do.

You mother may have a SEPARATE claim, independently of course, for the property lost.

Now, neither her nor your complaints and threats have been taken very seriously here largely because they insurance company does not see you as a threat. An attorney usually cuts through this malarkey since the adjuster knows counsel does not put up with this and WILL file suit if needed (whereas here, they do not see you as much of a threat without an attorney since you filing or winning a suit without counsel is unlikely). Then a settlement is usually reached. The attorney should take this on a contingency basis, meaning they do not get paid unless you do. Usual set up is their take is 33% settlement, 40% win at trial, 45% at appeal; plus some office costs. Everything is negotiable.

May I recommend the Texas Bar referral program - here. The attorneys are vetted and qualified. You should be able to find an attorney you are confident with and whom you can trust, and who is available ASAP. I know you had said that you spoke with one attorney, but try speaking with several and see who you feel comfortable with. Your mother and you may need different attorneys here.

I hope this helps and clarifies. Best of luck.

Surely you prefer that I be honest in my answer – please remember that rating negatively due to receiving bad news still hurts the expert – it is simply the way that the system is set up. Please use REPLY button to keep chatting, or RATE my answer when we are finished. (You may always ask follow ups free after rating.)