When a claim is made to an insurance company, it will be assigned to an adjuster to determine what benefits should be paid under the contract. This is not meant to be an adversarial process. The insurance company and its adjuster owe you — the claimant — a duty of good faith. This means they should work with you to make sure you understand what coverages you have and to assist you with how to go about claiming the benefits under your policy. In most cases, insurance claims are resolved as a result of good communication between the adjuster and claimant. However, there can come a point when the two are at odds about what should be payable under the policy.
If you have tried to resolve a dispute with your adjuster but have been denied, it is time to consult a lawyer. It is sensible to consult with a lawyer any time your insurance company refuses to keep paying benefits that it has previously paid or when it refuses to pay the full amount that you believe you are entitled to. A lawyer can assist you in dealing with your insurance company in relation to many benefits, including short-term disability, long-term disability, income replacement, critical illness, sickness and accident, life insurance, or mortgage insurance. If you believe that your insurance company is trying to bully you or that it is not engaging with you properly, this may be grounds for a bad faith claim. You should consult a lawyer to discuss this.