Sussex County Insurance Dispute Lawyers

When you purchase an insurance policy, you expect it to serve as a safety net when the unexpected happens. Whether it’s damage to your home, a serious auto accident, or a debilitating injury that prevents you from working, insurance is meant to offer peace of mind. Unfortunately, that peace is often shattered when insurance companies fail to honor their end of the agreement. If you’re facing a denied or delayed insurance claim in New Jersey, the skilled insurance dispute lawyers at Gruber, Colabella, Thompson, Hiben & Montella are here to help you, every step of the way. Contact us today for a free consultation.

Common Types of Insurance Disputes in New Jersey

Insurance disputes can arise in many different areas. Below are the main categories where insurance-related conflicts frequently occur.

Property Damage Claims

These disputes typically involve homeowners or business owners who have suffered damage to their property due to events like storms, fires, vandalism, or flooding. Common issues include the following:

• Disagreements over whether the damage is covered under the policy.
• Underpayment of claims, especially when the insurer undervalues the cost of repairs.
• Allegations of pre-existing damage or maintenance neglect.
• Denials based on exclusions such as “flood” or “earth movement” clauses.

Auto Insurance Disputes

New Jersey’s no-fault insurance laws add an extra layer of complexity to auto claims. Disputes often arise when:

• The insurer refuses to pay for medical treatment under Personal Injury Protection (PIP) coverage.
• There are disagreements about fault and liability in multi-vehicle accidents.
• Claims are denied under uninsured or underinsured motorist (UM/UIM) coverage.
• There are delays in vehicle repair or replacement reimbursement.

Disability Insurance Disputes

When someone is unable to work due to injury or illness, long-term or short-term disability insurance is supposed to offer income replacement. Disputes in this area may involve:

• Denials based on the insurer’s assertion that the claimant is not truly disabled.
• Claims that the condition is excluded due to pre-existing illness clauses.
• Termination of benefits after a short period without sufficient medical justification.
• Pressure on the insured to return to work prematurely.

Life Insurance Disputes

Life insurance is intended to provide security to loved ones after a policyholder’s death, but insurers may attempt to avoid payment by:

• Alleging that the deceased made false statements during the application process (material misrepresentation).
• Claiming the policy lapsed due to non-payment of premiums.
• Delaying payment while conducting lengthy investigations or requesting excessive documentation.
• Denying claims based on cause-of-death exclusions, such as suicide within the contestability period.

Health Insurance Disputes

While less common in litigation, health insurance denials still occur and can be devastating when medical treatment is urgently needed. These disputes may involve:

• Denial of coverage for necessary treatments deemed “not medically necessary.”
• Refusals to cover out-of-network providers or emergency services.
• Preauthorization issues that delay or block timely care.
• Recoupment attempts, where insurers seek to recover past payments already made.

Why Insurance Claims Are Denied or Delayed

An insurance dispute often begins with a denial letter. Sometimes, it is accompanied by vague reasoning or legal jargon that can be hard to interpret. Other times, there is no outright denial, but the insurer drags its feet, failing to respond or request unnecessary documentation over and over again. In New Jersey, insurance companies have legal obligations under both statutory and common law to act in good faith. When they fail to do so, they may be in violation of the New Jersey Unfair Claims Settlement Practices Act or similar regulations. Common reasons for claim denials are as follows:

• Policy Exclusions: The insurer argues that the specific loss falls under an exclusion in the policy.
• Lapse in Coverage: The insurer claims the policy was no longer in effect at the time of the incident.
• Misrepresentation: The insurer asserts that the policyholder made a material misrepresentation during the application process.
• Insufficient Documentation: The company may allege that the policyholder failed to provide enough evidence to support the claim.
• Disputes Over Value: Even if the claim is accepted, the insurer may undervalue the loss or offer a payout far below the actual cost of repairs or treatment.

These strategies are often designed to protect the insurer’s financial bottom line, not to honor the customer’s coverage. When delays are prolonged or denials are unjustified, this may amount to bad faith, which is a serious violation that entitles the insured to additional legal remedies.

Legal Remedies and How an Attorney Can Help

Resolving an insurance dispute is rarely simple. You may start by filing an internal appeal with the insurance company, especially if the policy requires it. This process typically has strict deadlines, and it often results in the insurer reaffirming its original decision. In some cases, policyholders attempt to escalate the matter through the New Jersey Department of Banking and Insurance, which can investigate unfair practices and help mediate some complaints.

However, for many claimants, especially when significant sums are at stake, the most effective course of action is to hire a team of experienced civil litigation lawyers. At Gruber, Colabella, Thompson, Hiben & Montella, our insurance dispute lawyers have decades of experience advocating for policyholders. We begin by thoroughly reviewing your policy, the claim history, and all communications between you and the insurance provider. We evaluate whether the insurer has acted in bad faith and whether litigation may be warranted.

If litigation becomes necessary, we can file a breach of contract claim against the insurer. In New Jersey, this allows you to seek the full amount of benefits owed under the policy, as well as potential damages for bad faith, including attorney’s fees and punitive damages in extreme cases.

Contact Our NJ Insurance Dispute Lawyers Today

If you’re dealing with an insurance dispute in Sussex County or anywhere in northern New Jersey, don’t try to fight this battle alone. Contact the skilled insurance dispute lawyers here at Gruber, Colabella, Thompson, Hiben & Montella today to schedule a consultation. We’re here to review your case, explain your options, and work tirelessly to secure the compensation you deserve.