
FAQ
Over the years, we
frequently have prospective clients ask us the same general questions
about us and their legal matter. This section is therefore designed
to provide you with very basic answers to some of those questions.
Please understand that
the information provided below is for informational purposes only.
The information in this section is not legal advice nor should it
substitute for legal advice. Nor does the information serve as
statements of law. Please do not act upon any information below
without first seeking professional counsel. The answers are all
based on California law only, and the answers may vary by
jurisdiction.
General Information Center:
Insurance Law Information Center:
Employment Law Information Center:
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General Information Center
Why should I hire an attorney?
This is a very common
question. We believe every prospective client should ask this
question of each attorney they are considering and every good
attorney should be able to provide a meaningful response.
The bottom line like
anything else: you get what you pay for. Many times consumers spend
very little time making large purchases regardless of the financial
cost. But when it comes to protecting their personal or company's
legal interests they sometimes question whether an attorney is really
necessary. The primary reason for this is that clients sometimes
ignore, or simply do not see, the immediate benefit of hiring an
attorney until it is too late.
The benefits to hiring
a qualified attorney are innumerable. An attorney is an advocate who
gives a voice to those who may not otherwise be heard. An attorney
is skilled at marshaling the relevant facts for a persuasive
presentation. An attorney can serve as a skilled advocate by
committing words to paper to persuade a particular reader or reflect
the parties' intent should their intent become an issue in the
future. An attorney can serve as an oral advocate and compose words
to instill emotion in a jury, persuade a trier of fact, or
communicate a particular tone. An attorney can ensure each
individual has equal access to the court system. An attorney can
look forward and then take action based on what his or her experience
tells them in order to try and avoid problems in the future. An
attorney speaks for society's downtrodden. An attorney can expose
a weakness in the law and effect legislative change.
Perhaps most
importantly, the right attorney has a significant amount of
experience dealing with the particular issues in question, and knows
not only what can be learned in the law books, but also the unwritten
expectations, the "tricks of the trade," so to speak. An
experienced attorney can often divine other's motivations, or
predict other's next moves, based on having dealt with similar
issues before. In much the same way you would not try to treat a
medical condition without the guidance of a doctor, using a lawyer
will give you a resource that often leads to far better results.
There are additional
specific benefits for our contingency clients. The client can engage
our firm to step in and immediately begin zealously advocating the
client's position without the client having to pay attorneys fees
out of their own pocket. For our clients in the insurance or
employment context this means the client has attorneys who are
comfortable with the David vs. Goliath dynamic of litigation and will
stand up against large corporations so the consumer does not have to
go at it alone.
Under a contingency fee
arrangement the attorney is invested in the client's case based on
the amount of hours it will take to prosecute a case and the expenses
the attorney will be advancing out of his or her own pocket. Thus,
the attorney is just as motivated as the client to maximize the
client's recovery, but in any event should at all times do what is
in the best interests of the client.
For our hourly clients,
the benefits are innumerable. The client gets an experienced
attorney whose experience and knowledge of the law can assist the
client in making important personal and/or business decisions, and
provide the client with options he or she may not otherwise have
without legal assistance.
In the civil context,
the bottom line for a plaintiff is to recover money and the bottom
line for a defendant is to avoid paying any money, or as little as
possible. Thus, when someone is sued, that person's or company's
assets are on the line until the lawsuit is resolved. That is why it
is very important to have an attorney who can navigate the client
through the court system and apply his or her experience to the
situation at hand.
To further answer this
question, we will use three common scenarios.
A common scenario is a
client who wants to perform what they consider a simple task, e.g.,
filing an insurance claim, communicating with an insurance company
after a claim is denied, filing an employment claim with a state
agency, forming a company, drafting a contract, negotiating a
purchase or sale, or even defending a small lawsuit.
In the words of William
Shakespeare, "and yet, methinks, I could be well content to be mine
own attorney in this case." (1 Henry VI (V, iii, 165).) There are
many people who think they can adequately represent their own
interests when it comes to legal work.
There is no question a
prospective client can search the internet or purchase a book at the
bookstore that purports to provide basic legal information or advice.
Of course, any prospective client can engage in self-help such as
drafting their own contracts or prosecuting or defending their own
lawsuit. Those kinds of persons normally find themselves seeking out
legal help when it is too late, which more often than not could have
been avoided had they sought an attorney's advice in advance.
There is no
one-size-fits-all approach to the practice law. Therefore, it is not
wise for consumers to copy contracts, or even wills or trusts, from
the internet or a book thinking it will protect their interests.
Many times, a consumer can commit a major blunder if they do not
realize the legal significance of a particular document, act, or
omissions. It is therefore wise to seek out legal help from a
qualified professional attorney.
Good attorneys earn
their fees by zealously protecting a client's interests and serving
as an aggressive advocate for a client's particular position. This
could mean avoiding a lawsuit before one is filed, aggressively
prosecuting or defending a lawsuit when filed, drafting documents
today to protect against what may occur in the future, or effectively
negotiating a certain point.
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Why should I hire PLDRC?
For the answer, please
click here:
Results
Technology
Client Reporting
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What factors should I consider when hiring an attorney?
There are many
important factors a person can consider before hiring an attorney to
handle their personal or business legal matter. Here are some of
them:
- Does the attorney
have experience in the type of legal areas in which you need
representation? A good attorney is confident in the areas in which
they practice. At the same time, that attorney should also know the
limits of his or her abilities and experience, and if they do not
accept your matter, the attorney should be willing to help you seek
counsel that will suit your particular needs. For a detailed look
at the types of cases our firm handles, please click here.
- Is the attorney
able to devote the time and resources necessary to zealously
represent your interests?
- Is the attorney a
good strategist? Does the attorney conceive, develop, and execute a
litigation or transactional strategy that will best advance your
interests?
- Is the attorney
proactive versus reactive? Does the attorney take a proactive
approach to the practice of law, or simply react to the opposition's
moves? For a look at our firm's philosophy, please click here.
- How does the
attorney feel about winning? Winning can mean a lot of different
things in a lot of different contexts. However, an experienced
attorney will understand the client is looking for someone to
zealously represent their interests at every turn.
- Is the attorney
cognizant at all times of his or her ethical obligations?
- Is the attorney
willing and capable of trying a case in the event a legal dispute
goes to trial?
- Is the attorney
capable of handling an appeal in your legal matter, if necessary?
- Is the attorney a
good negotiator?
- Are you
comfortable around the attorney? An attorney-client relationship is
a professional relationship. You may be called to work with your
attorney closely in many aspects of your legal matter. It is
therefore important that you feel comfortable interacting with him
or her.
- Does the attorney
take time to explain things to you and to answer your questions?
- Is the attorney
able to provide answers in clear and understandable terms?
- Does the attorney
return your phone calls or e-mails within a reasonable time period?
- Does the attorney
listen to what you have to say?
- Do not feel
intimidated by the attorney you are considering. You should never
allow a lawyer to strong-arm you into choosing their firm. The
lawyer's professionalism and experience should speak for itself.
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How do I know if an attorney's fee is fair?
The answer to this
question can be found in California Rules of Professional Conduct
rule 4-200. That rule states:
"(A)
A member shall not enter into an agreement for, charge, or collect an
illegal or unconscionable fee.
(B)
Unconscionability of a fee shall be determined on the basis of all
the facts and circumstances existing at the time the agreement is
entered into except where the parties contemplate that the fee will
be affected by later events. Among the factors to be considered,
where appropriate, in determining the conscionability of a fee are
the following: (1) The amount of the fee in proportion to the value
of the services performed; (2)
The relative sophistication of the member and the client; (3) The
novelty and difficulty of the questions involved and the skill
requisite to perform the legal service properly; (4) The likelihood,
if apparent to the client, that the acceptance of the particular
employment will preclude other employment by the member; (5) The
amount involved and the results obtained; (6) The time limitations
imposed by the client or by the circumstances; (7) The nature and
length of the professional relationship with the client; (8) The
experience, reputation, and ability of the member or members
performing the services; (9) Whether the fee is fixed or contingent;
(10) The time and labor required; (11) The informed consent of the
client to the fee."
Our firm's hourly
rates are based on the attorneys' years of experience, efficiency
of work, and overall effectiveness. The rates may be revised by the
firm annually based on generally understood prevailing rates in the
Los Angeles/Orange County legal community.
Our firm's standard
contingency fee is 40% of the client's gross recovery, and the
client pays the costs our firm has advanced out of his or her
remaining portion of the recovery.
The principal of PLDRC,
Neil Pedersen, has developed a business plan that avoids the
accumulation of unnecessary overhead and operating expenses that
would otherwise require the firm to charge higher hourly rates
similar to what the larger firms charge.
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What is a "Statute of Limitation"?
A statute of limitation
is a statute that sets the time limit within which you must file your
claim in court. If you do not file your claim within the statutory
time limit then you are forever barred from bringing the claim. This
is why it is important you seek legal advice early on so you do not
miss the particular statute of limitation that applies to your
matter.
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What is a contingency fee?
This is one type of a
fee arrangement our firm offers. Under our standard contingency fee
arrangement, we agree to represent the client in exchange for the
client's agreement to pay us a percentage (normally 40%) of the
client's gross recovery. Our firm advances all costs on the
client's behalf, and those costs are then re-paid out of the
client's portion of the gross recovery. We do not get paid our
attorneys fees unless and until there is a recovery. To give you an
example of how this standard fee arrangement works, assume the
client's matter settles for $100,000 and the client's costs are
$3,000. Under our standard contingency fee agreement, we recover 40%
of the $100,000, which is $40,000. The remaining $60,000 is the
client's portion, and from that the client then pays the $3,000 in
advanced costs, leaving the client with a net recovery of $57,000.
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What are "pre-paid" legal services?
Pre-paid legal services
are a fairly recent trend in the legal setting. A pre-paid legal
services plan is where a consumer agrees to pay a monthly fee in
exchange for the right to contact an attorney for very basic, limited
legal advice. That attorney then agrees to provide that consumer
with a very limited amount of legal advice or services, which
normally has time and workload restrictions. We do not offer
pre-paid legal services. We believe legal services should be
specifically tailored to fit each individual's need, and we believe
that there is no one-size-fits-all approach to the practice of law.
An experienced lawyer develops and applies a unique strategy to a
client's needs on a case-by-case basis. Conversely an experienced
lawyer does not offer a general strategy, legal service, or product
that is generically designed to fit a large group of individuals.
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What if I have a dispute with my attorney over fees?
The State Bar of
California provides a process by which all fee disputes between an
attorney and her client can be handled, known as Mandatory Fee
Arbitration. This is a low cost alternative dispute resolution forum
for resolving fee disputes between the attorney and the client. Our
firm's engagement letter contains a mandatory fee arbitration
provision.
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Is what I communicate to my attorney confidential?
With very limited
exceptions, yes. An attorney has a legal duty to maintain inviolate
the confidentiality of all confidential information relating to the
representation of a client. The exceptions to this rule are: (i) to
prevent a criminal act that the attorney reasonably believes is
likely to result in death or, or substantial bodily harm, to another;
and (ii) the client gives his or her consent to divulge the
information. Otherwise, confidential information you tell your
attorney cannot be divulged.
As the client, you are
the holder of the attorney-client privilege, and therefore you are
the only person who can waive that privilege.
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Is my attorney required to advise me of any settlement offer made in my case? If so, who has the authority to settle my case?
Yes, an attorney is
required to promptly communicate the amount, terms, and conditions of
any written offer of settlement to his or her client.
Unless otherwise
agreed, the client is the only person with the authority to accept or
reject a settlement offer. When communicating a settlement offer, an
experienced attorney should give the client realistic advantages and
disadvantages of accepting the offer so that the client can make an
informed decision. The ultimate decision to settle lies exclusively
with the client.
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Will I be required to work on my own legal matter?
At our firm, yes. A
client can be involved in many aspects of his or her legal matter.
At the outset, it may mean gathering documents and information to
allow the attorney to evaluate the client's legal matter before
agreeing to take the case. Once the attorney agrees to accept a
matter, the stage of litigation the client is most often involved in
relates to the discovery process. We require that a client
participate in answering written discovery, to the extent necessary.
This may mean answering written questions and gathering relevant
documents, or even performing very basic investigations. The client
will also be required to appear at deposition. Many times clients
can offer valuable insight into the type of discovery that he or she
should conduct in the litigation.
Requiring that the
client participate in the litigation process does many things. It
ensures that the discovery is accurate and complete, which is
critical since the client is required to answer the discovery under
the penalty of perjury. It allows the client to actually
participate in the overall process and have a stake in his or her own
legal matter. Finally, it allows the client to keep abreast of the
status of the case and the factual and legal strategies the attorney
is employing on their behalf.
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What are the basic stages of litigation?
Each litigation is
different, and it can take on many different forms and go through
many different stages. If you are interested in the various states
of litigation, please see What
to Expect if You Are Involved in a Lawsuit.
The experienced
litigators at PLDRC handle every aspect of the litigation from intake
all the way through appeal, if necessary. This means our clients are
not required to engage a different attorney to handle different
aspects of their case.
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What is arbitration?
Arbitration is an
alternative forum for resolving a dispute whereby the parties either
voluntarily, or are required by statute, to submit the dispute to an
impartial third party for resolution instead of by a judicial
tribunal such as a judge or a jury. Arbitration is required under
two different circumstances:
- A party can
contractually agree in advance to resolve a particular dispute by
arbitration, i.e., contractual arbitration; or
- A party can be
statutorily required to arbitrate his or her claim, i.e., judicial
arbitration.
Arbitration can be
binding or non-binding. Binding arbitration means the arbitrator's
decision is final, except for a very limited, narrow set of
exceptions. That means the client normally does not have the
opportunity for a reviewing court to take a second look at the
arbitrator's decision. Non-binding arbitration means the
arbitrator's decision is not final, and the plaintiff can proceed
to a court of law to have his or her claims heard before a judge or a
jury.
The most common type of
arbitration is binding contractual arbitration. In that instance,
the contract governing the parties' relationships will contain some
form of an arbitration clause. Many businesses offering consumer
services, such as many medical insurance companies, requires that the
consumer agree to binding arbitration in advance. The arbitration
agreement can be formed at virtually any stage of the relationship,
e.g., when an insured signs an insurance application, when an
employee signs an employment agreement or handbook, when the consumer
purchases a car, or when a consumer is issued a credit card or opens
a bank account. Large corporations offering a service such as
insurance have superior bargaining strength, and can easily force a
consumer to agree to arbitration. Unfortunately, consumers rarely
pay attention to the fine print, and do not realize they may have
walked away from their constitutional right to a jury trial until a
problem arises.
Some practitioners
believe arbitration benefits only the defendant, and enables the
defendant to remain shielded from large jury verdicts, and even
public scrutiny. The main reason insurers require arbitration is to
protect against a large jury verdict and a punitive damages award
when their egregious or unlawful conduct is exposed. Since
arbitration means a third party arbitrator (as opposed to a jury of
your peers) will hear and decide your case there is a greater
likelihood the arbitrator will not be as sympathetic towards you as
would a jury. Also, an arbitrator very rarely awards punitive
damages. Hence, large defendants who engage in unlawful conduct are
typically the ones who benefit from arbitration. Arbitration can
also make litigation more expensive since the parties are not only
paying administrative fees, but also an arbitrator's hourly rate,
all of which are in addition to the parties' attorneys fees.
Often, a litigant's discovery rights in arbitration are limited.
Finally, many arbitrators earn significant arbitration fees from
large corporate defendants who require that one particular
arbitration company handle all arbitrations, which may have an effect
on the impartiality of the overall process.
Some practitioners
believe there are some advantages to arbitration. Arbitration can be
more streamlined so that the parties can reach an arbitration hearing
much quicker than they can reach a trial. Some practitioners believe
that arbitration is a more cost-effective way of handling a dispute
due to the streamlined approach. From a defendant's perspective,
punitive damages are very rarely awarded and arbitrators tend not to
be as sympathetic towards a plaintiff as would a jury. In some
cases, an arbitration provision may even serve as a deterrent to a
plaintiff taking any action in the first instance.
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What is mediation?
Mediation is much
different than arbitration. Mediation is a process by which the
parties choose a trained neutral to facilitate settlement
negotiations between the parties. A mediator can be an attorney or a
retired judge with experience in the particular area of law.
Normally, the parties are placed into separate rooms and the mediator
floats between the parties as he or she conducts separate "caucuses"
to try and understand the dispute and find a resolution acceptable to
both sides.
There is no such thing
as "binding" or "non-binding" mediation. This means
mediation is generally a voluntary process. If the mediation is
unsuccessful, the parties continue to litigate. Sometimes a contract
may require a party to first mediate his or her dispute before filing
a lawsuit, which is common in standard real estate purchase
contracts.
Our firm believes that
mediation is a useful tool when the parties reach a point where the
old-fashioned way of settling a matter (i.e., letter writing or
verbal discussions between counsel) breaks down and the parties are
unable or unwilling to move any further. At that point, it sometimes
makes good business sense to have a trained mediator try and bring
the parties closer together to reach some sort of a resolution.
Normally, the parties split the cost of a mediator.
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Will I be kept informed about the status of my legal matter?
At our firm, yes. As
the client, you are always entitled to know the status of your legal
matter. You should feel comfortable asking questions at any stage of
the litigation, and your attorney should provide substantive answers.
You should not feel uncomfortable calling your attorney to inquire
about the status of your legal matter.
At our firm, we go one
step beyond and do something most firms do not. We copy our clients
with every single pleading, motion, letter, or document that we send
or receive relating to your legal matter. Normally we mail the
documents to the client at the client's expense. For those clients
who are technically savvy, we scan and e-mail the client .pdf
versions of those documents to avoid the client having to pay the
postage cost. This way the client can read whatever documents they
wish to stay abreast of their own legal matter.
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Is there a State agency that governs attorneys?
Yes, the State Bar of
California. The State Bar is the regulatory agency for California
attorneys in charge of admissions and discipline. It regulates
attorneys and assists in providing rules and standards for ethics,
such as the Rules of Professional Conduct, which attorneys are
required to follow. It also helps consumers find legal assistance,
learn about the law and the legal system in California, or work
better with an attorney. Their website is www.calbar.ca.gov.
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How does the firm bill me?
The answer to this
question depends on whether the matter is taken on a contingency or
hourly basis. Under a contingency fee agreement, we do not provide
the client invoices unless they request a copy. When a case settles
or the judgment is paid, we provide the client with a complete
accounting of the money payout, including the costs advanced on
behalf of the client. As the client, you are always welcome to
request a copy of your invoice at any time.
When we accept a matter
on an hourly basis, we invoice the client every 30 days and payment
is due within 15 days from the date appearing on the invoice. The
invoice contains detailed information such as the particular tasks
performed on the matter, the time spent performing those tasks, the
attorney who performed the particular task and their hourly rate, the
costs incurred on the matter, and the total amount due. At our
discretion, we can require that the client provide a deposit that
must be refreshed when the dollar amount drops below a certain
benchmark.
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Insurance Law Information Center
Generally speaking, what should I do when my insurance company has denied my claim, or rescinded or cancelled my policy?
First, you should not
panic. Many policyholders panic and instantly begin communicating or
fighting with the insurance company to try and convince the insurer
it is wrong and to reverse its decision. Very rarely is a consumer
successful at overturning an insurer's decision without the help of
an attorney. Also, consumers sometimes turn to various state
agencies for assistance and submit complaints. While some state
agencies are designed to protect the consumers of this state, they
unfortunately are unable to give your legal matter the attention it
deserves and cannot offer you legal advice about your specific case.
Second, you should ask
the insurance company to state in writing all of the reasons for
denying your claim, or canceling or rescinding your policy. This
way, a written record as to the insurance company's position begins
early on in the process.
Third, you should read
your insurance policy carefully. Most insurance policies contain a
mechanism for the insured to challenge the insurer's decision
through an internal appeal and grievance process, which can be time
sensitive. Most policies place time restrictions on when an insurer
must take certain steps to protect his or her rights under the
policy. If you do not feel comfortable reading through the policy,
you should have qualified insurance counsel do it for you as soon as
possible so that you do not miss any contractual deadlines.
Fourth, whether you
decide to engage our firm or a different attorney, we recommend that
an attorney be involved in the claim process as early as possible.
The lawyers in our firm have a combined total of over 26 years
experience in litigating insurance issues. We assist the
policyholder at every stage of the claim process, including drafting
a written response to the claim denial all the way through trial, and
appeal if necessary. It is always best to hire qualified counsel
early on because more times than not the attorney is able to quickly
spot the insurance issues and begin developing ways to resolve them.
Fifth, with the one
exception stated below, you should refrain from responding to the
claim denial letter with letters of your own without the assistance
of qualified insurance counsel. Many times an unsuspecting insured
can make harmful statements to the insurer, or fail to communicate
critical information that helps support the claim.
Sixth, you should fully
cooperate with your insurance company in providing information about
your claim and responding to their requests for information. As an
insured, you have a legal duty to cooperate with your insurance
company while your claim is being considered. As an insured, you
never want an insurance company to later argue that you denied the
insurance company requested information that would have allowed the
insurer to adequately investigate and consider the claim.
Cooperating may mean that you undergo an examination under oath,
which under many policies is required. By not cooperating you are
simply giving the insurance company ammunition to use against you
when they deny your claim. You want to be the one who later argues
you did everything you were required to do under the terms of the
policy, and it was the insurer who shirked their responsibilities.
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What does "insurance bad faith" mean?
The term "insurance
bad faith" is a moniker coined by courts and lawyers to describe
generically an insurance company's conduct legally known as "breach
of the implied covenant of good faith and fair dealing." Every
contract, including insurance contracts, contains an unwritten legal
duty that runs to both parties to the contract that promises to not
do anything to unfairly interfere with the other's expectations
under the agreement. The term is a bit misleading because it
suggests a policyholder must prove "bad faith"—something akin
to an evil motive—on the part of the insurer in order to win at
trial. While this is a common theme told to a jury, it is not a
requisite element. The insured must prove that the insurer
"unreasonably withheld" the policy benefits and not that the
insurer acted in "bad faith."
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What does the "duty to defend" mean?
Most liability policies
sold contain a provision that places on the insurer the duty to
defend its insured against certain lawsuits. Such policies usually
include Comprehensive General Liability, Homeowners and Renters,
Employer's Liability, Directors and Officers and others. Often,
the process of tendering the claim can be confusing or unfamiliar.
Although insurers have a duty to look for a reason to provide a
defense, often the research and analysis of a competent and known
insurance attorney is the only way the insurer can be convinced to
pick up the defense of the lawsuit. In complex cases, the
identification of, and coordinated tender to, dozens of insurers
potentially on the risk requires the unique and substantial
experience our firm can provide. When the insurer wrongfully refuses
to defend, our firm is uniquely qualified to litigate the issue.
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When does my insurance company have a duty to provide independent counsel?
Once an insurer has
agreed to defend a lawsuit, issues arise about who gets to control
the litigation, including the issue of who gets to pick the attorney
to represent the insured in the lawsuit. Although the insurer's
duty to surrender control of the litigation to the insured under
certain circumstances is set forth in statute and case law, there is
nonetheless often a real battle over that issue. Insurers, of
course, want their attorneys representing the insured. It is usually
in the client's best interest to have attorneys selected by them to
defend the lawsuit. This is because attorneys selected by the client
will consider all of the client's interests, including the ultimate
interest in getting the insurance company to pay for most or all of
any liability that might occur. Most panel counsel will not consider
your coverage interests, claiming to be "coverage neutral." Who
wants an attorney that is neutral about anything related to their
lawsuit? Our firm is very good at negotiating this issue, and if
necessary, litigating it.
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When does my insurance company have a duty to settle a lawsuit?
Often in litigation,
either after the insurer has rejected the defense of the lawsuit, or
has accepted the defense and is paying for counsel to defend, a
settlement is determined possible within the policy limits of the
insured. Under certain circumstances, the insurer can be compelled
(by the threat of future exposure to the entire judgment amount in
excess of policy limits) to pay the settlement. Our firm is very
familiar with the insurer's duty to settle, and when and how to
implicate that duty.
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When does my insurance company have a duty to pay a judgment (even if it is more than the policy limits in some cases)?
Those same insurance
policies that contain a contractual duty to defend also provide for
what is known as indemnity coverage – that is coverage for
judgments against the insured. However, often a judgment is not
clearly covered, and disputes arise related to whether the insurer is
required to pay the judgment, and if so, to what extent. The
attorneys at our firm are fully aware of the insurer's duties with
regard to payment of judgment, and can be very helpful in this
process. Again, as with all of an insurer's obligations, if the
insurer wrongfully fails to carry out its obligation to pay some or
all of the judgment, coverage litigation and perhaps even bad faith
claims can be competently and successfully carried out by the firm.
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How important is the insurance application?
It is very important.
The insurance company will do everything in its power to hold you
personally accountable for the information you provide (or don't
provide) in an application for insurance. The application asks for
certain types of information that the insurer's underwriters will
say they considered when determining whether the insurer wants to
undertake a particular risk, e.g., insure a house, car or a boat, or
provide medical insurance. The insurer argues it relies upon the
accuracy and completeness of the information contained in the
application when issuing the policy.
If the information in
the application is later determined to be inaccurate, incomplete, or
false then the insurer may have the right to rescind and/or cancel
the policy and the insured can be left facing a claim that the
insured may have to pay on their own. Normally, the application
states that the insured's signature means the insured attests to
the truthfulness, completeness, and accuracy of the information in
the application.
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What types of claims can I make against an insurance company, and what are the types of damages I can recover?
Generally speaking,
there are two basic claims a policyholder asserts against the
insurer: breach of contract and breach of the implied covenant of
good faith and fair dealing (i.e., "bad faith."). The former is
simply a breach of the terms of the policy. The later is based on a
promise implied into every insurance policy issued in this state that
the insurer will not do anything to unreasonably deprive the
policyholder of the benefits under the policy. Other claims may
include fraud, injunctive relief, or a claim for unfair business
practices.
In order to recover
damages, the insured's first step is to prove the claim(s) is
covered under the terms of the policy. If successful, the insured
will be entitled to the amount of the policy benefits as part of the
insured's general damages. Case law also suggests an insured can
recover for emotional distress associated with the breach.
To recover additional
damages, the insured must prove the insurer's withholding of
benefits was unreasonable. If successful, the insured can recover
damages for emotional distress and recover the attorneys fees the
insured incurred in pursuing the policy benefits, sometimes referred
to as "Brandt fees," named after a California Supreme
Court case.
Finally, if an
insurer's conduct is found to be fraudulent, malicious, or
oppressive by clear and convincing evidence, then a jury may also
award punitive damages. In certain instances, an insurance company
can also be ordered to refrain from doing something by way of an
injunction.
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What if someone, such as a spouse, agent or a broker, fills out my application for me?
This is a common
scenario for many insureds. Many prospective clients tell us that
someone other than themselves, such as a spouse or the insurance
agent, completed the application for the insured. Another common
scenario is someone other than the insured reads the questions on the
application aloud and the insured then provides verbal answers based
on the questions they heard. To avoid any problems or inaccuracies,
you should personally complete and sign the application yourself when
possible. You should make sure you understand the question being
asked and that you answer truthfully, completely, and accurately to
the best of your ability.
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Should I apply for an insurance policy over the internet?
Technology combined
with the internet has permitted insurance companies and insurance
agents and brokers to tap into a new base of potential insureds by
advertising and soliciting insureds over the internet. Most large
insurance companies allow a potential insured to prepare and submit
on-line insurance applications over the internet. Whether the
application is prepared while sitting at your kitchen table, in an
agent's office, or the public library, you should read and verify
that the information provided is complete, accurate, and truthful.
An insurance application is not something you should rush through,
which we commonly do when "surfing" the internet. It is
sometimes too easy to click on links on a webpage to complete an
on-line application. Therefore the conventional methods of preparing
and submitting an insurance application often times work better. It
is much easier to flip through a paper application to re-read
questions than it is to review an electronic version. Also, you can
take your time to complete a paper application and come back to it
when needed before submitting it versus completing the application on
the computer in a single sitting.
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What does it mean when an insurance policy is "rescinded"?
When an insurance
company rescinds your policy it means that the insurer has abrogated
or cancelled the entire policy, the effect of which is to place the
policyholder and the insurance company in the positions they would
have occupied had the policy never been issued. Consequently, the
insurance company will not pay any claims made under the policy and
the insured will be left without insurance as though he or she never
had it in the first instance. When a policy is rescinded the third
party (such as medical providers) then turn to the insured for
payment of money for services rendered, which in some instances can
be hundreds of thousands of dollars.
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Under what circumstances can an insurance company rescind my policy?
In California, an
insurer rescinds a policy by alleging that the insured has made some
sort of a material misrepresentation on his or her insurance
application. In order to cause the representation be "material,"
the insurer claims that it would not have issued the policy or
undertaken the particular risk had it known about the information it
claims was not disclosed on the application. Insurers argue that the
misrepresentation does not necessarily have to be intentional, and
instead argue the misrepresentation was even negligent or innocent.
There is a large body of insurance law and therefore rescission can
be a very complex area of insurance litigation. That is why you need
qualified counsel to represent your interests following a rescission.
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What does it mean when an insurance policy is "cancelled"?
Cancellation is
different than rescission. Cancellation means that the insurer will
pay whatever previous claims were made under the policy, but the
policy is cancelled prospectively as of a certain date such that no
future claims will be paid and the insured will not have any
insurance going forward.
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At what stage should I involve an attorney when my insurance company has denied my claim or rescinded my policy?
Whether you decide to
engage our firm or a different counsel, we recommend that an attorney
be involved in the claim process as early as possible. Many times an
insured who is not trained in insurance law can make factual mistakes
that turn into damning admissions in a letter, or leave out critical
information that supports the claim or refutes the rescission.
Sometimes clients come to us early enough so that we can assist them
in reviewing the claim prior to its submission and assist them in
drafting claim letters so that the proper information is provided
when the claim is considered. This way if the insurer still denies
the claim or stands on its rescission, a strong record of what has
occurred has already begun.
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Should I file a complaint with a state agency such as the Department of Insurance or the Department of Managed Care whenever I have a dispute with an insurance company?
Rather than immediately
turning to qualified insurance counsel, a policyholder sometimes
files a complaint with a state agency such as the California
Department of Insurance or the Department of Managed Healthcare with
the hopes that their issue will be resolved that way. While state
agencies like those are generally designed to protect the consumers
of this state as a whole, those agencies are many times unable to
give your legal matter the attention it deserves. Nor can those
agencies offer you legal advice about your specific case and the
specific issues you are facing. A policyholder can also make
mistakes that are deemed harmful admissions in written statements to
these state agencies.
There is an appropriate
time and context for filing complaints with state agencies regulating
insurers in this state. It is therefore wise to consult with
qualified counsel before making those complaints, or to assist you in
doing so.
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Employment Law Information Center
Am I an "at-will" employee?
In California, all
employees are considered to be employed "at-will" unless there is
an agreement between the employer and employee to the contrary.
Thus, unless you have a specific agreement with your employer that
says you are employed for a certain period of time, or that you
cannot be terminated unless the employer can demonstrate good cause
for termination, you are an "at-will" employee.
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What does "at-will" employment mean?
If you are an "at-will"
employee, that means you can quit at any time for any reason, without
giving notice. However, it also means that your employer can
terminate you at any time, for almost any reason, without notice. An
employer cannot terminate you for a wrong reason, meaning that there
are certain reasons for termination that are not acceptable under the
law. An employer cannot terminate you simply because you are one in
a class of people who are considered protected under the law. Those
protected classes include, but are not limited to, race, religion,
disabled status, age, gender and the like. Furthermore, an employer
cannot terminate you in retaliation for engaging in a protected
activity, or for refusing to engage in illegal or immoral conduct.
For instance, you should not be terminated for reporting illegal
discrimination or harassment in the workplace, nor should you be
terminated for refusing to break the law on the job.
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What should I do if my employer terminates my employment?
Unfortunately
the great majority of the time you have no recourse for being
terminated. In California an employer is allowed to discipline,
refuse to rehire, and even terminate employees for any reason,
even stupid or erroneous ones. Employers can act on bad information
without investigating the accuracy of it. They can make rash,
unprofessional decisions. They can be rude and uncaring. They can
even act contrary to their own practices and procedures for the most
part. There is rarely a legal right to sue an employer for engaging
in any of this kind of conduct. However, if you have been terminated
wrongfully -- meaning because you are a member of a protected class,
or in retaliation for engaging in a protected activity -- you should
engage competent counsel immediately.
There are time
limits involved in employment litigation that are unique to that area
of law. Some of those limits include the requirement to file
documents with governmental agencies within a defined period of time
after the termination. While you can file those documents yourself,
it is far better to have an attorney assist you with that process, as
a failure to name persons or include facts or claims can be used
later on to limit your possible recovery.
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