Insurance claims can be stressful—especially after a car accident, property loss, or denied life insurance benefit. Many policyholders immediately wonder whether they should call a lawyer, their insurance agent, or the insurance company itself.
In a recent episode of Insurance Hour, host Karl Susman was joined by attorney and longtime consumer advocate Dennis Beaver to break down when legal help is truly necessary, when it isn’t, and how policyholders can protect themselves from costly mistakes. Their message was clear: most claims should start inside the system, not in a courtroom.
Start With Your Adjuster and Agent First
One of the biggest mistakes policyholders make after a loss is immediately contacting a lawyer or a public adjuster. According to Beaver, most claims are designed to be handled through the insurer’s internal process.
Insurance companies have structured claims departments specifically to investigate and resolve disputes. Jumping straight to legal action often adds delays, legal fees, and unnecessary conflict.
If your claim stalls, the proper escalation path is:
- Your claims adjuster
- The adjuster’s supervisor
- Your insurance agent or broker
Agents and brokers can often advocate directly on your behalf. As Susman explains, that advocacy is a key part of their value to clients.
When Hiring a Lawyer Actually Makes Sense
While most claims should stay within the system, there are times when legal help is appropriate. Beaver points to several red flags:
- Your insurer is completely ignoring you
- The adjuster is misrepresenting coverage or making unreasonable delays
- The claim involves serious bodily injury, wrongful death, or major financial loss
Even then, Beaver cautions against assuming an attorney will always secure a better outcome in small claims. For minor auto accidents or low-dollar injuries, attorneys often recover little more than what a claimant could negotiate alone—minus a typical one-third legal fee.
Insurance Fraud: Small Lies, Big Consequences
A critical warning from both Susman and Beaver centers on dishonesty in claims. Even minor exaggerations can have major legal consequences.
Fraud includes:
- Padding estimated losses
- Falsifying receipts
- Adding items that weren’t damaged
- Backdating coverage
Beaver emphasized that even a single false item in a claim can justify denial of the entire claim. Fraud reports may also land consumers on national insurance databases, making future coverage difficult or expensive to obtain.
Trust the Process—But Document Everything
Most claim delays are the result of documentation gaps, not bad faith. Beaver and Susman stress the importance of keeping:
- Photos and videos of damage
- Repair estimates
- Receipts and invoices
- All written communication with the insurer
Insurance adjusters are trained to investigate inconsistencies, but they also follow strict process rules. When documentation is thorough and truthful, most legitimate claims are eventually paid.
If internal efforts fail and the denial is clearly improper, policyholders can turn to the California Department of Insurance (DOI). Beaver shared a case where a life insurance company accepted years of premiums, then tried to deny a death claim. The DOI intervened and forced the insurer to pay.
While the DOI doesn’t resolve every valuation dispute, it can be highly effective when an insurer ignores its legal obligations or wrongfully denies coverage.
Not every loss should become an insurance claim. Beaver advises paying out of pocket for minor damage when possible. Even a small claim can push you into a higher risk category, leading to:
- Higher premiums
- Fewer carrier options
- Non-renewal in tight markets
As Susman puts it, insurance is meant for catastrophic losses—not financial inconveniences.
Education, Accountability, and Consumer Protection
Beyond claims, Beaver highlighted how poor decision-making and entitlement often lead to unnecessary legal trouble. Whether in parenting or insurance behavior, avoiding accountability tends to create bigger problems over time.
The connection to insurance is clear: impatience, exaggeration, and blame often turn manageable claims into legal disasters.
- Always start with your adjuster and agent
- Escalate internally before seeking legal help
- Be completely honest in every claim
- Keep detailed documentation
- Reserve insurance for significant losses
- Contact the Department of Insurance for wrongful denials
- Research any attorney before hiring
Most insurance disputes can and should be resolved within the system. Legal action is a powerful tool—but it’s also expensive, slow, and unnecessary in many cases.
As Dennis Beaver bluntly advises: “Trust the system first. Tell the truth.”
For California policyholders navigating today’s complex insurance environment, that combination of patience, documentation, and integrity remains the strongest protection of all.
