Insurer's Refusal to Pay

Insurance claims against an insured’s own insurance policy are called “first party claims.” These claims have different laws that govern them than claims against another person or “third party claims.” Missouri provides a statutory remedy in addition to breach of contract claims for insureds who are seeking enforcement of the benefits promised in their insurance policies.

 

The Missouri Vexatious Statutes protect the insured from being abused by his/her own insurance company. “Vexatious” means “without reasonable or probable cause or excuse.” These statutes exist to make sure insurance companies play fair when presented with a claim from their insured.

 

The Missouri Supreme Court has found insurance companies responsible for vexatious refusal to pay claims even when they paid claim just before trial.

 

The elements for vexatious refusal to pay/settle are:

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1.) Issuance of an insurance policy to a Missouri resident or corporation;

2.) The insured sustains a loss and makes a claim under his/her own policy;

3.) The insurer wrongly denies or ignores the claim;

4.) The insurer’s refusal to pay/settle is willful and without reasonable cause or

excuse;

5.) The insured is entitled to damages for breach of the insurance contract, and penalties offered under the Vexatious Statues.

 

Under the Vexatious Statutes the insured can recover 20% of the first $1,500 of the loss and 10% of the loss in excess of $1,500 together with reasonable attorney's fees, in addition to the amount of recovery owing under the policy.