Detailed Answer
This article explains what you can do in West Virginia when an insurance company will not increase what it calls its final settlement offer. It covers why insurers sometimes refuse, practical options you can pursue, and how West Virginia law and regulators may help. This is educational information only and is not legal advice.
Why an insurer might refuse to raise its offer
- The insurer believes your claim is worth only that amount based on its investigation (liability, damages, or policy limits).
- The insurer asserts a coverage issue or policy exclusion applies.
- The insurer says supporting records (medical bills, repair estimates, receipts) are missing or inconsistent.
- The insurer is protecting its own exposure because policy limits are low or it thinks you can’t prove additional damages in court.
Practical options you can pursue in West Virginia
- Confirm why the offer is final. Ask the claims adjuster in writing why they will not increase the amount and what facts or documents led to that conclusion. Get the adjuster’s position on liability, damages, and coverage in writing.
- Review your policy. Read the relevant coverage, exclusions, deadlines, and dispute-resolution clauses (for example, appraisal or arbitration clauses for property claims). If your policy contains an appraisal clause, that is often a faster way to resolve disagreements about the amount of loss for property claims.
- Gather and organize evidence. Compile medical records, medical bills, wage-loss documentation, repair estimates, photographs, police reports, and any written communications with the insurer. Strong, organized documentation strengthens your negotiating and legal positions.
- Send a clear demand letter. Prepare a written demand that summarizes liability, documents damages, and explains why the prior offer is inadequate. Set a reasonable deadline for response. A formal demand often prompts renewed review.
- Try alternative dispute resolution. Propose mediation or arbitration if your policy or the insurer’s settlement practices allow it. Mediation can produce a negotiated settlement without filing suit.
- File a complaint with the West Virginia Offices of the Insurance Commissioner. If you believe the insurer engaged in unfair claim settlement practices, you can file a consumer complaint with the state regulator. The office can review the insurer’s handling of your claim and sometimes help resolve disputes. See the West Virginia Offices of the Insurance Commissioner: https://www.wvinsurance.gov/.
- Consider a lawsuit. If other options fail, you can sue the insurer for breach of contract (failure to pay benefits owed under the policy) and, in some cases, for unfair claim settlement practices. West Virginia insurance law and regulations governing insurer conduct appear in Title 33 (Insurance) of the West Virginia Code: https://code.wvlegislature.gov/title/33/. A lawsuit may recover the policy amount plus interest, attorney fees in limited circumstances, and possibly other damages depending on the facts and law.
What West Virginia law and regulators require
Insurance companies doing business in West Virginia must follow statutory and regulatory rules in Title 33 of the West Virginia Code and related administrative rules. Those rules prohibit unfair claim settlement practices and impose duties on insurers to investigate and handle claims reasonably. You can review Title 33 at: https://code.wvlegislature.gov/title/33/.
If you believe your insurer acted unfairly, you may file a complaint with the West Virginia Offices of the Insurance Commissioner at https://www.wvinsurance.gov/. The regulator cannot give legal advice, but it can investigate possible violations of the insurance code.
When to hire an attorney
Talk to an attorney if:
- The insurer’s final offer is far below documented damages or medical expenses.
- Coverage disputes or complex legal issues exist (bad faith, policy interpretation, multiple liable parties).
- The claim involves substantial economic or non‑economic loss, permanent injury, or a risk of missing legal deadlines.
The West Virginia State Bar can help you find a licensed attorney: https://www.wvbar.org/.
Typical timeline and next steps
- Immediately document all communications and preserve records.
- Within days, send a written demand and request reconsideration.
- If no change within a few weeks, consider mediation, appraisal (for property), or filing a complaint with the Insurance Commissioner.
- If still unresolved, consult an attorney about filing suit before any applicable statute of limitations runs out. (Time limits apply — act promptly.)
Potential outcomes
- The insurer reopens the file and increases the offer after new evidence or pressure from a demand, appraisal, or regulator involvement.
- You and the insurer agree to mediation or arbitration that produces a higher payment.
- You file suit and either reach a higher settlement or obtain a court judgment in your favor.
- Regulatory action prompts the insurer to change its handling practices, or the regulator issues sanctions in severe cases.
Disclaimer
This information is educational and general. It is not legal advice, cannot substitute for advice from a qualified attorney, and may not reflect recent legal changes. For advice specific to your situation, consult a licensed West Virginia attorney.
Helpful Hints
- Keep a written file of every call, email, letter, and invoice related to the claim.
- Request the insurer’s full claim file if you need to see what evidence the insurer relied on.
- If you have a property loss, check whether your policy contains an appraisal clause and read its procedures carefully.
- Don’t sign a release of all claims without knowing exactly what you are giving up.
- Act quickly: statutes of limitation and policy notice deadlines can bar later claims.
- Use the state regulator to report unfair treatment, but also consult a lawyer if the amount at stake is large or time sensitive.