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Insurance Law Intake Form

If your insurance claim has been wrongfully denied, you may be the victim of bad faith practices. Many situations can result in a bad faith insurance claim, including a delayed claim investigation or delayed payment of a claim. A bad faith action helps protect insured individuals when dealing with insurance companies. However, just be cause your claim has been denied does not mean you have a bad faith insurance claim. If you believe your claim has been wrongfully denied, contact an insurance law attorney today to determine if you have a valid bad faith insurance claim.

Louisiana Insurance Defense Lawyers

Since 1948, the New Orleans, Louisiana, based law firm of Bienvenu, Foster, Ryan & O'Bannon, L.L.C. has provided quality insurance defense services in cases throughout the state. Our clients are some of the most recognized names in the insurance industry. We have extensive experience with first and third party actions and have handled cases in nearly every category of insurance.

Contact our office to learn more about our services and how we can help you. You can reach us by phone at 866-459-6002 or via e-mail.

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Insurance Contact Form

*First Name

*Last Name

*Email Address

*Phone Number

*Zip

Street Address

Apt/Ste

Incident Street Address

Incident Apt/Ste

*Incident Zip

Date of Birth

Spouse's Name

Date of Birth (spouse)

State of Residence

Business Phone

Cellular or Pager

Best way to reach you:
Email  Phone 

Best time of day to reach you

Type of Insurance You Own

Insurance Companies You have Insurance Policies With

Do you have copies of your insurance policy(ies)?
Yes  No 

Have you read/are you familiar with your insurance policy(ies)?
Yes  No 

Are you familiar with the procedures for filing a claim with your insurance carrier?
Yes  No 

To the best of your knowledge, did you follow these guidelines when submitting your claim to the insurance company?
Yes  No 

Have you recently filed a claim with an insurance company?
Yes  No 

If Yes, Which company?

What type of claim?

Name of insurance agent you spoke with?

Date of Loss:

Date you filed your claim:

Was your claim denied?
Yes  No 

If No, were you informed of the reasons why the claim was denied?
Yes  No 

If Yes, why was the claim denied?

Are you concerned that your claim was wrongfully denied or that the insurance company acted in bad faith? Explain.

Have you received any settlement offers, communication from, or monetary checks from your insurance company as a result of filing your claim?

If you have not recently filed a claim with your insurance company, are you interested in filing a claim?
Yes  No 

What type of claim?

Name of insurance agent you have worked with, (if applicable)

How did you out about find us?

If somebody referred you to us, who was it?

Areas of special concern?

Are there any other issues we can assist you with?

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DISCLAIMER: This site and any information contained herein are intended for informational purposes only and should not be construed as legal advice. Seek competent legal counsel for advice on any legal matter.

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