What To Do If Your Insurance Claims Are Denied

Having an insurance policy offers us a feeling of safety. When you take out an insurance policy, you expect to be fully or partially covered in the event of an accident. However, insurance companies sometimes take advantage of their policy contracts’ fine print to deny their clients coverage. This denial often causes panic and frustration for accident victims already suffering from serious injuries. 

In some cases, the denial of a claim is reasonable and cannot be contested. However, there are instances in which insurance companies make poor judgments and can be held financially accountable. If you believe your insurance claim was unfairly denied, contact a qualified bad-faith insurance attorney to help you claim the compensation you deserve.

Why Did My Insurance Company Deny My Claim?

In some circumstances, insurance companies have the right to deny claims. In these cases, covering the cost of injuries is not the insurance company’s responsibility. Your insurer will deny your claim in any of the circumstances described below.

Cause of Injury Excluded From Policy

Every insurance policy has its limitations. Insurance policies will delineate the types of injuries they are required to cover and the total amount of coverage. In some cases, the cause of your injury may be excluded from your policy’s coverage. Insurance companies often make a point of adding these exclusions into the policy’s fine print, so you should carefully review your policy details before signing on with a new insurer.  

Your Policy Has Expired

Allowing your insurance policy to lapse can have serious consequences. During any lapse of coverage, however brief, you are considered uninsured. If you are injured with an expired insurance policy, your past insurer has no obligation to cover your injuries (even if you have since renewed your policy). To avoid this situation, make sure that your insurance policy is currently active and that your premium is paid on time. 

Insufficient Documentation of Injury

In order to receive compensation from your insurer, you need detailed documentation of your injury. This generally requires an official diagnosis from a medical professional and records of any treatments you have received. Without a diagnosis, you have no proof that you were injured, and your insurer may claim that you have suffered no injury.

Partial Liability or Failure to Mitigate Harm

If you were injured due to your own negligence or dangerous actions, your insurer might not be required to cover the costs of your injuries. Additionally, failure to mitigate harm (in other words, failure to take reasonable action to prevent further injury) can result in a denied claim. Failure to mitigate harm could look like waiting weeks before seeing a doctor, resulting in an exacerbated injury. 

Pre-Existing Condition

A pre-existing condition could include any medical issues you had before your accident. Your insurer may argue that your injury resulted from or was exacerbated by this pre-existing condition. If a pre-existing condition causes your injuries, your insurer may not be required to pay out. A medical professional must confirm that your injury is a result of your accident rather than a pre-existing condition or injury.

Unclear Connection Between Accident and Injury

To prevent clients from claiming more damages than were actually caused by the accident, insurance companies want definitive proof that your injuries were a direct result of the accident. Testimonies from witnesses to the accident or your doctor are important in establishing the cause of your injuries. If you cannot prove that your injuries were sustained in your accident, your claim could be denied.

Incorrect Information on Claim

In some cases, a claim may be denied on purely bureaucratic grounds. Providing inaccurate information while filing your claim may give your insurer all the grounds they need to deny your claim. Before submitting any documentation to your insurer, double check that all included information is accurate and up-to-date. 

What To Do After Your Personal Injury Claim is Denied

What options do accident victims have once their insurer has denied their claim?? If you believe your insurer unjustly denied your claim, take the following actions to ensure you receive fair compensation.

Ask for Clarification in Writing

Firstly, you should contact your insurer to learn why they have denied your claim. Ask them to explain in writing their exact reasoning for denying your claim. By insisting on this written record, you may find that your insurance company is bluffing and pays out after all. However, even if this isn’t the case, a written record of your insurance company’s grounds for denial of your claim will provide important documentation if you decide to challenge the denial down the line. 

Request an Internal Appeal

Every insurance company should have an internal appeal process. Clients have the right to request an internal appeal to make sure the adjusters have not overlooked key details of the case. Before taking legal action, initiate an internal appeal process to have your claim reviewed and reassessed. In some cases, this appeal may result in an overturn of the initial denial. 

Continue Gathering Evidence

If your claim was denied due to a lack of documentation, continue the process of gathering evidence while your claim goes through the appeal process. Evidence could include witness testimonies, police reports, a diagnosis from a medical professional, or photographs and video of the scene. Submit any new evidence you have gathered to your insurance adjuster. 

Start Searching For Qualified Attorneys

While your insurance company revisits your claim, it may be in your best interest to review your case with a qualified attorney. Look for local attorneys with experience representing clients whose insurance companies have denied coverage. When you have found an attorney who meets these criteria, schedule an initial consultation to review the steps you have taken thus far and to hear their suggestions for further action. 

Can I Sue My Insurance Company For Denying My Personal Injury Claim?

Even after requesting an appeal of your claim, your insurer may still deny any responsibility for your injuries. When you have no other options, consider suing your insurance company to help cover the costs of your injuries. The following examples are instances in which it would be appropriate to file a lawsuit against your insurer.

Breach of Contract

An insurance policy is a contract between the insurer and the insured. One of the most important aspects of this contract is the agreement that, in exchange for your insurance premium, your insurer will pay out in the event of an accident. If the insurer fails to uphold their end of the agreement, they are, at best, acting negligently and, at worst, purposefully withholding your rightful compensation. If your insurer is found to be in breach of your contract, you have the legal right to file a lawsuit against them. 

Bad Faith

“Bad faith” conduct encompasses a wide range of potential breaches of duty. When an insurance company acts in “bad faith,” they violate the faith their clients put in them to cover them in the event of an accident. Examples of “bad faith” actions include failure to defend their client in a lawsuit or thoroughly investigate the accident. Filing a bad faith insurance lawsuit could result in your insurer being forced to accept your claim and compensate you accordingly. If your attorney establishes that your insurer was guilty of fraud or the purposeful infliction of emotional suffering, they could also be held financially liable for punitive damages.

Do I Need a Personal Injury Attorney?

It is difficult to prove that an insurance company has breached its contract or acted in “bad faith.” To do so, you need extensive knowledge of the details of your policy contract and the liability assigned to insurers. Hiring a personal injury attorney with a specialty practice area in bad faith insurance law will ensure your case is reviewed by someone with extensive knowledge of policy law reviews your case. A quality attorney will protect your right to fair compensation by establishing your right to challenge your insurer’s denial of your claim.