What Do You Do When The Insurance Company Denies Your Personal Injury Claim?

Your insurance company owes you a duty to act in good faith. This duty is the premise of the whole contractual relationship and needs to be upheld when your insurance company denies your personal injury claim. Although your insurance company can deny your personal injury claim, in good faith, for any number of legitimate reasons, you as the insured have the right to contest this denial if you feel it is unreasonable.

If you feel your insurance company has acted in bad faith or their reasons for denying your claim are unreasonable, you should study your insurance policy for possible coverage exclusions and ask your insurance company for a detailed explanation for your denial. If the insurance company does not provide a valid or detailed explanation for denying your claim or you believe they may have acted in bad faith in their denial, you may need to consider legal action.

Unwarranted or wrongful denial of an injury claim is not only a breach of good faith but also a breach of contract as an insurer is contracted to pay for valid claims under their policy. If you believe your insurance company has breached its contract or duty of good faith in denying your personal injury claim, you should contact a personal injury attorney. If it is determined the insurance company breached its contracts in the duty of good faith, the insured will be compensated for their injury claim and may be awarded damages caused by the denial of their claim.  Bringing legal action, you allow yourself the opportunity to be compensated for your claim, as well as for damages caused by the denial an insurer is likely claims compensation and possible damages caused by the denial of your claim.

They may have breached their duty to act in good faith. An insurance company may breach its duty of good faith by failing to thoroughly investigate a claim, failing to negotiate a settlement, or by issuing an unwarranted denial of an injury claim.

The Following Are Examples Of Reasons Insurance Companies Deny Personal Injury Claims.

  • Policy Exclusion

Insurance companies will often hide exclusions to coverage of certain types of injuries in the fine print of your insurance policy. These exclusions are often briefly and vaguely discussed in your insurance policy and in some cases, may even be illegal. If your insurance company’s denial cites an obscure exclusion of coverage in your policy, you may want to contact a personal injury attorney to inquire about the legality of the exclusion.

  • Expiration or Lapse of Coverage

It is not uncommon for an insured to forget or neglect to renew various types of coverage that are not automatically extended or renewed. In most cases, the insured will not be able to make a claim for injuries or losses that occurred after the coverage expiration date.

  • Incorrect or Incomplete Claim

Ensure your claim is accurate and submitted correctly as insurance companies may deny your claim due to incorrect information or a failure to adhere to claim submission requirements.

  • Delay in Treatment/Failure to Mitigate your Injury

Insurance companies may deny your claim if they see that you have not taken the proper steps to mitigate your injuries through immediate and follow-up medical treatment. Your credibility as a policyholder is paramount to a successful personal injury claim. Many personal injury claims are denied due to an insured’s lack of a good faith effort in their recovery.

  • Limited or No Medical Records

If there is no proof of your injury through medical records and reports, an insurance company may deny your claim. They may also deny your claim if your medical records are incomplete. It is very important that you make an immediate complaint and seek immediate treatment following your injury so there is medical evidence of your injury.

  • Pre-existing Condition

The insurance company may also deny your claim citing your injury pre-dated the alleged date of your accident. It is important you include accident reports and medical records in your personal injury claim to avoid confusion on dates and pre-existing conditions.