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  • Writer's pictureRobert Schuerger II

What If the Claims Adjuster Denies Coverage for My Injury? | Navigating Insurance Claims

Dealing with the aftermath of a personal injury is never easy. There are often mounting medical bills, and since victims often need time off work to recover, it can put them under serious financial strain. In cases where the accident happened because of the negligence of another party, pursuing compensation from the other party’s insurance company can be the victim's one and only chance at obtaining financial relief.


However, when the claim is denied, it can seem like all is lost. However, that isn't always the case. With the help of an experienced personal injury attorney, claimants can ensure that their insurance claims aren't denied unfairly.


Understanding Insurance Claims

Understanding Insurance Claims


After filing a personal injury claim, victims are contacted by an insurance adjuster. His or her job is to investigate the claim by interviewing the claimant and key witnesses to determine the extent of the insurance company's liability.


It's important to remember that insurance companies are businesses, so like all businesses, their ultimate goal is to maximize their profit margins. To do this, they often go to great lengths to pay as little as possible or deny claims altogether.


Insurance companies often entrust this task to the insurance adjuster. In other words, his or her job is to find a way out of having to pay the claimant compensation for their damages. An insurance adjuster requests for medical records and exams as well.


This is why it is imperative that victims seek the help of a personal injury lawyer who will work in their best interest and ensure that their rights are protected and that they are not taken advantage of.


What Does an Insurance Claim Denial Mean?


When an insurance adjuster refuses to provide coverage after an accident, personal injury settlement negotiations are not necessarily over. This may just be another part of the injury settlement process.


In rare circumstances, an adjuster will argue that there is no available coverage. However, if the claimant indicates that they will not relinquish their claim, the adjuster may begin negotiating a settlement anyway.


Reasons for Denying Coverage


There are a number of reasons why an insurance company may refuse an insurance claim. Claimants must ensure that they read the denial letter that they receive from the insurance adjuster carefully before taking further action. Here are some of the reasons for the insurance company's decision:


There Are Policy Exclusions

Insurance policies are agreements of contracts drawn up between a policyholder and an insurer. They specify the types of claims that an insurance company is obligated to pay and which claims are not covered.


When purchasing car insurance, it's important that policyholders pay close attention to the type of coverage they select and the financial protection they offer. A driver may own an older vehicle, for example, and believe that comprehensive and collision insurance coverage is unnecessary.


However, if the vehicle is stolen or a car accident occurs, the insurance provider will be unable to assist them unless they have adequate coverage.


The insurance company's adjuster can access the inclusions detailed in the auto insurance policy when examining the claim a victim files. If the policy does not permit coverage for the damages suffered, a letter of denial is inevitable.


In such cases, a victim may be able to file a personal injury lawsuit against the at-fault party instead to recover damages suffered as a result of the accident. It's best for claimants to talk to a reliable attorney for assistance.


There Isn't Enough Supporting Evidence


When filing an insurance claim against the at-fault party's insurance carrier, claimants must demonstrate that the insured was indeed at fault for the accident. Their claim may be refused if they do not submit hard evidence to back it up.


Medical records, witness statements, photographs, and police reports are just some of the types of evidence that victims may submit to support their claim and ensure that they receive due compensation.


Insurance Premiums Have Not Been Paid on Time


Failing to pay premiums on time may bring about a gap in insurance coverage, which means that the policyholder will not have an active policy against which to file a claim.


This is why it's imperative that home and car insurance premiums are paid on time to ensure that coverage is available should the need arise. It's also important for policyholders to remember that a lapse in coverage could lead to fines and other penalties, which may even include the suspension of their driver's license and car registration, in addition to the possibility of the claim being denied.


There Isn't Enough Coverage Available


The truth is that it can be tempting to opt for the minimal coverage required by the state to save money on car insurance premiums. However, when involved in a motor vehicle accident that causes multiple injuries or hits an expensive automobile or building, it's easy for policyholders to find themselves without coverage.


If a driver is liable for $50,000 in damages that comprise property damage ($20,000) and injuries ($30,000), the insurance company may only cover $20,000, leaving the policyholder liable for the balance. In such cases, victims may pursue personal injury claims to secure the remaining amount.


What to Do If the Insurance Company Refuses to Pay a Personal Injury Claim


Suppose the adjuster has denied a claim. In that case, there are steps that claimants can take to increase their chances of obtaining compensation.


Ask for a Letter in Writing


Suppose the adjuster conveyed the message telephonically. In that case, the first step would be to request a letter in writing. This will reveal whether the adjuster is simply trying to hoodwink the claimant or if they were serious about the denial. It will also give the other party a chance to respond and see the reasons for the refusal.


Gather Evidence to Support the Claim


When they receive a denial letter, it's important for victims and policyholders to examine the contents of the letter carefully. In many cases, there is insufficient evidence to prove liability, so providing more proof can help to get the ball rolling again.


Providing witness statements, police reports, expert witnesses, photographs, surveillance footage, medical records, and more can be included in an appeal. It's important that victims retain their original documents and send copies to the insurance company, as these can be used later as evidence in a personal injury lawsuit.


Write An Appeal Letter


In this letter, the policyholder or claimant will explain why they disagree with the insurer's decision. Be sure to explain what evidence has been included and why it is relevant. It's also a good idea for the writer to reference information from the policy and denial letter.


Seek Help from an Experienced Personal Injury Attorney


Understanding legal jargon can be tough, which is why hiring a personal injury lawyer to help with the appeal can be beneficial. Moreover, if coverage was denied because of insufficient coverage, an attorney can help the claimant file a personal injury lawsuit to recover the balance. They will also conduct a thorough investigation to help uncover key evidence that may be used to support the personal injury claim. An attorney can also help with other things such as having to talk to the other drivers insurance adjuster.


Can a Claimant Take Legal Action Against the Insurance Company for Denying Their Claim?

Can a Claimant Take Legal Action Against the Insurance Company for Denying Their Claim?


Claimants can sue an insurer for failing to pay a claim for a valid reason. However, it's important for them to remember that insurance companies often have large legal teams, so hiring a reputable and trusted lawyer is a must.


In general, there are two reasons for taking legal action against an insurer:


Bad Faith Conduct


When an insurer acts in bad faith, claimants or policyholders have the right to sue. If an insurance company fails to treat an accident claim properly or breaches its duty of good faith to its client, it can be charged for bad faith. Should the person who files win a bad-faith lawsuit, the organization must pay a penalty as well as provide coverage.


Breach of Contract


When a person obtains insurance coverage, they enter into an agreement with the insurance provider. As a result, the rejection of a valid claim could be considered a breach of contract. By refusing to pay a claim without a sufficient legal basis, the insurer could have broken the agreement.


To determine if the insurance carrier breached the terms of the contract, claimants will typically need to engage with a reliable lawyer to review the policy's text and examine the denial of their claim.


Received a Denial Letter from an Insurance Adjuster? Schuerger Shunnarah Trial Attorneys Can Help!


When an insurance adjuster denies a car insurance claim, it can leave claimants feeling despondent and discouraged. The good news is that a claim denial doesn't necessarily mean that it's the end of the line for the claim. With the help of an experienced lawyer, victims can dispute the denial and ensure that their rights are enforced.


An attorney will conduct a thorough investigation and ensure that key evidence, such as medical reports, is presented to back up the claim. They will also fight for the claimant's rights and ensure that every avenue is explored in the quest to obtain justice.


Schuerger Shunnarah Trial Attorneys are well-versed in personal injury law and will stop at nothing to ensure that the at-fault party's insurance company pays the compensation that the victim is rightly due.

To learn more at a free consultation or have a reliable lawyer go to war for them, claimants can contact the firm.

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