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  • Writer's pictureMuammar Reed

Can Insurance Deny an Injury Claim?

When you've suffered an injury from a car accident and have insurance coverage in place (or the person who hit you has insurance coverage), you expect that your insurance company will come to your aid and provide the necessary financial support. However, insurance companies can and do deny injury claims for various reasons. In this article, we will explore the circumstances under which an insurance company can deny your injury claim, your options if your claim is denied, and the legal actions you can take against your insurer.

1) Why Your Injury Claim Would Be Denied?

Insurance companies may deny an injury claim for several reasons, including:

a) Lack of Coverage: If the injury is not covered under your policy or if your coverage has lapsed or been canceled.

b) Late Reporting: Failing to report the injury promptly can lead to denial.

c) Policy Exclusions: Your policy may have specific exclusions that prevent coverage for certain types of injuries or events.

d) Misrepresentation: If you provided inaccurate or false information when applying for the policy or during the claims process, your claim may be denied.

e) Failure to Follow Procedures: If you did not follow the proper procedures for filing a claim or seeking medical treatment, the claim may be denied.

f) Insurance companies have been told a different version of events by their insured.

2) Options after Injury Coverage Denial?

If your injury claim is denied, you have several options to pursue:

a) Appeal to Your Insurance Company: You can appeal the denial by providing additional documentation or information to support your claim.

b) Mediation or Arbitration: Some policies have provisions for resolving disputes through mediation or arbitration, which can be less adversarial than litigation.

c) Legal Action: If all else fails, you can take legal action against your insurance company (or the 3rd party driver) to seek the coverage you believe you are entitled to.

3) What Types of Legal Action Can I Take Against My Insurance Company?

When your injury claim is denied, you can take legal action against your insurance company through various means, including:

a) Filing a Lawsuit: You can file a lawsuit or demand arbitration against your insurer to compel them to honor the policy and provide coverage for your injuries.

b) Complaint to Regulatory Authorities: You can file a complaint with your state's insurance regulatory authority, which may investigate the denial and take action if your insurer is found to be in violation of insurance regulations.

c) Seeking Damages: In some cases, you may be able to seek damages for the harm caused by the insurance company's denial of your claim.

4) Causes of Action Against Insurance Company: Breach of Contract and Bad Faith

Two common causes of action against insurance companies for denied injury claims are:

a) Breach of Contract: You can allege that the insurance company has breached its contract with you by wrongfully denying your claim. You will need to demonstrate that you met all the policy requirements for coverage.

b) Bad Faith: You can allege that the insurance company acted in bad faith by unreasonably denying your claim, failing to investigate properly, or intentionally delaying payment. Proving bad faith can result in punitive damages in some cases.

5) Tips for Suing the Insurance Company for a Denied Claim

If you decide to sue your insurance company for a denied injury claim, here are some essential tips:

a) Consult an Attorney: Hire an experienced attorney who specializes in insurance law to guide you through the process.

b) Gather Evidence: Collect all relevant documents, including your insurance policy, correspondence with the insurer, medical records, and any evidence supporting your claim.

c) Follow Legal Procedures: Ensure that you comply with all legal procedures and deadlines for filing a lawsuit.

d) Be Prepared for Negotiations: Your attorney may attempt to negotiate a settlement with the insurance company before proceeding to trial.

e) Stay Informed: Keep yourself informed about the progress of your case and maintain open communication with your attorney.

In conclusion, insurance companies can deny injury claims for various reasons, but you have options for pursuing coverage and compensation. Whether through appeals, mediation, or legal action, it's crucial to be informed, consult an attorney, and follow the appropriate procedures to protect your rights and seek the coverage you deserve when your claim is unjustly denied.

This article is not legal advice and does not create an attorney-client relationship. Each case is different and it is recommended that you consult a licensed attorney in your area if you have been injured or have a potential personal injury case.

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