Actions Available If Adjuster Has Said Your Injury Not Covered Under Policy

Insurance adjusters study the terms in the document that explains the coverage offered to a given policyholder, one that has, allegedly, caused an accident. Those terms might not apply to the incident that has been linked to a certain claimant’s injuries.

After completing that study, the adjuster decides whether or not the reported damages should be covered by the document that the company’s policyholder has purchased. Sometimes the adjuster’s decision results in a denial of coverage.

Possible reasons for denial

The policy’s coverage has lapsed. The location of the reported accident does not meet the requirements, as stated in the studied policy. According to the policy’s terms, the responsible driver has no right to claim coverage.

Approach suggested for claimant that has been denied coverage

• Ask for a written explanation: What was the reason for the adjuster’s decision?
• Ask for a copy of the studied policy, or a copy of the portion that had appeared relevant to the injury-causing incident.
• If necessary, check to see whether or not someone else might be held at least partly responsible for the reported accident.

Adjusters sometimes seek a lawyer’s opinion, regarding the extent to which a given policy requires payment of compensation to a given claimant.

Claimants should not feel defeated, if sent a document that has given a lawyer’s opinion, as support for a denial of coverage. Legally, an attorney’s opinion is not binding. In other words, it cannot be used as basis for an adjuster’s decision, regarding whether or not to cover a certain incident.

Of course, the average claimant might struggle to convince those in the claims’ department of an insurance agency that an explanation about a particular decision has lacked the necessary legal standing. That is why smart claimants make a point of hiring an Injury Lawyer in Barrie.

Other situations that could signal a claimant’s need for a lawyer

Situation where the insurer of the allegedly responsible driver has insisted that the hit driver was partly responsible for the reported damages; the insurer’s allegation could be based on an adjuster or lawyer’s opinion. Situation where the same insurer has questioned the severity of a reported injury.

Situation where the defendant’s insurer has questioned the claim that the victim of a reported accident should expect to face the need for more medical care in the future. That anticipated care would highlight the existence of an ongoing condition, one that had been caused by the accident-linked injury.

In all of the above situations, a lawyer’s tactics might be used to place some added pressure on the insurance agency. Ideally, that pressure could be used to reverse a decision, often one that has pushed the same agency to deny a claimant’s request for coverage.