Reasons Given For Denial of Some Accident Claims

If claimants were able to learn why any of their insurance claims were denied, then each of them would be apt to have a better feel for the reasoning behind the denial. A claimant’s insight into such reasoning could allow him or her to do a better job of fighting the insurance company’s action.

Possible reasons for denial

• Delay in seeking treatment, so that there was no proof of injuries
• Examination of issued policy shows that it does not cover the reported accident.
• Defense claims that plaintiff was guilty of comparative or contributory negligence
• Claimant filed late, and in doing so had created a negative effect on the investigation
• Claimant had delayed treatment, causing absence of sufficient proof for injuries
• Claimant had a pre-existing condition
• The policy has expired
• Arriving officer issued a DUI to driver seeking coverage
• The claim exceeds the policy’s stated limits
• Claimed damage did not have link to accident

What is suggested response, if claim has been denied?

Request a written statement that explains the reason for the denial. Such a statement should include evidence of facts that were a basis of the denial. Those facts could include a reference to existing laws or specifics on the terms in the insurance policy.

If there is no response to an oral request, let your Personal Injury Lawyer in Barrie present a written request. Make a copy of same.

Speak with a lawyer. This should relieve claimant of need to worry about fact that claim has been denied. Instead, the claimant’s chief concern would be getting treated for the accident-linked injury. A lawyer’s assistance could also prove valuable, if it became necessary to show that the insurance company had demonstrated “bad faith.” In other words, keep in touch with any attorney that has been contacted.

Speak with the adjuster’s supervisor, or send the same supervisor a copy of the letter that was written to the adjuster, the one requesting an explanation for the adjuster’s action. File a complaint with the state’s Department of Insurance. Keep sharing with lawyer the actions taken, and the responses to any contacts made with someone in insurance company. Any of those might be grounds for a charge of “bad faith.”

–Has the Department of Insurance said that a legitimate claim had been denied?
–Has the insurance company failed to provide proof of the fact that an investigation of the claim had been carried out?
–Has the Department of Insurance indicated that the claim process had not been followed in the proper manner?
–Had the insurance company failed to offer relevant information to all of those that were taking part in efforts to learn more about the basis for the fact that the original claim was denied?