What Happens if Your Insurance Claim Is Denied?

Car Injury Accident - Insurance Claim is Denied?

When you are injured in a car collision that was not your fault. You've done the duties you were supposed to do, such as filing a collision statement with the policemen, informed your insurance carrier, submitted your medical and car repair bills to the other driver's insurance, and gave documentation of your damages and losses.  What happens if that insurance claim is denied? Just because they are refusing to pay for your damages doesn't mean they are jusitified.

When an insurance claim is denied, you are a distinct disadvantage if you don't know the law. You may even surmise they are trying to wear you down.  To force you to go away, so they don't have to pay out any money. Insurance corporations are, after all, in the business of making money.

When that denial letter appears in your mailbox, it can be disheartening. However, but there are other avenues you can pursue with your claim. A meeting with a competent lawyer in Kansas City may be to help. A lawyer with experience handling insurance cases and especially denials can assess the details of your case and present some alternatives for proceeding. That may involve appealing straight to the insurance corporation or filing a suit in court.

What reasons do insurance companies deny?

When your insurance case is denied, the insurance corporation has to give you a basis for the denial. Common grounds for rejection of cases include:

Disputed Liability — The insurance corporation may say that their policyholder didn't cause the collision, or that the crash didn't cause the damages or losses you're demanding.

Policy Exclusions — Insurance policies typically include a lengthy list of items they will not cover.  For example, intentional actions are rarely covered by insurance contracts.  Insurer often relies on one of these things on the list, commonly called exclusions, to say that their policy doesn't cover your accident.

Lapsed Policy — If the policy premiums were not paid at the time the incident occurred, the policy might have expired, and the insurance corporation would say that no coverage existed at the moment of the event.

Failure to Notify — Policyholders have a duty to notify insurance corporations of events in a reasonable period after the occurrence. If they fail to do so, the insurance corporation may claim it didn't have a chance to investigate the event and may reject the case.

Duty to Act in Good Faith

When a policyholder obtains insurance, that insurance policy functions as a contract. The policyholder consents to pay the premiums for insurance, and the insurance corporation agrees to pay claims unless one of the policy exclusions applies. Parties to a contract are expected to act in good faith, which frequently means that they enter into the deal with sincere and honest intentions. That means if an insurance corporation rejects your case, it is assumed to have a genuine reason to do so. If the corporation knows its policyholder is at fault and no exclusions apply. Still, they denied anyway. The company may be acting in bad faith, or deliberately not satisfying the company's contractual responsibilities.

There are some claims under Missouri law that are considered inappropriate claims practice. If the corporation that refused your request in any of these actions, you may have a claim against the corporation for improper claims practice. An attorney with knowledge handling insurance disputes can help you ascertain if one of these happened to you:

The corporation falsified information about the policy or coverage

The corporation failed to acknowledge information about claims with reasonable promptness;

When responsibility was reasonably clear, the company did not participate in good faith attempt to resolve cases;

There was no fair investigation, and the corporation denied your case without having adequate knowledge;

The corporation tried to settle your claim for less than a reasonable person would think your request was worth.

Appealing a Denial 

Most insurance corporations have a method for disputing your case. A lawyer can help you pull together all of the proof and documents you'll need to petition for the basis for the rejection and present them to the insurance corporation on your behalf. Your attorney can affirm your claim for why your case should be paid under the policy and negotiate with the insurance company for compensation. That process may include going to the arbitration of your claim, where each side offers evidence to an unbiased third party, and that person decides the dispute.

Filing a Lawsuit

If the insurance corporation acted in bad faith, you might be able to sue the corporation for the improper claims practice. If you decide to do this, you will need a lawyer.  Call our injury lawyers in Kansas City and have us by your side. Call us at (816) 474-2060 for a free legal consultation with McCollum Injury Law Firm.

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