How You Should Respond To Personal Injury Insurance Denial

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Since you are reading this piece we can fairly assume that you or one of your loved ones have had a denial of a Physical injury insurance claim. While you gather all the courage to fight injury and physical pain, being denied insurance benefits only adds insult to injury. Insurers make every possible attempt to attract you with their television, print and social media ads highlighting benefits of their insurance plans, in equal measures they seldom miss out on an opportunity to deny, delay or minimize the damages payable. So how do you respond to denial of physical injury insurance claim? You need to be determined to fight the injustice in the post-denial phase and exercise your legal options. Here we take a look at the ways in which you must respond to personal injury insurance denial.

Denial of a Physical injury insurance Claim

# Review Reasons for Denial      
Start by reviewing the reasons for denial of your claim. Every insurance policy has its exclusions and if your injury was specifically excluded from coverage of the plan it would clearly be mentioned in the letter or email that the company has sent you while rejecting your claim. Many customers fail to read through theirvoluminous insurance plans and don’t review the exclusions before signing the dotted line. If this is the case there is little that you can do about it now. However on many occasions customers are denied benefits for the most frivolous reasons in such cases insurance companies tend to use complicated terminology to airbrush their mischief.

# Get a Seasoned Attorney Onboard    
If your injury wasn’t specifically excluded in their plan and you have found mischief in their response you need to immediately seek help from a seasoned personal injury attorney. Your attorney would carefully examine the denial from a legal perspective and help you send letter to the insurance company challenging the frivolous grounds on which the claim has been denied. Your personal injury attorney would use all his/her legal acumen to clearly highlight how the denial breached the terms of the contract that both the parties agreed upon.

Denial of a Physical injury insurance Claim

# Legal Remedies  
If the insurance company doesn’t respond to your letter or doesn’t offer a satisfactory reason for the denial of your claim you need to seek legal remedy. Some insurers would offer to compensate you with minimum amount and in such a case your attorney would suggest you the right course of legal action. He/she would clearly explain to you the entire process of filing a personal injury lawsuit and its possible outcome. A good attorney won’t promise you a fixed timeframe but would offer you an estimated timeframe based on precedence and his/her personal experience. You need to keep in mind that you can earn a favorable verdict from the court under two circumstances – Breach of Contract and Bad Faith.

  • Breach of Contract – When you sign the insurance plan you and the insurer enter into a contract. If the insurance company denies you benefits that were agreed upon while singing the contract it is the perfect grounds for filing a ‘Breach of Contract’ lawsuit. Your lawyer would closely examine the contract and present it in front of the jury how the insurer failed to honor the terms agreed upon. Apart from earning your compensation you may also be awarded damages for the ordeal caused by the denial.
  • Bad Faith – You can charge the insurer of ‘Bad Faith’ when it fails to treat you fairly. For instance when benefits are denied for no valid reason or the company doesn’t adhere to the protocols while investigating injury claims it amounts to Bad Faith. In such cases apart from your benefits the company may have to pay punitive damages.
Posted in: Physical Injury