How To Respond To Denial of Insurance Claim?

Insurance adjusters study the circumstances surrounding a given claim, before proceeding with an investigation. Depending on the results of their study or investigation, some adjusters elect to deny specific claims.

Possible reasons for denial

• The accident’s location or its cause does not match with the requirements that have been stated in the purchased policy.
• The claimant has submitted an incomplete or inaccurate claim form.
• The claimant allowed too much time to pass, before seeking treatment for his/her injuries.
• The claimant’s medical records do not offer the insurer a sufficient amount of information.
• The claimant’s injury was not caused by the accident, but instead, it demonstrated the effects of a pre-existing condition.
• The claimant’s failure to follow the prescribed treatment
• Claimants that have failed to pay their premium should expect to receive a denial letter.

Significance of denial

If there is no sound reason for the act of denying the submitted claim, then the insurance company has chosen to breach its contract with the policyholder. A breach of contract qualifies as a demonstration of bad faith.

If an insurance company has displayed bad faith, then the denied claimant/policyholder ought to search for an experienced personal injury lawyer.

Personal injury lawyers in Aurora knows how to report an act of bad faith to the proper state authorities. A lawyer would make a copy of any letter written to such authorities, and would send one copy to the adjuster’s supervisor.

Adjusters do not like to have their actions receive an evaluation. Any one of them would be apt to reverse the decision about denying coverage to a given policyholder/claimant.

Still, the copy of the letter sent to the state would go into the supervisor’s file. The adjuster would be aware of that fact. Hence, he or she would not feel inclined to issue another denial of any future claims from the same individual.

The possible exception to the above-mentioned practice

There is one time when an adjuster would not hesitate to deny a submitted claim, even if the submitting claimant had written to state authorities about a previous denial. That one exception to the rule could emerge, if the adjuster’s knowledge included observations made, following submission of an earlier claim.

Perhaps the claimant’s early actions had included an effort at deceiving the insurer. Maybe the policyholder had faked the existence of a serious injury. Adjusters that knew about such activity would hesitate to accept another claim from the same individual. ‘’

The adjuster’s words and actions could transform the concerns of an accused driver into feelings of comfort. Those feelings would reflect the discovery of an adjuster’s plans, regarding how to deal with a certain insurance claim. That plan would call for denial of the same claim.

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