Car accidents, medical mishaps, slip and fall incidents, and workplace injuries share a common need: insurance should be available to help when these unexpected events occur. You rely on the people responsible for these incidents having insurance to pay for any harm or damage.
Once you’ve had an accident, you submit a claim to your insurance company, expecting they will cover your growing financial losses. But what if they reject your valid claim, and you need money urgently? How can you handle a denied insurance claim?
Why Was Your Claim Denied?
Insurance companies can deny personal injury claims for various reasons.
Policy Exclusions
Insurance policies typically include a list of situations or circumstances that are not covered, known as exclusions. The insurance company will disapprove your claim if your injury or accident falls under one of these exclusions. For example, some policies exclude coverage for injuries sustained while engaging in certain high-risk activities.
Lack of Coverage
If the person responsible for your injury doesn’t have insurance or their coverage is insufficient to cover your damages, you can be out of luck. In such cases, there’s no insurance to claim against.
Late Reporting / Statute of Limitations
Most insurance company policies require you to report accidents promptly or within a specific deadline. Failing to do so can result in a claim denial, making it challenging for the insurance company to investigate the incident effectively.
Disputed Liability
The insurance provider has the right to withhold payment where there is disagreement over who has liability for the accident. This often involves a legal process to establish fault.
Pre-existing Conditions
Insurance companies can question if your injuries existed before or were unrelated to the accident. They could use your medical history against you to deny your claim. Providing evidence linking your injuries directly to the accident is crucial.
Incomplete Documentation and Evidence
Insurance companies require documentation and evidence of the accident, your injuries, and medical treatment to process a claim. If you fail to provide complete and sufficient documentation, they can deny your claim due to a lack of evidence.
Failure to Seek Timely Medical Treatment
Delaying medical treatment after an accident can lead to questions about the severity and causation of your injuries. Insurance companies can argue that your injuries weren’t serious or resulted from another incident.
Misrepresentation
Providing false or inaccurate information during the claims process is a serious matter. If discovered, it can lead to your claim being denied and even legal consequences.
Policy Lapses
If the policyholder’s insurance was not active at the time of the accident, there’s no coverage available, and your claim will likely be denied. This often happens when premiums haven’t been paid.
Policy Limits
Insurance policies have coverage limits. If the damages exceed these limits, you’ll only receive compensation up to the maximum the policy allows, which can not cover all your losses.
Failure to Cooperate
If you don’t cooperate with the insurance company’s investigation, refuse to provide necessary documents, or fail to attend medical examinations requested by the insurer, your claim can be denied.
No Third-Party Liability
If no one else is at fault for your injuries (no third party), attempting to claim against your insurance policy can be inappropriate or fruitless, leading to a denial.
Understanding these reasons can help individuals navigate the personal injury claims process more effectively and take steps to prevent claim denials when possible.
What to Do if Your Insurance Claim is Denied
If you face a denied insurance claim, it’s important not to panic and, most importantly, not to give up.
Seek an Explanation
Your initial action should involve requesting a written explanation from the insurance claims adjuster regarding the denial. This explanation will outline the specific reasons behind the denial. If you have one, reviewing this explanation in detail with your attorney is highly advisable.
Send a Follow-up Letter
In cases where the insurance company fails to provide a written explanation, you or your attorney should send a formal letter to the insurance adjuster. This letter acknowledges the claim denial and that your request for an explanation was also denied. It conveys your determination and could prompt the adjuster to reconsider or offer a settlement.
Utilize the Letter as Evidence
Your letter is important evidence should you pursue a bad-faith insurance claim. It demonstrates your commitment to resolving the matter and holding the insurance company accountable for its actions.
File a Complaint
Depending on the circumstances, consider filing a complaint with your state’s Department of Insurance. This can help bring regulatory attention to your case and lead to a resolution.
Initiate the Appeals Process
If you disagree with the denial or believe there is an opportunity to rectify any issues, you and your attorney should promptly initiate the insurance company’s appeals process. Time is of the essence.
Gather Strong Evidence
Collect all relevant evidence to support your appeal. In car accident cases, gather photographs, police records, witness statements, statements from accident reconstruction professionals, medical records, and other pertinent documents. For slip-and-fall accidents, assemble medical records, witness statements, photos, video footage, store procedures, and evidence of poor lighting, slippery conditions, or lack of signage.
Present Your Appeal
Your attorney will work with you to compile and present your appeal, including the newly acquired evidence. The goal is to convince the insurance company to reconsider their denial and approve your claim.
Be Prepared for Outcomes
Ideally, the insurance company will review your additional evidence and reverse their denial, providing you with the compensation you deserve. However, if they deny your claim again, and you have a strong case, you can decide to take legal action against the insurance company.
Consult an Experienced Attorney
When your insurance claim is denied, it’s wise to consult with experienced lawyers in Calgary to assess the grounds for a potential appeal. They can guide you through the legal process. This will ensure that your human rights are protected and pursue your claim in court if necessary.
How Calgary Personal Injury Lawyers Can Help
Dealing with giant insurance companies can be daunting, especially when your legitimate insurance claim is rejected. In such challenging times, personal injury attorneys in Calgary can be invaluable allies in your pursuit of justice. This is how they can help:
Document and Evidence Collection
The right personal injury attorney gathers all relevant documents and evidence about your denied claim. This includes medical records, accident reports, witness statements, and other supporting documentation. Their expertise ensures that nothing vital is overlooked.
Legal Advocacy
Your lawyer will craft a compelling legal letter on your behalf, which will be sent to the insurance company. This letter serves as a vigorous defence of your claim, outlining why it should be reconsidered. The lawyer’s legal expertise can significantly strengthen your case.
Utilize Forensic Experts
Sometimes, personal injury attorneys bring forensic experts to provide professional analysis and testimony. This can lend credibility and weight to your claim, especially in complex cases where the circumstances are disputed.
Skilled Negotiation
Your attorney can negotiate intelligently on your behalf when the insurance company makes an issued settlement offer. They have the experience and knowledge to assess whether the offer is fair and just, and they can advocate for a more appropriate settlement amount if necessary.
Mediation and Arbitration Representation
If negotiations do not yield satisfactory results, personal injury attorneys are well prepared to represent you in mediation or arbitration meetings with the insurer. They will navigate these proceedings on your behalf to secure a favourable resolution.
Litigation Support
In cases where an amicable resolution cannot be reached, your lawyer can take your case to court. They will guide you through the entire litigation process. They will represent your interests and present a compelling argument for your claim.
Legal Knowledge and Expertise
Injury lawyers specialize in this field of law. They possess an in-depth understanding of personal injury laws, regulations, and precedents specific to Calgary. This expertise is crucial in navigating the complexities of your case.
Call a Knowledgeable Personal Injury Lawyer
Having your personal injury claim denied by an insurance company is not the end of everything. Stay positive, gather evidence, and consult a trusted personal injury lawyer to help you fight for your deserved compensation.
At Sidhu Personal Injury Lawyers Calgary, we prioritize our client’s needs. We’ll fight and support you throughout the legal steps. Contact us today for a free consultation, and we can look into your situation together.
