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Have a Denied or Delayed Claim?

It’s helpful to know right off that insurance companies have a clear and obvious advantage when it comes to personal injury claims. They know that 99 percent of people who are involved in accidents do not understand all the complicated laws and procedures that pertain to personal injury claims. 

Because of this, too many insurance companies attempt to deny a person’s legitimate injury claim. They expect that the vast majority of people aren’t savvy enough to do anything about it. So, another tactic by the insurance companies is to postpone claims. They do this assuming that the claimant’s resources are limited and the legal bills are mounting. 

And if there is a payout, it is usually far less than the amount the claim is worth. 

This is why you should consult with a personal injury attorney if you are involved in a personal injury accident. 

Insurance agent regrets to inform victim about refusal to pay compensation

Common Reasons Your Personal Injury Claim Could Be Denied

  • The policy does not cover the nature of the accident
  • The insurance policy has elapsed
  • You did not prove the insured caused the accident
  • The policy does not cover the location of the accident
  • The accident did not cause your injuries
  • The person who caused the accident is not covered by the insurance policy

Even if your claim was denied, you have legal recourse to attempt to secure the money you have coming to you!  You are entitled to pursue a claim against the person who caused the accident and the insurance company for that person. 

Consider that the insurance claim may be in bad faith or in breach of contract. When you consult with a personal injury attorney, they can review the policy and the facts of the case to conclude if the denial is based on a valid legal reason. Keep in mind that the claims adjuster could be attempting to pressure you into dropping your claim. 

Steps You Can Take in the Event of a Delay or Denial

Seek an Explanation of the Denial of Claim

The first step is to request from the claims adjuster an explanation for the basis of the denial, and this should include a copy of the relevant part of the insurance policy related to the denial. If the claims adjuster refuses to cooperate, you should contact a personal injury lawyer right away. 

You also have more legal recourse if the adjuster tells you the attorneys for the insurance company have denied the claim or if they provide you a letter from the attorney denying the claim.  This just amounts to being the opinion of the attorney for the insurance company. Don’t assume the attorney’s opinion is correct. A personal injury lawyer will work in your best interest to review the case and make sure you are not being misled. 


File a Personal Injury Lawsuit

If you get nowhere with the insurance company, you might need to file a personal injury lawsuit. Be aware that you have a limited amount of time to file a lawsuit, in Washington State – three years. If you do not file a lawsuit within this time frame, you lose the right to receive compensation. Contacting a personal injury lawyer as soon as possible after your accident serves your best interest. 

Causes of Action Against Insurance Company:  Breach of Contract and Bad Faith 

Basic Terminology:  It is to your advantage to understand the basic terminology of a legal case against an insurance company. For example, a first-party claim is a claim against the insured’s own insurance company. A claim against the insurance company of the person or business that caused the injury is known as a third-party claim. 

Breach of Contract:  When you sign an insurance policy, you, the insured, enters into a contract with the insurance company. A wrongful denial of a claim is a breach of the contract. The insurance company violated the contract by not doing something it contracted to do – pay for valid claims made under the policy. If it is found that the insurance company breached the contract, the insured will be compensated for the injury claim and could be awarded expenses or “damages” caused by the denial. 

Bad Faith:  An insurance company engages in bad faith when it breaches, or violates, its duty to treat insured people in a fair and reasonable manner. There may be actions of bad faith if – the insurance company failed to investigate an injury claim, or wrongfully refused to defend a covered individual in a lawsuit, or wrongfully failed to pay out a valid claim. If a bad faith act is proven, the insurance company may be liable for fraud or intentional infliction of emotional distress, and the injured party may recover punitive damages. 

Roberts Jones Law Is Here To Serve Your Legal Needs

The Roberts Jones personal injury attorneys have your back. With the help of one of our experienced personal injury lawyers, justice will be served. 

At Roberts Jones Law we will provide you with the guidance, care, and support needed to secure the compensation you deserve. If you have been injured as a result of someone’s carelessness, breach of duty of care, or deliberate act, you have rights under the law to seek compensation for your damages. 

Trust the attorneys at Roberts Jones Law when you want legal services catered to your individual needs. 

This article is for informational purposes only and does not contain legal advice. 

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