How To Respond To Denial of Coverage For Accident Injury?

Any policyholder has the right to contest the denial. That means that the insurance company can be held legally responsible for how the denial might have harmed the affected policyholder.

What is expected of an insurance company, according to the law?

• It is expected to investigate any submitted claim.
• It is expected to offer fair and reasonable treatment to all claimants.
• It is expected to have a valid reason for refusing to compensate any injured and insured policyholder.

Companies that do not live up to those expectations have breached their promise to carry out a good faith effort. The evidence of such a breach can become grounds for a lawsuit.

Procedures that would precede a claimant’s pursuit of a lawsuit

Claimant would hire a personal injury lawyer in Edmonton. They would try to obtain an explanation for the denial of coverage and would check to see if the claim had been investigated.

Your lawyer would study the degree of fairness or reasonableness in the treatment given to the attorney’s client, by the insurance company. When lawyers discover an absence of an agency’s ability to satisfy its expectations, they can file the papers that work to formalize a lawsuit.

The act of issuing a denial of coverage could qualify as an example of negligent behavior.

• It would demonstrate carelessness, a refusal to be careful.
• It would illustrate the company’s breaching of its duty to exercise care towards its policyholders.
• That breaching might have forced the claimant to forego some required treatments.
• That breaching might have aggravated a given injury’s severity. In other words, the breaching could be linked to development of a more severe injury.
• The aggravated injury would have burdened the claimant with newer and heavier damages.

The insurance company’s actions would have satisfied all four elements of negligence.

According to the law, when a plaintiff can prove the existence of all 4 elements of negligence, then that same claimant can pursue a lawsuit against the negligent party.

Consequently, the law might give a denied policyholder grounds for seeking a deserved amount of compensation from an insurance agency, even after having received word of a denial. A personal injury lawyer could work to uncover the grounds for pursuit of such an effort.

A discovery of those grounds could trigger initiation of a lawsuit. The sued insurer would have to pay out money that the company had hoped to keep in its safe. The company’s conduct would force the payment of money that the policyholder had been denied.

The same conduct might even push the court to require a payout that was quite a bit larger than whatever compensation the claimant had been seeking. That is why most adjusters choose to negotiate with a claimant.

For more information about legally contesting the denial of coverage in an injury claim, talk with BPCAB Personal Injury Lawyer.