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Dealing With a Denied Insurance Claim

September 10, 2020
denied insurance claim

When you regularly make payments to an insurance company, certain duties are expected of them. One of these is that the adjusters will deal in good faith when handling your claims, and provide coverage when you need it. The unpleasant surprise of an insurance claim being denied can be shocking and frustrating. Fortunately, there are steps you can take to resolve the issue if you believe your claim was unfairly denied. 

Determining Whether the Denial is Wrongful

If an insurance company is denying payment when there’s no legitimate reason to do so, it is considered bad faith. A wrongful denial will typically lack a reasonable explanation, since they are obligated to explain why that decision was made. Find out exactly why the company denied your claim then review all of the documentation you submitted. If you have solid evidence making a clear connection to your argument, your claim denial may be wrongful. 

Some other signs of bad faith tactics by an insurance company are: 

>An inadequate or delayed investigation into the claim. 
>Refusing or delaying payment when there is clear evidence of liability. 
>Failing to approve or deny a claim within a reasonable amount of time. 
>Denying a claim after the contestability period has passed, on the grounds of misrepresentation. 

Laws against bad faith exist in Texas to protect policyholders from insurance companies engaging in unfair or deceptive business practices. 

Common Reasons for Claim Denials

It is the job of a claims adjuster who works for an insurance company to carefully review each claim and determine if there is a valid reason for denying it. Common reasons for denials include: 

>Not filing your claim on time. The time limits vary in Texas, depending on the nature of your claim. For example, the deadline for a car accident claim will differ from a workers’ compensation claim.
>Missing or incorrect information on your claim form. 
>Your condition doesn’t meet the definition set by the policy. 
>Lack of medical evidence.
>The injury is a pre-existing condition.  
>The policy does not cover the nature or location of the accident.
>The insurance policy has lapsed.
>You failed to prove that the insured caused the accident.
>The person who caused the accident is not covered by the insurance policy.
>Video surveillance and social media. 
>Tips for Fighting an Insurance Company

Acting in bad faith saves an insurance provider money, which is why many are more than willing to do so. The insurer is also banking on you doing nothing to fight back after they wrongfully deny or delay your claim. Before filing an appeal or suing, work with an insurance bad faith attorney that can review your case closely in order to determine why your claim was denied. Hiring a law firm will gain you access to the extensive resources you need to fight back against a large corporation, such as your insurer. They will be able to advise you on how best to combat that initial decision and obtain the compensation you deserve. 

Wondering the Worth of Your Personal Injury Case?

After a personal injury accident, your top priority should be recovering. Not trying to figure out which damages you may be eligible for and determining the value of your claim on your own. Consult a Texas personal injury lawyer from Begum Law Group.

To find out how much your personal injury claim is worth, contact The Law Giant right away. You can count on us to investigate your situation and ensure you secure the fair compensation you deserve. To schedule a free, initial evaluation of your case, contact us today at (866) 523-4167.

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