The role of an insurance company is to protect you by providing coverage for things like personal injury or property damage. however, there are cases where an insurer does not meet her expectations and does not provide the coverage for which she signed up.
If your insurer denied your claim, there are options to explore, including suing an insurance company for denying a claim.
can you sue an insurance company for denying your claim?
The answer is yes, but only under certain circumstances. There are legitimate reasons to deny a claim, and not all denials are grounds for a lawsuit.
however, your policy is a legally binding agreement. If your insurer does not comply with the terms of this policy, you have every right to file a lawsuit.
For example, an insurer may violate this legal agreement if it denies a claim that is within the coverage of the policy. She can also file a lawsuit if her insurance company misses the deadline to issue a payment or breaches the agreement in any other way.
when can an insurance company deny a claim?
Your insurer may deny a claim in different scenarios:
- You didn’t pay your premiums and let your coverage lapse.
- You are making a claim for something that is not covered by your policy. For example, car insurance policies cover the drivers named in the policy, but are not valid if you lend your vehicle to someone else.
- provided false information when purchasing coverage or filing a claim.
- You missed the deadline for reporting the incident to local authorities or you didn’t file a claim on time.
- After conducting an investigation, your insurer determines that you are responsible for the incident and do not qualify for a payment.
- Your insurer can also dispute things like the cause of your injuries after an investigation. for example, the insurance adjuster may determine that your injuries were pre-existing.
- Your insurer may also dispute the extent of your injuries or the extent of property damage.
- If you can’t provide evidence of the extent of the injuries or damage or can’t prove who is at fault, your insurer may deny your claim.
- If your insurance agent doesn’t give you the coverage you requested or didn’t tell you about the options available, you can sue them for negligence.
- There would be a basis for a negligence claim if your insurance agency failed to explain what your policy covers or lied about it. if they lied about their coverage, you could sue for misrepresentation.
- You can also file a negligence claim if your insurer failed to meet its obligations. includes failing to respond to a complaint or appeal letter or conducting a proper investigation.
- If your insurance provider didn’t notify you that you were facing insolvency or didn’t tell you that your policy was about to expire, you could sue them for negligence.
- Your insurer denied or delayed your payment without being able to give you a valid reason.
- Your insurance company did not respond to your claim or appeal.
- the adjuster did not conduct an adequate investigation.
- the adjuster requested additional evidence, even though he already had all the information he needed.
- Your insurer did not explain why it denied the claim and has not cooperated.
- Your insurance company says your claim is not covered by your policy, even though you have enough coverage.
how do insurance companies deny claims?
After you file a claim and pay your deductible, your insurer will review and investigate the claim. the purpose of the investigation is to make sure that what happened is within your policy.
In some cases, your insurer will send someone to inspect the damage in person. it is a common practice for home insurance claims.
Insurance companies often work with mechanics who can issue statements explaining how much damage your vehicle sustained for auto insurance claims. When it comes to medical claims, insurers rely on the expertise of the health care providers who care for you.
An insurance adjuster will inspect the damage in person or review the evidence presented by different professionals. They will assess whether your policy covers the incident or injuries and determine how much the insurer will pay you.
The adjuster may decide to underwrite or deny the claim if their investigation determines that the claim is not within what is covered by your policy.
what can you do when a claim is denied?
Finding out that your insurer is denying your claim can be devastating and stressful. however, you should know that you have options.
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You can file an appeal with your insurer and request a review of the adjuster’s decision. You can also file a complaint with the state agency that regulates insurance where you live.
If your insurer is unwilling to review your decision, your next step should be to file a lawsuit.
How do I fight a denied insurance claim?
Before you can even think about suing an insurance provider for denying a claim, you need to take a few steps to show that you tried to work with the insurer.
You have the right to request an internal appeal. write a letter to your insurer to request an appeal. There are rules and regulations in place that require insurers to review appeal requests in a timely manner, especially for health coverage claims.
You can also request an external review. each state has an agency that regulates what insurers can and cannot do. this entity also has the authority to act as a neutral third party when reviewing denied claims. After reviewing the evidence, her state agency may determine that her insurer has to pay the claim she denied.
Legal representation can give you an advantage by submitting a claim appeal letter or contacting your state regulatory agency. You will also need a lawyer if you decide to sue to have a judge review the denied claim.
how to sue an insurance company
Start by gathering all the evidence you have. You will need all the documents that show what happened and that show the extent of the damage or injury. Your goal is to show that your claim is within what your policy covers.
You will also need a copy of the claim you filed and a copy of your appeal letter, if applicable.
You should contact your insurer and request an internal review. You will receive a letter explaining why the insurance company denied your claim. you will need this letter during the lawsuit.
Depending on where your insurer does business, you may be able to file a lawsuit in federal or state court. You can sue your insurer for bad faith, negligence, emotional distress, breach of contract, or even fraud.
who are the lawyers suing insurance companies?
When suing an insurance provider for denying a claim, it’s best to work with an experienced attorney. An insurance claims attorney is someone who specializes in these types of cases.
The insurance industry is a heavily regulated market. You can benefit from working with a specialist who knows these regulations. In addition, insurance claims attorneys have advanced negotiation skills and can sometimes settle with your insurer before going to court.
why can you sue your insurer?
You can file different types of claims against your insurance provider. Keep in mind that you can sue your insurer for more than one thing.
sue an insurance company for negligence
From a legal standpoint, negligence is failing to act or comply with the terms of a legal agreement. In some cases, you can sue an insurer for gross negligence, which is a failure to act that results in a lack of respect for safety.
You can sue your insurer for negligence or gross negligence if it took action or failed to act in a way that resulted in harm to you:
Can I sue my insurance company for emotional distress?
Emotional distress is the result of intentional actions or negligence that results in a strong emotional reaction, such as anxiety, anguish, or humiliation.
Suppose the denied claim made it difficult to recover after an accident or caused you anxiety while dealing with a serious health condition. in that case, you can sue your insurer for emotional distress.
You should also consider suing for emotional distress if your insurer made it difficult to request an appeal or did not treat you courteously during this process.
sue the insurance company for bad faith
A common type of claim against insurers is bad faith claims. bad faith refers to dishonest practices, sometimes with fraudulent intent.
You can file a bad faith lawsuit in the following scenarios:
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Having your insurer deny your claim can be stressful and discouraging.
however, you should know that you have options available to you. You can contact your insurer and request an appeal, file a complaint with your state’s regulatory agency, and file a lawsuit.
If you decide to file a lawsuit or need help navigating the appeals process, having an experienced insurance claims attorney by your side can make a significant difference.
At stoy law group, denied insurance claims are one of our specialties. Contact us for a free initial consultation to find out if your denied claim is grounds for a lawsuit!