People carry insurance to protect themselves and their families in case of an accident or unexpected injury. Monthly premiums are paid with the anticipation that the necessary insurance coverage will be there when required. However, some insurance claims are denied, leaving the policyholder feeling frustrated, angry, and confused. When this unfortunate situation occurs, you might not know what happened or what steps you should take.
Insurance claims are denied for many different reasons, including missed premium payments, the incident was excluded under the policy’s terms, and a lack of documentation or evidence. What steps you need to take depends on why your claim was denied. Insurance companies employ attorneys, accountants, and adjusters to protect their interests and decrease their liability. You need our experienced Fayetteville, AR insurance attorneys advocating for you.
After an accident or devastating injury, the proceeds from an insurance claim might be necessary to pay your additional and ordinary expenses. If your insurance claim is denied, it could place you and your family in an economic crisis. Call (479) 316-0438 to review your options.
Some Common Reasons Insurance Claims are Denied
Insurance claims are denied for many different reasons. To determine if the denial is valid or if you have grounds to challenge it, you need to know why it was denied. Below, we discuss some of the reasons a claim could be rejected. This list is not exhaustive, so it is crucial to speak with one of our Arkansas personal injury attorneys to review your specific case.
You Contributed to the Accident
Some accidents are clearly the fault of another person or party. However, in other cases, who was to blame is vague or questionable. If the available evidence indicates that you were at fault or could have avoided the incident, then an insurance company adjuster could reduce or deny your claim. For example, if you were driving after a night of drinking and another person hit your car, your conduct could give an insurer grounds to deny your claim. Our knowledgeable personal injury lawyers will examine your case to help establish that your behavior did not contribute to or cause the accident.
Insufficient Medical Records or Documentation
If you want to be reimbursed because you suffered an injury, it is vital to receive medical treatment. Any delay or hesitation in having your injuries examined by a medical professional could result in your insurance claim being rejected. Without a documented medical record, an insurer will argue that your injuries were not caused by the accident or incident. Furthermore, if you do not receive medical attention or follow through with treatment, an insurance company will doubt the seriousness of your injury, believing that you are exaggerating your symptoms.
Just because you have your injuries tended to immediately following an accident does not mean your insurance claim is guaranteed. Your claim will likely be denied if the medical documentation does not support the severity of your injuries. Furthermore, if your medical history suggests a pre-existing condition, your claim could be denied or significantly reduced. Our Springdale personal injury lawyers will help you gather the documentation you need.
A Lapse in Coverage
Sometimes a claim will be denied because a policyholder allowed their insurance coverage to lapse. If you failed to make your monthly premium payments, then your insurance coverage might not be applicable. One late payment should not result in the discontinuation of coverage. You should speak with our knowledgeable insurance lawyers if you believe you had coverage but were denied.
The Incident Was Not Covered Under the Terms of the Policy
Some denials are based on the terms and provisions of the policy. For example, your damages could exceed your policy limit. Additionally, you could have failed to comply with one of the policy’s terms, such as failing to report the incident within a reasonable amount of time. Because some policies have ambiguous language, it is important to have one of our experienced Rogers personal injury lawyers review the contract before accepting the adjuster’s interpretation.
Some Insurance Claim Denials Are in Bad Faith
There are many reasons why an insurance claim could be denied. However, if you believe these do not apply in your situation, the insurer could be acting in bad faith. Bad faith means that the insurance provider is not adhering to their obligations under the terms of the policy. Some examples of acting in bad faith include not returning phone calls, purposefully misinterpreting policy provisions, or omitting important information. While an insurance adjuster is working to limit their company’s liability, they must act in good faith.
Actions to Take if Your Claim is Denied
If an insurance claim is denied, the first thing you should do is request a written explanation. You have every right to dispute their determination. If you do not agree with the reasons for the denial, you could appeal the decision.
Nonetheless, if your insurance claim is denied, you should consult with one of our experienced Arkansas personal injury attorneys as soon as possible. Our office will examine your claim, investigate the accident, and evaluate the insurance company’s decision. Depending on the situation, it might be prudent to negotiate with the insurance company, file an appeal, or sue the insurer for bad faith.
Many of the potential issues that arise could also be avoided if you have competent legal representation before speaking with an insurance company. Our office will help ensure that you gather the necessary medical documentation and comply with any provisions in your policy that could trigger a denial if ignored.
Call Our Arkansas Personal Injury Attorney if Your Insurance Claim is Denied
When an insurance claim is denied, an injured accident victim’s life becomes significantly more difficult. Some denials are completely valid. However, if you believe your claim was denied because of bad faith or another reason, call our Bentonville personal injury attorneys. The lawyers and staff at our office have decades of combined experience working with difficult insurance providers. If you have been injured and have complied with the terms of your policy, you deserve to be compensated. Call (479) 316-0438 today.