What Actions Could You Take If An Insurer Has Refused To Cover Your Injury?

Sometimes, an insurance adjuster tells a given claimant that his or her claim cannot be covered under the designated insurance policy. In the case of a 1st party claim, a customer of the insurance company that had employed the adjuster would have purchased the policy in question.

In the case of a 3rd party claim, the party that was alleged to have been at-fault for the accident would have purchased the policy in question. That policy should have promised financial coverage for the policyholder, in the event of an accident, one for which the same policyholder had been held liable.

Why might an insurance policy not cover an injury that was sustained during an accident?

• The policy of concern has lapsed.
• The place in which the accident took place is not in agreement with the policy’s terms.
• The person responsible for the accident was not covered, according to the policy’s terms.
• The accident took place in a state with a no-fault insurance law.

Actions to be taken by an injured victim that has been denied coverage by an insurance company:

Ask the adjuster to send a written explanation of the reason for the denial. Ideally, that action has the ability to win the adjuster’s cooperation. The adjuster would give the reasons, and the person that had been denied coverage could respond to each of the reasons that had been stated in the adjuster’s response.

Admittedly, it is possible that an adjuster might refuse to cooperate, and, thus, not provide the denied victim with the desired explanation. When that has been the situation, then the person that was issued the denial should send a letter that included all the details, such as the nature of the injury and the reason for the denial of coverage.

Personal injury lawyer in Waukegan knows that the adjusters realize that such a letter could be used in a lawsuit. In addition, adjusters do not like to have such a letter in the company’s files, in a place where the adjuster’s superior might find it.

Hence the sending of such a letter should work to encourage a greater degree of cooperation from the letter’s recipient (the adjuster). That cooperation should lead to the demonstration of a greater effort on the adjuster’s part, to reach some sort of settlement. Sometimes, it helps for the individual that has been denied coverage to seek a lawyer’s assistance. Still, the same individual should never assume that everything ought to go smoothly, upon the retention of a lawyer. That would be a foolish assumption.

Every attorney looks to his or her client for feedback. Consequently, anyone that has hired an attorney, while dealing with an adjuster’s tactics, should make a point of always staying on top of the case.

Leave a Reply