What To Do When Your Personal Injury Claim Is Denied

Written by Rohani Egbert
7 · 23 · 19
What To Do When Your Personal Injury Claim Is Denied

Imagine you are enjoying your day biking and suddenly a car runs into you from behind and knocks you down. You are left with numerous injuries and it takes you weeks to recuperate. You are unable to go to work and have to suffer a loss of wages. Armed with documents, when you file an accident claim, you are very sure about getting the claim without any delay but you get the shock of your life when your personal injury claim is denied. 

What To Do When Your Personal Injury Claim Is Denied

Insurance is a product that is supposed to protect you when anything goes wrong. It is devastating to know that your personal injury claim has been denied. However, this happens very often and insurance companies give a number of reasons behind the denial of claims. It does not make it any better for anyone who is in need of coverage and then have it denied. However, there are steps you can take after your insurance claim is denied. If you take these steps, you will be able to find a resolution to the same. 

Review the reason behind the denial of personal injury claim

First and foremost, you need to set the denial aside and then take a look at it with fresh eyes and read the document very carefully. You need to study and understand the language used and the reasons for rejection mentioned therein. Now you need to use these reasons to search the policy for specific exclusions.

There are many policies which have exclusions but they remain hidden in the text and the policyholder is not aware of the same. This is why you need to look for the same terms that were used in the letter of denial. It could be present in the fine print on the policy and it could be the reason why your personal injury claim was denied. Once you know the reason behind the denial of the claim, you need to understand why it was denied and go through the policy thoroughly. 

Challenge the refusal

If you are sure that the personal injury claim has been denied in error, you need to write a letter to the insurance company. You need to be very concise and clear in the letter. If you have noticed anything incorrect, you need to specifically point it out and state a reason behind it. If you think that something is not clear, you need to request the insurer to clarify. The insurance company will respond with a clarification or with a request for action. There are some policies which need mediation in order to resolve disputes. 

Causes for action

In case the insurance company acts in violation of the policy, or does not respond to the challenge and denies to investigate the claim, you can file legal action against the company. It is a breach of contract between you and the company and you have the right to file legal action. The company has acted in wrong faith and you can file a lawsuit against them.

It might not only open up the chances of getting your earlier claim but will also provide for any additional damages incurred due to stress in the process of fighting the rejection of the claim. If your claim has been denied by your plan administrator, Justin Kimball from Preszlerlaw-ns.com says to be careful speaking with them since they may use what you say against you at a later time.

Discuss with a professional

At this stage, you need to contact an attorney to help you seek justice. Accidents often require hospitalization and could take a few days for the injury to heal. If there is a serious injury, it will need many weeks of hospital stay and a long time to recover. This means losing out on work which is why it is important to receive the claim. You need to discuss with an attorney about the reason behind personal injury claim denial and how you can work to receive the claim amount. The professionals come across the same situation time and again and they know how to handle it best. 

Do not deal with an insurance company all by yourself. They can confuse you with jargons and you might be left with no choice but to forego the claim and accept the denial. You need to remember that the denial of a claim is not the end of the road and you have a legal right to fight for your money and you need to do it in the right manner.

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Rohani Egbert