If you have received a denial for your personal injury claim from your own insurer or a third party’s, you have many options at your disposal. You should always dispute the denial, especially if the injury was severe and its associated medical costs were high.
Disputing the claim denial may involve re-examining the language of the policy or disputing the circumstances as the insurer sees it. A dispute with the insurer of a third party may also involve determining liability for an accident.
You can review all of these dispute avenues and your case with the help of an experienced personal injury lawyer. Here are some of the actions that you and your attorney can consider together.
Review the Insurance Policy and the Denial Reasons With a Personal Injury Lawyer
Together with an attorney, you can review the reasons for denial outlined in your denial letter and compare them to the language of your policy. You will want to pay particularly close attention to the benefits and exclusions areas of your policy. Your incident may be excluded under some circumstances, for instance, but perhaps your insurer wrongfully interpreted some information you gave them.
Insurance policy contracts are complex and governed by many exceptions and sub-categories. For instance, your car insurance may not cover an accident in your own vehicle if the insurer determines you were performing an errand for your boss that was “within the scope of employment.” Lots of gray areas like this emerge, and it takes familiarity with contract law to determine where your injury case falls within these gray areas.
Send a Dispute Letter to Your Insurer, or Request More Detail
Careful analysis of your policy contract and the information in the denial can allow you and your lawyer to draft a letter disputing the denial. In this letter, you can state your reasons that you think the claim should not have been denied.
You can describe sections of the “statement of benefits” in your policy to show why your incident should be covered. You may also review the language of the “exclusions” section to explain how your insurer may have misinterpreted some information.
Keep your letter as detailed and concise as possible. Leave emotion or irrelevant narratives describing your claims process out of the dispute letter. A representing attorney can help you meet these criteria while crafting a convincing argument interpreting the language of the policy and making counter-arguments against the logic of the denial.
Consider Hiring a Personal Injury Attorney Before You Agree to Arbitration or Pursue Civil Action
Many insurance policies require you to submit to an arbitration or dispute resolution process to settle your disputed claim. Arbitration decisions are binding, and you will be at a disadvantage knowledge-wise without the counsel of an experienced attorney.
You may also decide to file a civil suit against the insurer for breach of contract, bad faith, or erroneous interpretation of liability with third-parties. Having a knowledgeable personal injury lawyer with you during this process can increase your chances of a successful dispute or lawsuit.