What Is Denial of Coverage in Personal Injury Law?
Denial of coverage occurs when an insurance company refuses to provide benefits or compensation for a claim submitted by a policyholder or injured party. In personal injury cases, this happens when the insurer determines that the claim is not covered under the terms of the policy. A denial can apply to medical bills, property damage, or liability claims, leaving the claimant to cover the costs themselves.
Commonfor Denial of Coverage
- Policy Exclusions: The claim falls under a specific exclusion outlined in the insurance policy.
- Lapsed Policy: Coverage was not active at the time of the accident due to missed payments or policy expiration.
- Failure to Notify: The policyholder did not report the accident or file the claim within the required time frame.
- Disputed Liability: The insurer argues that the claimant or another party is at fault for the damages.
- Insufficient Evidence: Lack of supporting documentation, such as medical records or proof of loss.
What to Do After a Denial of Coverage
- Review the Denial Letter: Carefully read the insurer’s explanation for denying the claim.
- Gather Evidence: Collect documents like medical records, accident reports, or photos to strengthen your case.
- File an Appeal: Many insurers allow policyholders to dispute a denial through an appeal process.
- Consult an Attorney: A personal injury attorney can help challenge the denial, negotiate with the insurer, or file a lawsuit if necessary.
Why Denial of Coverage Matters
A denial of coverage can leave victims without essential financial support for medical expenses, property repairs, or lost income. Legal representation ensures that insurance companies are held accountable and that policyholders receive the benefits they are entitled to under their insurance policy.
