policy is a legal contract which insures policyholders and pays for any
damages covered by the policy. There are various forms of insurance
available including auto, liability, property, fire, health, disability,
workers' compensation and life insurance. Insurance gives policyholders
peace of mind by offering them a degree of protection against financial
losses. However, that peace of mind can quickly turn to confusion or
frustration when a claim is disputed or denied.
What Are Some Of The Reasons An Insurance Company
Can Turn Down A Claim For Payment Of Medical Expenses?
While some of
these may be legitimate reasons to deny coverage, each case is different and
many require a trained eye to look over the fine print of your policy to
determine if your rights are being violated. You may be able to appeal the
denial of your claim and get the denial overt urned. A lawyer specializing in insurance disputes can help you with this
urned. A lawyer specializing in insurance disputes can help you with this process.
What Responsibilities Do I Have To My Insurance
Company When Filing Claims?
will be primarily governed by the provisions of your insurance policy.
Generally, you may have several responsibilities in obtaining benefits
from your insurance company. Policyholders must file claims by the time
deadline set by the insurance policy or by law, cooperate with the company
and provide all information the company requests. You also may be required
to give a written statement concerning the accident or incident or to
undergo a medical examination. Failing to do any of these may result in
a denial of coverage. When dealing with your insurance company it is best
to send and receive everything in writing and keep copies in case conflicts
all of the responsibility lies on the shoulders of policyholders. Insurance
companies must pay or deny your claim in a reasonable period of time.
If your claim is denied, the insurance company must provide, in writing,
reasons for the denial. They also have a duty to provide written policies
in clear language that can easily be understood by the average person.
Courts are often lenient with policyholders when there is more than one
way to interpret a policy. The policyholder may get the benefit of the
What Can I Do If The Insurance Company Has Erred
In Denying My Coverage?
If an insurance
company denies a claim with little or no basis, you may be able to appeal or file a
claim based on bad faith. Time is of the essence. You should schedule a prompt consultation with an attorney so quick action can be taken. Bad faith regulations were imposed on insurance
companies to make them responsible to policyholders and protect them.
Policyholders may be able to claim bad faith when an insurance company:
If your insurance
company does one or more of these things, you may be able to collect
damages. Damages available to the policyholder depend on the type of
insurance and the particular policy. You may be able to collect any expenses
or foreseeable losses which you incurred as a result of the denial along
with any interest. You may also be able to collect for lawyer’s fees which
resulted from the denial of treatment. Occasionally punitive damages are
What Alternatives To Filing A Claim In Court May
Be Available To Me?
Not only can a qualified lawyer help you understand your policy, but he or she may be able to suggest alternatives to filing a claim in court. Alternatives may include arbitration, mediation or negotiation with your insurance company. Arbitration is when both sides present their version of the dispute to a neutral party. After listening to both sides and considering all information, the arbitrator decides whether to award any damages and the amount of the damages. Mediation is a process in which both sides and a mediator try to reach a reasonable conclusion to the claim without court involvement. Negotiation is an attempt by both parties to reach an agreement without any outside involvement from a mediator. It is possible that no conclusion will be reached and that parties will have to proceed with their claim in court.
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