Did an insurance company deny your claim? Then, learn the possible reasons for such denial and what to do if your insurance claim was rejected in Virginia.
Surviving an accident or a health crisis is a terrible experience. That’s why individuals take out an insurance policy. In addition, the law makes buying an insurance policy mandatory in some instances. This way, an injured worker or road user, for example, can file a claim for payment of compensation against the insurance company when the insured event occurs.
Insurance law and the personal injury claims process will also allow legal action against insurance carriers. Unfortunately, claim denials are common in the insurance industry. An insurance company can deny several compensation claims for various reasons.
Therefore, it’s best to retain a Virginia insurance attorney from your initial claim stage. Unfortunately, not many law firms can go up against the insurance industry. However, we can guarantee the payment of claims from your insurance company if you hire a VACAIL lawyer.
Why Will an Insurance Company Deny My Claim?
Insurers like a health insurance company typically have an arsenal of reasons for denying insurance claims. So, there’s a high chance that your initial claim application will be rejected. You’ll most likely get this denial letter through your mail address.
In addition, denials often apply to practically any type of claim. That’s why you must know the common reasons for insurance claim denials.
You Failed to Notify Your Insurer When the Insured Event Occurred
After an insured event occurs, the next step is to inform the insurance company. This notice effectively begins the compensation process. So, failing to notify the insurer may be grounds for a claim denial.
You Delayed Getting Medical Treatment
After a car accident, you can sustain catastrophic injuries. Therefore, it’s best to seek immediate medical treatment. If you don’t, your injuries can worsen. This aggravation of your injuries will mean the insurer has to pay more. So, an insurance company can deny your claim because of your carelessness.
The Claim is Beyond or Outside Your Insurance Coverage
An insurance policy is a contract between the insurer and the insured. It spells out what events and losses are insured. In addition, it specifies conditions for getting your benefits. However, individuals sometimes file claims for injuries or losses not covered by the insurance policy. An insurance claim may also go beyond the policy’s maximum coverage amount. In both instances, the insurer will deny the claim.
There are many other possible reasons for insurance claim denials. For instance, insurance oversight can occur where the insurer didn’t pay attention to your claim. In addition, a duplicate claim will most likely be thrown out by an insurance company too. Finally, insurers will also deny bad faith claims once they have admissible evidence of bad faith.
What Can I Do if an Insurance Company Denies My Claim?
Fortunately, the law doesn’t leave you handicapped in the event of an insurance claim denial. Instead, an appeals process provides an opportunity to get justice. Therefore, it’s best to exploit these formal appeal procedures immediately after the rejection of your initial claim.
Internally Appeal the Decision
Once you get your denial letter by email, you can request an internal appeal. An internal appeal means that you’re asking the insurance company to conduct a better review of your claim. Of course, this must be after you’ve adequately reviewed your claim form.
Furthermore, you can send any additional evidence showing that the insurance company made a mistake. After submitting this request for corrective action, it’ll be best to follow up with the insurer to ensure that they give your claim priority.
Request an External Appeal
The internal decision review process may not produce a favorable decision. Where this happens, you can file an external appeal. You can also request an external review where the insurance company didn’t reply to your internal appeal request. Here, an independent party reviews your claim and your insurer’s decision.
Notably, you must file this request with the Bureau of Insurance under the Virginia State Corporation (VSC). The VSC regulates the business of insurance in Virginia. So, they must receive your request within 120 days after receipt of a notice of your right to an External Review. However, you must first contact the Bureau through its toll-free number or email address.
Finally, this external review is usually a last resort. That is, an applicant must have exhausted the insurance company’s internal appeal process before requesting an external review. However, there’s an exception for cancer patients. This is because of the urgent condition of many cancer patients.
Can I Sue My Insurance Company for Denying My Claim?
Yes, if all else fails, you can bring legal action against your insurer for a claim denial. However, many valid insurance claims usually don’t get to this stage. Instead, the appeal process must have established your right to compensation. However, you’ll need an insurance attorney if you’re considering filing a lawsuit.
Suppose your attorney convinces the court of your right to damages. Then, the court will order payment of the insurance amount and other consequential sums. Notably, an insurance lawsuit will be necessary in cases of bad faith denials. A bad faith denial means that the rejection is because of invalid and unethical reasons.
A bad faith denial is a breach of contract. This is because your insurance policy is a contract between you and your insurer. You’ll thus get the insurance sum and additional damages for breach of contract.
A typical example is the remedy for arbitrary refusal to pay motor vehicle insurance claims. So, suppose an insurer fails or refuses to pay a claim worth $3,550 or less. If the court finds a bad faith denial, the insurer will pay double the amount due. In addition, they’ll pay the attorney’s fees and other expenses.
Get the Best Insurance Attorney for Your Case Today!
Has an insurance company denied your accident insurance claim in Virginia? If so, getting their decision by mail must have been shocking. First, however, you need to fight for the medical bills and other compensatory damages you deserve. Handling this compensation process alone will be challenging. That’s why you need an excellent Virginia insurance attorney.
Fortunately, the lawyers at VACAIL can help you through this complicated process. Our lawyers can handle any type of claim. Furthermore, we’ll work with you from the initial claim application until the final payment. With our years of experience, you can rest assured that you’ll get the best results. So, call us today for a FREE consultation on your case.