Some adjusters will claim that a policy’s terms do not include a provision for coverage of the sort of incident that has been reported by the policyholder. In that case, the policyholder should undertake the following actions.
Write series of letters
Write a letter to the adjuster and request an explanation for the denial. Ask for reference to the relevant sections in the purchased policy. If the adjust has failed to offer an explanation, then write a second letter, and in that letter spell out the message in the refusal. This second letter would become part of the claims file.
Personal injury lawyer in Spruce Grove know that most adjusters should become more cooperative at this point, but some might continue insisting that the reported incident is not covered.
Some might suggest that one of the company’s lawyers has stated that there is no coverage for the reported incident, due to the wording in the purchased policy. That suggestion should not keep a persistent policyholder from insisting on a greater amount of cooperation.
Total lack of cooperation amounts to a display of bad faith. That could be reported to the state authorities.
What if the denial of coverage has come from an adjuster in the defendant’s insurance company?
In that case follow the same actions, but direct the letters to the adjuster that has issued the denial.
—Ask for an explanation of the denial
—If none offered, write second letter and spell out message in refusal
—Ask for a copy of the defendant’s policy.
—Do not accept any argument that the company’s lawyers have declared that the wording in the policy rules out the need for coverage of the reported incident. There could be ambiguities in any policy.
How do such ambiguities get resolved?
No one should think that the opinion of a single lawyer, or a team of lawyers from one company would be able to resolve such ambiguities.
The denied policyholder has the right to challenge the company’s decision in court. The policyholder’s attorney should be able to provide the judge with a copy of the defendant’s policy, along with a written explanation of the denial.
The judge would be required to read and study both of those documents. The judge would decide on the meaning of any ambiguous statements in the defendant’s policy.
The judge could declare the need for coverage, according to the policy. In that case, the insurance company would need to go along with that request, unless it wanted to appeal the judge’s decision. Few insurance companies want to waste time and money on such an appeal. So, the judge’s decision remains the final word, with respect to the expected coverage for the reported incident.