No policyholder should view denial of coverage as the last and final word. All policyholders have a right to contest any such denial.
Why an insurance company might deny a request for coverage of a reported injury
• The type of injury mentioned in the policyholder’s claim does not match with any of the injuries that were named in the purchased policy’s terms.
• The promised term for coverage has lapsed.
• The claimant has failed to comply with the claim submission requirements.
• An allegation that the reported injury was caused by the claimant’s pre-existing condition
• Claimant’s failure to mitigate the injury’s effects
• Evidence of a delay in pursuit of, or utilization of treatment
• Submission of only a limited number of medical records
If there were no basis for a denial of coverage, then the company that had chosen to deny delivery of financial help could be accused of having adopted bad faith practices.
Any policyholders that suspected the adoption of such practices should carry out a careful examination of the words in their purchased policy.
If a bad faith claim were to add to the amount of stress in the claimant’s life, then that same person/claimant would have a right to increase the amount of money requested, as payment for pain and suffering.
Insurance companies can avoid a charge of using bad faith practices, if any one of them has chosen to limit the amount of compensation, upon discovery of something that might have been sighted as a reason for not covering a given claim.
For instance, an insurer might instruct an adjuster to allege that a claimant with a pre-existing condition was supposed to be wearing some type of protective device, at the time of the accident. The absence of that same device would then become the reason for a proposed reduction in the size of the promised compensation.
Sometimes miscommunications can trigger a denial of coverage.
For instance, a doctor’s secretary might misinterpret a finding and think that the doctor had failed to observe any injury. Alternatively, the physician doing the initial examination might be unfamiliar with the patient/victim’s medical history.
Either of those circumstances might push an insurer to deny any compensation for injuries. Yet the insurer’s decision could always be contested. Of course, an effort at contesting such a decision ought to be made after arranging for assistance from a legal mind, such as a Personal Injury Lawyers in Red Deer.
The insurance company would have to acknowledge the claimant’s right to challenge the refusal to cover reported injuries. Moreover, the same company would understand the extent to which it could face legal consequences, if it chose to fight the challenge to its decision, regarding whether or not to cover an injury.