Sometimes the claims adjuster responds to a claimant’s demands by issuing a denial of coverage.
Possible reasons for adjuster’s actions
• The relevant policy (claimant’s or defendant’s) had lapsed.
• The accident was not covered, because it did not take place in one of the locations that were mentioned in the policy.
• The accident type did not fall under any of the types that were mentioned in the policy.
• The responsible driver was not covered by the policy.
• The accident had taken place in a no-fault state; there could be no third-party claims.
The issues surrounding the denial would get addressed during the negotiation process.
The denied claimant would have the right to ask for a written explanation. If the adjuster did not produce that written explanation, then the claimant could write a letter to the adjuster and repeat the request that had been made over the phone. Naturally, the claimant would include in the letter significant details about the original request.
If the adjust did provide the claimant with a written explanation, he or she would still have the right to ask for a copy of the insurance policy. Again, if there was no answer to that request, the claimant’s option would be the same as before: Write a letter to the adjuster and repeat the request, as per personal injury lawyer in Gloucester.
If none of those actions lead to reversal of the denial, then the claimant should check to see who else might be held responsible for the reported injury, or reported losses.
One fact that all claimants should keep in mind, while struggling to have insurance overturn a denial
An adjuster might try to justify the denial of coverage by sending a letter with a statement from the insurance company’s lawyer. That statement might suggest that the law supported the adjuster’s actions. No one that received such a letter should feel compelled to believe that it contained a verifiable truth.
The lawyer’s opinion would never function as the last and final word in a court of law. A judge would have the ability to overrule any claim made by a lawyer. In other words, the insurance company’s letter would not serve as proof that the adjuster had been acting legally, when choosing to deny the requested coverage.
Every insurance company is supposed to display good faith, when dealing with a policyholder or an accident victim. A company’s failure to show good faith could become the basis for a lawsuit. The company’s lawyers would be called on to make it look like the company was in the right.
In that way, it could reduce the chances that it might need to face a lawsuit. Still, it could not do away with that real possibility.