What Do To When Your Insurance Company Denies Your Claim

A determination by your insurance company that youan insurance company denied the claims of a parent
are not covered is not the final word, but only thefor the death of their child, when that child died after
beginning of a process for you to obtain thelosing control of a car he was driving.  Scientific
insurance coverage which you purchased.   Uponexamination of blood samples showed trace amounts
further investigation, facts may come to light whichof a prescriptive medicine, a medicine which was not
may cause the insurance company to re-evaluate itsprescribed to the child.
position and provide coverage.The insurance company denied the claim upon the
Also, if suit is necessary, the courts may find thatbasis that the child was under the influence of a
you are covered by your insurance policy when yourcontrolled substance, and coverage for such was
insurance company says you are not covered.excluded by the policy.  The parents hired an
The realities of insuranceattorney who reviewed the policy, reviewed the
Whether you are a business that purchased achemical analysis and obtained information from a
commercial general liability insurance policy or anforensic pathologist about the chemical analysis.  The
individual who purchases a homeowner’s policyattorney’s efforts proved that the amount of
or a life insurance policy, “peace of mind”the controlled substance that appeared in the
was probably a big selling point made by the sellingchemical analysis was the minimum amount which
insurance agent.  In return for payment of moneycould be registered by the test, and that a test
to the insurance company today, the insurancereading of this amount could mean that there was
company promises that it will be there for you in thenone of the controlled substance in the child’s
future should you suffer a loss.bloodstream.
Unfortunately, many find that after havingEnd result –
consistently paid their premiums, an insuranceUpon being presented with this information, the
company denies their claim when they call upon theirinsurance company reversed its position, provided
insurance company for the coverage promised in thecoverage, and paid the full amount of the accidental
insurance policy. In many cases, the one wholife insurance proceeds to the parents.  This is an
determines and advises you that your insuranceexample where facts relevant to coverage where
policy does not provide coverage is not an attorney,not apparent to the policy holder and the adjuster. 
but a claims adjuster without knowledge of LouisianaAn experienced attorney was required to discover
insurance law.the relevant facts and present them to the insurance
Should your insurance company deny you coverage,company.
you should seek the advice of an attorney familiarFamily #2 – Life Insurance Disputes
with the interpretation of insurance policy language.In another situation, an insured was delivered an
When doing so, you are obtaining the opinion of ainsurance policy while in the hospital.  The insured
person trained in insurance law and not employed bywas diagnosed with a terminal illness during this
the insurance company.  If your attorney’shospital stay and died soon after.  The insurance
opinion is that you are entitled to coverage, thecompany denied coverage claiming that the insured
denial of your claim is the beginning of yourknew of the presence of this disease prior to
claim’s process, not the end.delivery of the life insurance policy.  The
Why insurers and the insured always seem to be atinsured’s surviving spouse obtained the services
oddsof an attorney and suit was filed.
As an insurance company is a business, and a goal ofEnd result-
a business is to make a profit, it is understandableThis attorney conducted a thorough and exhaustive
that an insurance company has a bias towardsresearch of the deceased’s medical records. 
denying insurance coverage.  However, this bias mayThis attorney discovered that the only evidence of
not be the only reason for an insurance companythe deceased having knowledge of a terminal illness
denying coverage to its insured.occurred within one day after the life insurance policy
At the time that you prepare and submit your claimwas delivered.  The attorney presented this
to your insurance company, you may not know all ofinformation to the insurance company and the
the facts and the insurance adjuster may not knowinsurance company settled the law suit by paying
all of the facts particular to your situation.  In thisbenefits to the surviving spouse.
situation, an attorney can review the insuranceBusiness Scenario – Lawsuit protection
provisions, discover the relevant facts that triggerIn another situation, a commercial business was sued
coverage and transmit these facts to the insurancefor libel and slander.  That commercial business had
adjuster for a re-determination of coverage.purchased a comprehensive general liability policy
When problems with claims persistwhich provided coverage for attorney’s fees
If the adjuster continues to deny coverage in theand court costs in defending this claim.  The insurer
face of the newly presented facts, your attorney willrefused to provide coverage.
be able to further pursue and protect your interestsThe business hired an attorney to defend the
by filing suit against the insurance company.  In thisbusiness in the libel and slander suit.  That same
suit, your attorney will ask the court to declare thatattorney then sued the insurance company for
you have coverage under your policy.reimbursement of the insured’s attorney’s
In some situations it is not the lack of knowledge offees and court costs incurred in defense of the libel
certain facts which cause the insurance adjuster toand slander suit.
deny coverage, but the policy language as the policyEnd result-
language relevant to your claim may have acquired aThe result of this suit was that the court found that
legal meaning which is not apparent to the layman orthe insurance policy sold to the business provided
the insurance adjuster upon reading of the policy. coverage for a cost of defense and that the
Again, your attorney will be able to explain to theinsurance company owed reimbursement to the
insurance adjuster the legal meaning and ramificationsbusiness for the attorney’s fees and costs it
of the policy language and how that meaning entitlesincurred in defending the suit.  Interestingly, the
you to coverage.insurance company owed this “cost of
Should the adjuster continue to deny coverage in thedefense” whether the business won or lost the
face of such law, your attorney will be able tolibel and slander suit filed against it.
further pursue your interest by filing suit against theThere are many more examples in the law books
insurance company asking the court to determinewhere an insurance company denied insurance
that you are covered by your policy.coverage to its insured, only to later be found by the
The above situations may be best explained by realcourts to have provided coverage to its insured. 
life examples:Each case is different, and each case must be
Family #1 – Accidental Death Claimcarefully examined.
In a claim for accidental life insurance policy proceeds,