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Reasons for Insurance Claim Denials in West Virginia

Posted in Insurance law on November 30, 2020

You may not expect any roadblocks to obtaining insurance benefits for an accident or injury in West Virginia. Filing an insurance claim and following the agent’s directions should lead to a positive outcome. Unfortunately, insurance companies primarily want to save money. This can mean finding any reason to deny an insurance claim. Learn the most common reasons for claim denials in West Virginia to determine if yours is valid or in bad faith. 

Liability Dispute 

If the insurance company does not believe it should be liable, or legally responsible, for your damages, it will deny the claim. The insurance company will look to your state’s liability laws for answers. After a car accident, for example, the company will look at your state’s fault law. West Virginia is a fault state, meaning the party liable for an auto accident will be the person who at fault for causing the wreck. If the company does not believe its policyholder is to blame, it will deny benefits.

Comparative Negligence

In some cases, the insurance company may allege your own comparative negligence for the accident or injury. This defense states that you are partially to blame for the accident. If the insurance company finds proof that you contributed to the accident, it may deny full liability. It may reduce the amount it awards you for your medical bills by your percent of fault or deny the claim altogether. If you wish to argue against the comparative negligence defense, you may do so by requesting an internal or external claim review. 

Lack of Medical Care or Evidence

One of the main types of evidence an insurance company will look for when analyzing a claim is a medical evaluation. It is critical to go to a doctor or hospital immediately after an accident in West Virginia. If you wait days or weeks after your accident to see a medical professional, this shows an insurance company your injuries were not serious, or that they may not be from the accident. With an immediate medical evaluation, on the other hand, it can be easier to prove your injuries resulted from the accident. Obtain copies of all relevant medical records to submit with your insurance claim as evidence. 

Missed Deadline

You will have a deadline for bringing an insurance claim after an accident in West Virginia. Although each company is unique, most require initial claim submissions within one to three days of the accident. If you wait too long to file, the company may deny your claim based on a missed deadline. Act quickly to seek benefits after an accident to avoid this issue. 

Insurance Form Errors

An insurance claim denial may be reversible if the company based its decision on missing information or an error on the insurance form. You may be able to fix the administrative error and resubmit your claim for a different outcome. If you wish to strengthen your claim and avoid this problem from the start, hire a West Virginia injury attorney to fill out and submit the paperwork for you. 

No Coverage Available

Some claim denials occur simply because no coverage is available on the policy. If you are seeking damages from a defendant who does not have insurance or not enough insurance, for instance, the company will deny your claim. Review the terms of the policy you are using before you submit a claim. 

Was Your Insurance Claim Denial in Bad Faith?

An insurance company must give a reason if it decides to deny a claim to benefits. If the reason does not match the details of your case, you may be the victim of insurance bad faith. Bad faith is an intentional wrongdoing by an insurance company to save its investors money. Denying a claim without a valid reason is an example of insurance bad faith. If you suspect bad faith, contact a lawyer for a free consultation. You may be able to bring an insurance bad faith claim.