How to Dispute Coverage Denial with an Insurance Company

Insurance companies will send you a coverage denial letter when they believe their investigation is complete and there are no grounds for granting you coverage and therefore not pay for your damages. There are many reasons why an auto claim is denied. The most common reasons for denials are: non-payment of premium, the coverage is specifically excluded form the policy, and/or there could be issues of misrepresentation. In any situation, you should follow the steps below to overturn the insurance company decision.

Difficulty: Moderate

Instructions

Things You'll Need:

• Your auto policy
• Your insurance bills

1. Ask for the specific reason of why you do not have coverage. This sounds easy enough, but insurance company will send you a vague coverage denial letter without giving you the specifics. They will tell you that they cannot afford coverage for your loss at this time. This is because most insurance carries do not want to commit themselves to one reason for a denying your claim. Nor do they want that this letter be used against them in a court of law.

2. Ask them to put it on writing. You have a right to know why the insurance company denied payment for a claim in which you believe there is coverage. With insurance coverage, you have the burden of showing that you had a loss. The burden then shifts to the insurance company to show that the claim is excluded.

3. Determine the best cause of action. The insurance company must carry a heavy burden of showing that there is no coverage. They must show by a preponderance of the evidence that no coverage exists. This means that any/and all information and evidence collect against your for the coverage denial must prove no coverage. Questions of coverage, inconclusive evidence, or evidence that is vague cannot be considered against you.

4. Remember that an insurance policy is a contract of adhesion. A contract of adhesion is a contract where one party has more negotiation power over the other. When you get an insurance policy, you do not get to strike clauses out or modify the terms. Either you pay certain premium for certain coverage or you do not get it. You cannot modify the terms of the policy. This means that the insurance company is the strong party of the contract, which comes with a caveat. The contract or policy must be construed against its drafter (the strong party). Therefore, if the exclusions and conditions of the policy are not crystal clear, or they are ambiguous or vague, they must be construed against the insurance company, thereby granting you coverage.

5. Ask a lawyer. There is no question that you can deal with insurance companies yourself and seek coverage. However, having insurance companies dispute you over coverage can be complex and frustrating. You have more rights than insurance companies will tell you. Insurance companies can sometimes waive their right to give you a coverage denial for all your claims. Only an attorney versed on the subject of insurance can help you overturn such decision.

6. Ask the office of the insurance commissioner (or department of insurance). All states have insurance commissioners or a high ranked official that controls and supervise the business of insurance on your state. These departments are often helpful, although they cannot give legal advice; they can point you on the right direction and give you a sense if what you are claiming has merit.

Tips & Warnings

• If things do not make sense, ask you adjuster until you understand, they have a duty to you
• Have them put everything on writing. This will help your case later on
• Talk to a local attorney about your specific circumstances. She will be able to give you a better insight if coverage should be granted.

Resources

• Car accident help
• Find a lawyer in your loca area

[sunnyglitter]

on 8/5/2009 :::sighs::: I wish I had done this years ago. 5*