PIP insurance in New York covers medical bills, partial reimbursement of lost wages and property damage; however, insurance companies may deny a personal injury claim for various reasons.
Denials could result from unclear policy language; in such instances it would be wise to consult an attorney.
Policy Exclusions
Policy exclusions are designed to limit coverage for certain events or injuries, helping insurers strike a balance between covering fortuitous losses and remaining financially solvent. Policyholders should review their policies carefully in order to understand which exclusions exist, while also remembering that insurance companies may misinterpret or apply the language unfairly during claims processes.
Most insurance policies contain exclusions that are specific to each type of policy in question, for instance commercial property policies often do not cover damage caused by flooding; to make sure any such incidents will be covered, business owners need to purchase separate flood insurance policies. Policyholders can also find exclusions in personal auto, homeowners’, and general liability policies.
An insurance company may deny claims if an incident falls within an exclusion clause. Common examples are injuries from intentional self-harm or high-risk activities; although, some exclusions are optional so if insureds wish, additional premium payments can provide coverage for such incidents.
Other types of exclusions are necessary to limit overlaps in coverage and control premiums, for instance a general liability policy’s exclusion of employee negligence may be available under workers’ compensation coverage; some exclusions are subject to “severability clauses”, found in the conditions section, that ensure even if courts find certain provisions invalid they remain part of a valid policy contract.
Denying an insurance claim can be devastating for the injured party. They may have paid their premiums over many years only to be subjected to an unsympathetic denial. But legal recourse provides a means of fighting back against unreasonable denials and getting financial compensation that they deserve. A lawyer can examine your policy’s exclusions to assess whether legal challenges should be initiated against any reasonable denials; and also help dispute unclear policy language that might serve as grounds for denials.
Policy Lapse
Insurance policies exist to safeguard individuals against the unexpected financial hardships. But when individuals fail to consistently pay their premiums, their policies become lapsed – leaving beneficiaries vulnerable against costly medical bills and other potential financial issues. It is therefore vitally important that people always pay their premiums on time.
Once a policy lapses, insurers no longer owe any legal obligations to pay out claims. Reactivation may be possible under certain conditions but is usually time consuming and involves applying and underwriting with new underwriters; depending on how long since their last examination it could also require taking a medical examination again.
Policy lapses may arise for various reasons. Insurance companies typically give an extended payment grace period before it lapses – usually 30 days. Failing to make premium payments within this timeframe usually results in the policy becoming inactive; there are however, exceptions that exist.
Mismanagement by an insurance company could result in the nonpayment of claims; this may include losing checks or not recording payments correctly, missing deadlines or failing to record payments properly. Group life plans generally offer grace periods to cover missed payments; similarly if an employer makes mistakes while administering life insurance plans and allows their plan to lapse, employees should have strong grounds to argue they are entitled to benefits.
Insurance companies strive to maximize profits by collecting premiums while paying out minimal claims payments. Unfortunately, insurance adjusters frequently use their position to deny valid claims or devalue them using unfair policy terms or biased interpretations of facts – this is why it is crucial that an experienced attorney be by your side when dealing with insurance companies.
Incomplete Police Report
Police reports are essential pieces of evidence in any car accident claim, helping establish liability, assess damages and injuries, and facilitate settlement negotiations with insurance providers. An incomplete police report can complicate this process considerably and lead to further delays for claims processing.
Insurance companies may use discrepancies in reports to dispute your account of an accident and shift blame to someone else, delaying compensation payments and making it hard for victims to access fair reimbursement for their injuries.
An accurate police report depends on its author; however, due to the chaos of an accident scene they may be hasty in documenting their findings as quickly as possible – leaving little time for double checking facts or making any necessary corrections before reporting back their findings. This can result in mistakes being made which compromise accuracy.
Immediately notify the police officer if you detect an obvious mistake or oversight in the report, explaining what caused it and providing evidence that supports your version of events. Officers are more likely to listen if your approach is friendly and respectful; providing proof may even make their attention shift towards amending their report accordingly.
Dependent upon the nature of the error being contest, you may be able to convince an officer to amend their report accordingly. This includes errors of fact such as details about your vehicle, insurance coverage or location of accident; while omission errors can be more difficult to rectify; such as when they did not include complaints of pain or injuries you reported.
At the scene of any car accident, it is imperative that you review and use the police report immediately as part of your documentation, such as witness interviews, photos from the scene, medical records and accident reconstruction experts. Keep in mind that police reports are one source of evidence, which may contain biases, mistakes or inconsistencies – something to keep in mind as soon as you open one up!
Bad Faith
Insurance companies who act in bad faith breach an implied covenant of good faith and fair dealing, giving rise to legal claims which can be brought as either tort claims or under specific laws. It differs from breach of contract lawsuits as it doesn’t involve specific terms but rather encompasses more of its spirit than anything written into policy agreements.
Bad faith practices include denying coverage for valid reasons, failing to give reasonable consideration to claims, or employing tactics intended to pressure injured parties into giving up. Bad faith also includes misrepresenting policies deliberately.
As part of their obligations to treat claims fairly, insurers must undertake a full investigation, which includes reviewing medical evidence and any other pertinent details, such as accident reports. Blanket denials based on outdated internal guidelines do not fulfill this responsibility; neither should there be any unreasonable demands during the claims process and they should be willing to negotiate an acceptable settlement in accordance with damages suffered.
If the at-fault party’s insurance company denies your personal injury protection benefits, seek legal advice immediately. An attorney can review the reasons for their denial and present them with valid, factual arguments to counter their decision. They may even file suit against them seeking both your denied claim as well as punitive damages for their behavior.
An experienced bad faith attorney can be invaluable after an accident, providing you with the coverage that is rightfully yours. They’ll carefully examine your case before recommending an effective strategy of action; negotiate with insurers on your behalf in pursuit of fair and timely settlement; if negotiations break down they can file suit to seek compensation for lost income, out-of-pocket expenses, medical bills, property damage and emotional distress damages; depending on state laws it may also cover emotional trauma claims as well. Getting advice from an attorney to pursue this route can help tremendously; consult one for further advice regarding filing a bad faith claim against at-fault party’s carrier today to learn your options for filing this type of claim against their insurance carrier!
