Gwinnett County Insurance Claims Attorney

Reasons for an Insurance Denial

Most people happily pay their monthly insurance premiums because they expect coverage if an accident strikes. Much to their disappointment, the insurance company gladly accepted their monthly premium checks only to deny a claim for no good reason. Many of them are angry and for a good reason.

Common reasons insurers deny a claim include:

• The policy does not cover the loss.
• The loss is too minor and does not exceed the deductible.
• No loss occurred at all.
• The policy lapsed.
• The insured’s actions actually caused the damage, so they are to blame.

Many of these reasons are legitimate. For example, if a policyholder has not been paying premiums, it is reasonable for an insurer to consider the lapsed coverage. Likewise, if your loss falls outside the policy’s limits, there is no reason to expect range.

However, in many cases, an insurer does not have a valid reason to deny a claim. Instead, they might use vague language to justify their decision or outright misrepresent what the insurance policy states. In addition, some insurance contracts are so confusing that policyholders have yet to decide whether they should expect coverage.

Unfair Insurance Practices

Georgia insurers must act in good faith when processing claims and dealing with their policyholders. Unfortunately, many insurers use

bad faith tactics with the hope of discouraging injured people from submitting a claim. We have seen many questionable tactics, including:

• Failing to investigate a claim thoroughly or in a prompt manner
• Failing to settle a lawsuit where responsibility for the damage is clear
• Refusing to pay benefits when they are due for no good reason
• Failing to protect an insured from getting sued in court by, for example, not settling a dispute
• Requiring an unreasonable amount of paperwork before paying a claim

Consider the following example: You accidentally crash into someone in the parking lot and admit that you weren’t looking where you were going. In this scenario, it is obvious you are at fault for the collision, and your insurance company should pay compensation to the motorist you struck. If your insurer refuses to do so and you get sued, you can incur significant expenses defending yourself. Furthermore, because the insurer had no reason to refuse to pay the motorist, you could have a bad faith insurance claim against your insurer.

How to Submit an Insurance Claim Properly

We must admit that sometimes people have their claims denied because they need to follow the proper process. To protect your right to compensation, remember the following:

• Notify your insurer promptly of any incident or accident you think will be covered by your policy. Your insurer should give you a deadline, which might be 24 to 72 hours after an accident. This is enough time to notify them, even if you suffered injuries in an accident.
• Fill out all paperwork correctly. If you have a question, ask. You don’t want to do paperwork over because you left something out or provided inaccurate information.
• Provide all requested supporting documents. You might need to submit medical bills or other proof of loss. Ensure to obtain this documentation promptly and provide it to the insurer at the correct address.
• Respond to questions promptly. You can’t expect an insurer to be prompt if you delay answering their questions.
• Stay organized. Keep note of when you submit information.

Remember to keep copies of everything you submit and preserve copies of all communications, such as letters and emails. If you speak to someone on the phone, remember to jot down the person’s name, the date and time of the call, and a summary of what you discussed. You might need to refer back to these notes.

Compensation After an Unfair Claim Denial

The primary benefit of pursuing legal action is to get your claim approved, but there are other tangible benefits. In particular, you might qualify for additional compensation, which an insurer must pay as a penalty for not acting in good faith. The statute that governs your claim will determine the precise amount.

For example, suppose you have a loss that your insurer refuses to pay. In that case, O.C.G.A. § 33-4-6 states that the insurer is liable for up to the amount of the loss and up to 50 percent of the liability or $5,000, whichever is greater. Furthermore, you can also get all reasonable attorneys’ fees, which makes pursuing a lawsuit much more realistic.

If you suffered $10,000 of damage to your vehicle and make a claim under your collision coverage, you may be able to seek the $10,000 plus $5,000 as a penalty. In addition, you should also receive a range of your attorneys’ fees. This compensation should provide a powerful incentive for Georgia insurers to act in good faith.