The Claims Adjuster Denied Coverage. What Next?

The Claims Adjuster Denied Coverage. What Next?

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The law allows a victim of an accident to seek compensation for their damages. That means you can file an injury claim with an insurer, whether yours or the other party’s insurance service provider. A claim adjuster may contend that your insurance policy doesn’t cover the incident, probably because your policy lapsed, the nature of the location isn’t covered, or the entity responsible for the accident isn’t insured.

Sometimes, the claim adjuster might say that you don’t qualify to file a third-party claim due to other reasons. In case the adjuster contends your coverage, that doesn’t end at claim settlement negotiations. Rather, the coverage question becomes an additional element in your claim negotiations. This makes the negotiation process more complex than you think, and it’s best to have a personal injury lawyer Los Angeles to boost your chance of getting a fair compensation offer.

Seek the help of an attorney

Once the claim adjuster has denied your claim, like him or her to provide a written explanation of the primary reasons the insurance company denied policy coverage. The explanation must reference all the policy provisions that may have limited your coverage. This will help you and your lawyer understand whether the adjuster will offer you a chance to respond to the specific reasons your claim was rejected, or the insurer is just bluffing.

In case the claim adjuster doesn’t agree to offer a written explanation of why your insurer denied coverage, your attorney should write a letter to the claim adjuster to confirm the conversation, the coverage denial, and the refusal to offer an explanation in writing. Such a letter could pressure the claim adjuster to give an explanation. This is because there’s no insurance claim advisor or supervisor who will let such a letter making its way into the company’s file.

In the event that you decide to file a lawsuit while pursuing your claim or go to the insurance commission, that letter will prove that the insurer has not been cooperating in establishing a solution to your claim issue. Remember, you should also keep a copy of your insurance policy. This will shed more light on the specific sections that the claim adjuster relies on when denying policy coverage. Though you have put more pressure on your insurer, the adjuster might still refuse to continue with the negotiations. In this situation, you will need to use other forms of pressure to push the negotiations further.

If you show that you aren’t ready to abandon your claim, the claim adjuster may begin to cooperate and take part in the negotiations willingly. If not, it’s time to file a lawsuit against the insurance company. After all, you have enough evidence of injuries and the insurer’s failure to cooperate.

Never be scared of the insurer’s lawyer’s letters

There is a good chance you get a letter from the insurance company’s lawyer indicating that there’s no coverage. Don’t be swayed by such a letter. Just consult with your lawyer, and he or she will find the most appropriate way of responding to the claim.

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