Unfortunately, it’s a regular occurrence for people with insurance policies to find that when the time comes, the insurance company decides it doesn’t have to provide coverage after all, despite regular monthly payments from a customer. This can be a confusing, vulnerable situation for people, which unethical insurers sometimes rely on.
Of course, there are valid reasons for an insurance company to refuse to pay a claim or even demand repayment of a claim that’s already been paid. Insurance fraud, especially in injuries, happens all over the world. People have successfully fooled insurance companies into paying out for false injuries, so these insurers are often paranoid about paying out for a false claim.
However, in other instances, a legitimate accident victim may find that an insurer has decided not to honor a claim despite a real and painful injury. Sometimes, this is even for deliberate, malevolent reasons and may involve deception or distortion of facts and records to avoid paying a legitimate claim.
Insurance companies have years of experience dealing with their own policies and deciding when to honor a claim and when to refuse it. Unfortunately, that doesn’t always translate to the correct or ethical decision, and sometimes insurers exploit their position.
They know, for example, that most people have little legal experience, especially with lawsuits. They also know that most Americans don’t necessarily have the “financial war chest” required to wage a long, drawn-out legal battle against a big corporation with an army of lawyers. Because of these factors, some less ethical decision-makers at insurance companies know that if they put enough pressure on someone complaining about a denial, the sheer legal force arrayed against such a person may make them buckle under.
However, just because an insurance company decides to deny a claim, that doesn’t mean the decision is final. And just because an insurance company has a significant legal mechanism buttressing it doesn’t mean that a win in court is guaranteed.
Experienced attorneys can help claim denials in various areas, such as personal injury, workers compensation, and even social security disability insurance. In some cases, such as with a personal injury or wrongful death claims, they work on a contingency fee, only collecting payment for legal services if they win the case or negotiate a settlement. Once an insurance company knows that someone has legal representation and even a willingness to go to court, the public nature of such a lawsuit is often something they would like to avoid, and negotiations—or even out-of-court settlements—can begin.
And of course, if it goes to court, you know you have an attorney in your corner.