Ohio is a fault state, which means that those who are responsible for causing an accident will be required to compensate any other injured parties. In most cases, the injured party will file a third party claim with the at-fault party’s insurer, seeking coverage for medical expenses and property damage. Unfortunately, these claims are often denied, so if you were recently involved in an accident and your insurance claim was denied, it is important to speak with an experienced insurance claims attorney who can help you seek the compensation you deserve.
There are two types of insurance claims: first party claims and third party claims. First party claims are those that are filed with a person’s own insurer. Third party claims, on the other hand, are filed with someone else’s insurer. The type of claim that a person files depends in large part on who was at fault in an accident, although it’s always a good idea to report an accident with your own insurer even if you weren’t at fault.
Although many claims are approved, which allows injured parties to quickly recoup their losses, many more legitimate claims are denied. Insurance claims are denied for a number of reasons, many of which are procedural in nature. For example, a claim may be denied because a person failed to file on time or forgot to submit the results of an independent medical examination. In other cases, claims are denied because an insurer insists that the type of accident the claimant was involved in is not covered by his or her policy, or the damages may exceed the policy’s limits, leaving an injured party with only part of his or her bills covered. Those applying for long-term disability benefits with their insurer may find their claims denied because their disability is not considered severe enough. In many situations, an at-fault party may not even have insurance coverage, which will require the accident victim to file a first party claim with his or her own insurer. Unfortunately, these claims are also often denied.
Fortunately, when a claim is denied, the claimant can file an appeal with the company or file a complaint with the Ohio Department of Insurance. If a claim is again denied, the claimant may be able to file a suit against the insurer if there is evidence that it breached its contract, violated insurance law, or acted in bad faith by unreasonably denying a claim, changing a policy without notice, or failing to complete an adequate investigation.
Finally, claimants who have exhausted all administrative remedies, have been denied a fair settlement, or were involved in an accident with an uninsured driver can file a personal injury claim in court where he or she may be able to collect compensation for medical expenses and lost wages.
If your insurance claim was recently denied, please contact Lafferty, Gallagher & Scott, LLC by calling 419-241-5500 or by sending us a brief message and a member of our dedicated legal team will evaluate your case for free.
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areas of practice we handle, including personal injury, workers’ compensation and insurance claims issues.