How Limitations of Carrier Could Affect Coverage of Damages

The terms in any car insurance policy always include mention of limits. That is the maximum amount of money that a specific policy would provide to the policyholder, following a request for the coverage of accident-linked damages. If an insurance company were to learn the amount of claimed damages exceeded a given policy’s limits, then it might refuse to pay for even a part of the reported damages.

Choice facing claimant that has received such a refusal:

Resubmit and wait for the insurance carrier to review the case, or

Hire a personal injury lawyer in Bowmanville: Pay for the time that a lawyer could put into an effort that was aimed at showing why the submitted and refused case deserved to receive the attention of the insurance company.

Possible reasons for refusal to cover reported damages

Size of damages exceeds the stated limit in the applicable policy.

Insurance company felt that the driver’s behavior helped to cause the accident: That could be the case if the driver had been accused of a committing a DUI, of traveling through a red light, or of speeding.

The claimant had failed to file the required paperwork on time.

Insurance company has stated that it needs a better collection of evidence, in order to cover the level of damage that has been reported to the adjuster.

Insurance company has found no mention of the claimed injury in the available medical report
In the absence of testimony from an expert, the insurance carrier has reason to doubt the veracity of the submitted claims, regarding the nature and extent of the reported injuries.

Alternative coverage that might be explored by a hired attorney

Using health insurance to cover the cost of treatment. Health insurance would not cover the cost of any required long-term care, or the expenses that could be created by administration of therapy.

Depending on the state where the accident took place, a lawyer might check to see if the car’s occupants, excluding the driver, would be covered by the terms of a required insurance policy.

Advantages associated with hiring a lawyer, instead of having the insurance carrier review the case

A lawyer’s examination of the submitted case, along with the refusal would include an attempt to see if the court might extend the deadline for filing a personal injury lawsuit. An insurance company would hope to avoid such a lawsuit, and so, would never check to see if an extension might be granted.

Lawyers are also familiar with the language in an insurance policy. That familiarity allows them to identify weaknesses in the argument that has come from the insurance adjuster. A lawyer’s access to medical experts could also prove valuable, in light of an adjuster’s allegations.

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