Insurance Denials and Claims
Life is full of troubling circumstances like property damage, health problems and litigation. Families, individuals and businesses purchase insurance to protect themselves from financial difficulties when those unexpected situations come up. When your insurance company disputes or denies your claim, you should contact a Portland insurance claim denial lawyer.
Was Your Insurance Claim Denied? We’re Here to Help.
If you have been injured or have experienced property damage, you expect your insurance company to compensate you for the damages. After all, you have been paying the premiums for years. What we see at the Johnston Law Firm is insurance companies challenging or disputing your claim. They refuse to pay you the money you are owed, and provide a long list of exclusions and reasons why. As your attorney, we are confident in our ability to negotiate with your insurance company and work toward recovering full and fair compensation on your behalf.
“The difference in representation between my first attorney and Marc Johnston, was night and day. Marc reached out to my medical providers and got their unbiased medical opinion for my case. He worked with experts to determine not only the costs of treatments to date, but also calculations for future medical care. This information was presented in the mediation Marc led that resulted in a settlement that was far more reasonable than the settlement offer my original attorney described to me as fair. Even though the fee was based on a fixed percentage of the gross settlement, the service from The Johnston Law Firm didn’t stop there. Marc and his assistant actively worked with various medical providers to reduce my medical bills to a fraction of their original totals; more consistent with the rates charged to insurance companies. This resulted in over $10,000 of additional net proceeds to me in the settlement. Finally, Marc assisted me with other financial matters that related to the collision. Increasing medical bills and out of pocket co-payments left me overextended on credit card debt. Marc was able to work with the credit card companies to reduce the exorbitant debt, resulting in more proceeds from the settlement. Anyone considering using The Johnston Law Firm for a personal injury case need look no further. The expertise, professionalism, and customer service of Marc and his staff are amazing.”
– Jessica L.
Our firm provides legal advice and representation to residents of communities throughout Oregon and Washington in a wide array of insurance coverage disputes, including:
While the above list reflects the types of insurance coverage disputes we handle most frequently, we encourage you to contact us with disputes not referenced here. We bring considerable expertise to every kind of insurance coverage dispute under every kind of insurance policy.
Why Your Insurance Claim May Be Contested or Denied
An insurance company wants to dispute or deny your claim because doing so will save it money in the long run. In fact, one of the primary jobs of an insurance adjuster is to find ways to reduce the value of your claim. That being said, in order to actually deny or dispute your claim, the insurance adjuster will need to come up with a valid (or seemingly valid) reason. Common reasons why an insurance claim may be contested or denied include:
- The insurance adjuster claims a policy exclusion. One of the ways that an insurance adjuster will try to deny your claim and save the insurance company money is to claim that a policy exclusion exists. This means that while the insurance adjuster is indeed recognizing that you’ve suffered an injury or damages and should be compensated, they’re also saying that your policy doesn’t cover those specific damages or the way in which they were incurred. This is especially common with homeowners’ insurance claims, but can also happen with motor vehicles and other injury claims, too.
- You’re told that you didn’t give the insurance company enough notice. When you are involved in an accident and suffer damages, you have a duty to provide your insurance company with notice of the accident within a reasonable amount of time. Typically, our lawyers recommend that you provide notice within 24-48 hours; however, you should check your policy to determine whether or not there is a specific time frame in which you must report, or else risk claim denial.
- You have a pre-existing condition. If you have a preexisting condition, an insurance adjuster could use this against you to claim that they don’t owe you money for a new injury you’ve suffered, because that ‘new” injury was actually preexisting. For example, say you had a knee surgery two years ago, and in your slip and fall accident, that injury was seriously aggravated to the point that you need a second surgery. While an insurance adjuster may try to get off the hook for paying for this, you deserve to be compensated for all new injuries you sustain, including the worsening or aggravation of existing injuries.
- You haven’t done your due diligence to avoid further injury/heal to the extent possible. When you are involved in an accident, it’s very important to follow your doctor’s orders related to your medical treatment. If you don’t, the insurance adjuster may argue that you didn’t do your due diligence to mitigate further harm and that if you had, you would have healed to a greater extent than you have. The best way to get ahead of this is to follow your doctor’s order to a T and to keep a thorough record of all the care you receive. We also recommend staying off of social media, as an insurance adjuster may try to follow you online to obtain evidence that can be used against you.
- There are limited medical records. Another thing that may harm your claim is in the event that there are limited medical records/evidence to support your claim for injuries. For example, if you are claiming that you broke your arm in a car crash but there is no record of you going to the hospital after the crash, or if there is no record of an actual bone fracture, you’ll have a very hard time recovering a settlement. This is one of the reasons that we always advise our clients to seek medical care immediately after a crash, even if they don’t think they’ve been seriously injured. Make sure you request a copy of all of your medical bills, prescriptions, and other relevant documents, too.
- The insurance adjuster argues that you were at fault for the accident. Finally, one way that an insurance adjuster may be able to wiggle out of paying your claim is by making the argument that you were at fault for the accident, and therefore their client’s liability insurance policy should have nothing to do with compensating you. Watch out for this argument, and be sure you have a skilled attorney on your side to protect you!
FAQs About Insurance Claims
- Should I give a recorded statement to the insurance company? Our lawyers strongly recommend against giving a recorded statement to an insurance company unless you’ve already spoken to an attorney who gives you the go-ahead. Giving a recorded statement is usually the first mistake, as anything you use in that statement can be used against you to deny your claim – and likely will be.
- An insurance company isn’t responding to me or is unreasonably delaying in processing my claim – what should I do? The insurance company has a duty to process your claim and do so at a reasonable pace – unreasonable delays are a sign of bad faith. If your insurance company isn’t returning your calls and an unreasonable amount of time has passed since you filed your claim, you should connect with an attorney who can represent you in talking to the insurance company.
- I’ve been offered a settlement, but I don’t think it’s fair. What are my options? Another big mistake that people make is accepting an insurance offer that’s unfair and undercuts the value of their claim because they think they don’t have any other options. The truth is that you do have options, and you do not have to accept an unfair settlement offer! If you think that a settlement offer is unfair, we recommend talking to an attorney. An attorney can reject the settlement offer on your behalf and begin the negotiations process to reach a settlement that’s fair.
- What should I do if my claim has been denied? If your claim has been denied, you may feel as though you’re out of options. You have the right to appeal a denied claim, and you should. Before you start the process though, it’s recommended that you speak to an attorney who can represent you during the process and improve your chances of success.
- As an individual, it can be difficult to get an insurance company to treat you fairly. In fact, insurance companies routinely deny claims until you hire an insurance coverage lawyer. Such tactics require a heavy hand, and an experienced insurance coverage lawyer. Having a dedicated advocate on your side forces the insurance company to take your claims more seriously. We will work to get a settlement, but our firm is comfortable representing you through insurance litigation in the courtroom if it becomes necessary. Sometimes, it is the only way to get your insurance company’s attention.
Contact a Portland Insurance Claim Denial Lawyer
If you have questions regarding insurance coverage and denials, contact the Johnston Law Firm by calling 503-546-3167 or via the e-mail form on this website. We offer a free initial consultation and flexible hours by appointment.
Johnston Law Firm, P.C. proudly represents clients in all cities and counties in Oregon: Portland, Gresham, Milwaukie, Lake Oswego, Tigard, Beaverton, Hillsboro, Multnomah, Washington, Clackamas.