There are a variety of situations where disputes about insurance coverage may arise, including cases involving injuries that occurred because of a person's actions. In these situations, insurance companies may deny claims for numerous reasons, claiming that exceptions to coverage apply or that injuries were not accidental. This can put people in a difficult situation as they seek compensation in personal injury cases or similar matters, and they may need to take legal action to fight against the denial of claims. Fortunately for people in these types of cases, the Wisconsin Supreme Court has ruled that cases involving reckless conduct may not necessarily be excluded from insurance coverage.

Dostal v. Strand

In a recent case, the Wisconsin Supreme Court considered the denial of an insurance claim made by a woman based on the wrongful death of her child. The woman had left the three-month-old child in the care of its father. While he was providing care, he dropped the child on the floor, resulting in a skull fracture. Rather than contacting emergency services, he put the child to bed. The child later died from the injuries suffered in the fall, and the father was convicted of second-degree reckless homicide.

The mother brought a wrongful death lawsuit against the father, seeking compensation for loss of society and companionship, as well as other damages. While the mother believed the incident should have been covered by the father's homeowner's insurance policy, his insurer, State Farm, claimed that the incident was not covered under the policy. State Farm claimed that because the father was convicted of reckless homicide, the incident was not considered an accident and was not covered under the policy. In addition, State Farm claimed that even if the incident was considered an accident, a "resident relative" exclusion applied because the victim was the man's child, and an "intentional acts" exclusion applied because the criminal conviction showed that he engaged in behavior that created a substantial risk of injury.

By Law Clerk Nathan Froemming.

Has your insurance claim been denied despite the presence of a “contamination clause” in your insurance policy? The coronavirus has caused businesses to close across the nation, resulting in lost revenue for many small business owners. As a result, many businesses, especially restaurants and bars, are reviewing their insurance policies to see if they can file an insurance claim to seek relief.

One common provision found in insurance policies is a “contamination clause.” For example, an insurer may pay for lost business income caused by “‘Contamination’ that results in an action by a public health or other governmental authority that prohibits access to described premises or production of your product.” Furthermore, “contamination” is defined in some policies as “a defect, deficiency, inadequacy or dangerous conditions in your products, merchandise, or premises.” This is the language found in one insurance policy, so different policies might have different language or exclusions that may impact the coverage. An insurance claim will always depend on the terms of an individual policy, so remember to look at your own policy.

Most people purchase a life insurance policy in hopes of protecting their family against future financial burdens their death may cause. According to the Insurance Information Institute, the total amount of life insurance benefits and claims in the United States in 2018 was $784 billion dollars. This amount includes death benefits, disability benefits, annuity benefits, and other types of payouts relating to life insurance claims.

Although thousands of life insurance claims are approved each year, many claims are also denied. If you have received notice that your claim has been denied, you should speak to an attorney and take the appropriate steps to ensure that you receive the benefits you deserve.

Determining the Reason for Denial

Following the denial of a life insurance claim, you should be sure to understand the reasons why the insurance company believes the benefits should not be paid. The company must provide a valid reason for the denial. A few reasons a life insurance claim may be denied include:

By Attorney Kristen Nelson

In recent years, a number of news stories have surfaced about healthcare providers who have committed fraud by overbilling patients. While there are some unscrupulous entities that intentionally do just that, sometimes what looks like an attempt to commit fraud is nothing more than human error. For example, a bill could come from the billing department that assumed a specific service was performed because it appeared on the original paperwork and was never removed when the service was not rendered, or a patient could be charged for medication that was ordered but never received. 

When someone suffers a personal injury, they may struggle with a variety of financial issues involving the need for medical treatment and the inability to work and earn an income. Insurance companies become involved in many of these cases, and an injury victim will often be covered by an insurance policy held by the person who caused the injury. Unfortunately, many accident victims come to find out that insurance companies can be unreasonable. 

When a person files an injury claim, the negligent party’s insurance company will often offer to pay a certain amount based on the amount of coverage. However, these offers may not fully cover the victim’s expenses or meet their needs. In these cases, a victim may choose to pursue litigation against the insurance company and/or the negligent party.

After a lawsuit is filed, the parties will conduct discovery, during which evidence will be gathered and depositions will be taken. After this process is completed, the attorneys for the victim and the insurance company may be able to agree about the extent and dollar amount of damages. At this point, a settlement can be reached.