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.

If you have filed a claim with an insurer following a car accident and received a denial, you are not alone. This happens to many accident victims, but it does not necessarily mean that you are without recourse. Take these steps to help you determine your legal options following the denial of your claim: 

Understand Why You Were Denied

While all denials lead to you not being paid for your losses, there are many reasons why an insurance company could deny your car insurance claim. These reasons may include:

• The policy does not provide coverage for the claim. It may be that the policy you selected does not cover the loss you experienced. For example, some people opt to forgo collision insurance and only take out a liability insurance policy, the minimum required by law.
• The driver does not qualify as a person insured by the policy.
• The accident took place during a lapse in coverage caused by the policyholder’s failure to pay premiums.
• You have reached policy maximums for insurance coverage amounts, and your insurer will not cover your entire loss.
• You failed to notify your insurance carrier about the purchase of a new vehicle.

In many cases, insurers issue a denial because they believe that the policy at issue does not cover the loss. Sometimes, however, insurers make a denial in bad faith, which is against the law. If you believe that this is the case, you should speak to a lawyer as soon as possible.

A homeowner’s insurance policy is meant to cover losses on your home and when you consistently pay the monthly premiums for that policy, you expect your insurance company to pay when a loss does occur.

In many cases, a homeowner’s insurance policy operates as it should. However, sometimes insurance companies try to avoid payment under the terms of their own policies.

If you sustain a loss that you believe is covered by your homeowner’s insurance policy and your insurer rejects the claim, your insurance company should explain to you in writing reasons for denial of your claim, including which provisions your claim does not meet or which provisions preclude you from having a valid claim. You should re-read these sections of your policy so you can understand the insurance company’s reasoning fully and in context.

When you have been in an accident that has caused you to suffer either property damage or bodily injury, the last thing you need is for an insurance company to avoid living up to its obligations. Unfortunately, however, there are occasions when insurance companies deny benefits under an insurance policy without having a good reason to do so. When this occurs, you might have a lawsuit for bad faith against the insurance company.

Bad Faith in Wisconsin

To establish a claim against an insurance company for bad faith in Wisconsin, the insured must establish (1) the absence of a reasonable basis for a determination of a denial of benefits; and (2) knowledge or reckless disregard by the insurance company of the lack of a reasonable basis to deny coverage.