What Can I Do About a Wrongful Denial Insurance Claim?

When you take out an insurance policy, you never think the company might not pay when the time comes. Insurance companies have more knowledge and money than their policyholders when it comes to handling claims. Tulsa courts require insurance companies treat you fairly and act honestly in their policies, and that’s what you expect when you pay your premiums.

Oklahoma has laws that inhibit insurers from dealing in bad faith. While the specifics depend on an individual’s circumstances, in general, an insurance company must put its customer’s interests on par with its own. While an insurance company may investigate and sometimes even deny claims, it may not act unreasonably.

If your insurance company doesn’t do what they promise or treat you fairly when dealing with your claim, you can take them to court, but you’ll need a competent Tulsa bad faith insurance attorney to navigate the legal system.

What Is a Wrongful Denial?

Professional woman displaying a card with 'Claim Denied' text

When an insurance company fails to deliver on its commitments, policyholders can file a claim against the company, often referred to as a wrongful denial or bad faith claim. The objective is to seek compensation for the harm suffered and hold the insurance company accountable for their unfair practices.

If your insurer acts unjustly, you might recover compensation to cover your damages. The court may award you punitive damages to discourage and penalize the insurer for their unfair treatment, providing a measure of justice for policyholders facing such situations. These legal remedies ensure that insurance companies uphold their end of the insurance agreement and treat their customers fairly.

What Is the Unfair Claims Settlement Practices Act?

In Oklahoma, the Unfair Claims Settlement Practices Act (UCSPA) applies to any situation where someone files a claim against an insurance policy or insurance company contract. The UCSPA contains rules for guiding the behavior and duties of insurance adjusters when looking into and resolving claims.

Not adhering to these guidelines could mean you have grounds for a case.

When you contact the insurance company with a question or concern, they should respond within 30 days.
If you file a lawsuit, the insurance company must acknowledge receiving it within 30 days.
The insurance company should give you the necessary forms and help you with the process quickly so that you can follow the policy rules.
After you provide all the required information for your claim, the insurance company has 60 days to tell you whether they accept or deny it. If they need more time to investigate, they must tell you within that same 60 days.
The insurance company cannot take more than 120 days to complete their investigation, except in suspected fraud or arson cases, but they need specific information to justify a longer investigation.

UCSPA violations do not provide policyholders with a private right of action, but they may use them as evidence in a wrongful denial case.

Proving a Wrongful Denial

To file a wrongful denial claim, you must show that the insurance company did something wrong when handling your valid claim. It’s more than just a simple mistake in the denial process.

To prove a wrongful denial case in Oklahoma, the person suing (the plaintiff) has to show four things:

They had insurance and had a right to make a claim.
The insurance company acted unreasonably.
The insurance company didn’t treat them fairly or act in good faith when handling the claim.
The insurance company’s unfair behavior directly caused harm to the plaintiff.

A civil wrong (tort liability) happens when the insurance company unfairly and in bad faith withholds payment from its insured. These laws are difficult to understand. An experienced lawyer can help you make sense of when and how you can sue an insurance company for a wrongful claim.

Why Was Your Claim Denied?

Insurance companies might say no to your claim for several valid reasons.

They could say:

They think their customer didn’t cause the accident or your injury.
They believe you had some part in causing the accident or your injury.
Their policy doesn’t cover the specific accident that hurt you.
They think the accident didn’t really lead to your injury.
You waited too long to ask for help.
The insurance policy expired or stopped.
You didn’t give enough proof of your injuries and losses.
The medical records don’t support your request for money.

When the insurance company sends you a letter saying no, have a lawyer read it carefully. Your lawyer can explain why they said no and determine if it is legitimate. They love to fill their letters with hard-to-decipher legal and insurance jargon.

Ask a lawyer to help you sort through it so you understand entirely. A lawyer can also remind you of the deadline for filing an appeal or requesting a review.

Filing a Wrongful Denial Appeal

It can break your heart to follow all the rules and participate in the accident investigation just to find that the insurance company denied your claim. Now what?

Appealing an insurance company’s decision to deny your claim is no easy task. Suppose you’ve had an accident, and your insurance company denied your claim. In that case, you can get the money you deserve faster by working with an experienced lawyer who will lead you through the steps of appealing the denial. This way, you can improve your chances of a successful outcome and receive the funds more quickly.

You can expedite the process.

Ask for a supervisor

Before proceeding with an appeal, go beyond the insurance adjuster and ask to speak with a supervisor who may provide insight into the denial and whether you have grounds to pursue it further.

Working with someone in authority can help you understand why your claim was denied and quickly clear up any misconceptions. The insurance adjuster and supervisors are there to make the company money – not you. Double and triple-check everything they tell you. A wrongful denial lawyer will immediately detect any untruthful statements.

File online

A growing number of insurance providers offer the convenience of tracking your claims online, enabling you to dispute a denied claim through their website. Read the fine print, however. There may be contingencies that can slow or halt the process.

If you don’t have a lawyer for your accident case, contact an experienced attorney as soon as possible. The sooner you reach out, the sooner the attorney can start helping you. Your lawyer understands what information your case might need, when to contact the state insurance adjuster, and how to write an appeal letter.

What Compensation Do I Deserve in a Wrongful Denial Claim?

You should be entitled to compensation if you succeed with a wrongful denial insurance claim. Your damage award depends on many elements. The nature of the insurer’s misconduct and the losses you experienced play a significant role in your reward.

If your insurance company wrongfully denies your claim, you might get compensation for:

Money you lost because your insurer didn’t process your claim right
Money you spend on lawyers and court proceedings to make your insurer take responsibility for their harmful actions
Extra money the court decides the insurer must pay as a punishment for their misdeeds
Fines that the law says insurers must pay for unfair claims handling
Stress and emotional trouble they put you through

A skilled lawyer experienced in handling insurance matters can uncover the full extent of compensation entitlement that often goes unnoticed by individuals and ignored by insurance companies.

How to Know You’re Dealing with a Wrongful Denial

Insurance companies are notorious for beating around the bush when you need things finished quickly. They scrutinize every detail to minimize the amount they pay you.

Several signals can tell you that your insurance company is about to deny your claim.

Failing to investigate a claim properly. The insurance company may make mistakes that make it look like your claim is flawed. They could fail to consider specific evidence when deciding who bears fault, or they may not investigate all aspects of the claim.
Misrepresenting your coverage. Insurance policies often include confusing language that you may struggle to understand. The company’s agents use this complex language to confuse you, insisting that your policy doesn’t have the coverage you paid for.
Acting in their own best interests. Insurance companies are lawfully obligated to act fairly and honestly toward insured people, including paying claims within the policy’s confines. Unfairly handling claims, including denials, for no reason does not represent your best interests.
Changing the terms of the policy without notification. Sometimes, insurance policies change after your initial policy is created. If so, you should receive due warning, including written communication about the change terms. Any coverage shifts should occur at the end of a contract rather than in the middle of the coverage period.
Failing to offer a reason for the denial. Your insurance company can legally deny claims for many reasons, but they must explain the denial and how it fits within the terms of your policy.
Not providing clear communication. Sometimes insurance companies need more data to process a claim. Instead of denying the claim, the company should communicate those needs and give you enough time to provide it. The company must issue their requests in writing using understandable language and clearly explain why they need it and how it will help the claim process.

Insurance companies must provide clear and transparent information whenever you ask for it. If you’re confused about their answers, it’s a good sign they’re trying to mislead you.

How Can Working With a Tulsa Wrongful Denial Lawyer Help You?

If you file an insurance claim and it’s denied, you’ll need a lawyer to file your appeal and gather the proper evidence to increase your odds of a successful appeal. There are many other benefits to having a lawyer.

Tulsa Wrongful Denial Claims Lawyer, **Daniel Aizenman**

They explain how much compensation you deserve. Your claim might have been excessive for the nature of your accident, or you may have attempted to request coverage for items not specified in the policy, resulting in the denial of your entire claim. Working with an attorney gives you valuable guidance on what to request and anticipate from your insurance provider.
They help you better review the insurance policy. Insurance companies all provide varying policies to their clients. Understanding these policies can be perplexing, especially regarding coverage limitations and the reasons for denial. A lawyer can alleviate this confusion and provide clear explanations. Additionally, a lawyer can assist in identifying potential policy loopholes or elucidating why your claim was rejected.
They fight for your rights. If you must negotiate with the insurance company or end up in court, a lawyer will fight for you and ensure your civil rights are considered. You’ve invested in your policy, now it’s time to protect what’s rightfully yours. Enlist a lawyer to champion your rights and safeguard your interests.

Wrongful denial claims require you to accomplish multiple stressful, demanding, confusing tasks before you can even file the claim, with more to do to ensure its success.

It’s impossible to do it all alone. Hire a qualified Tulsa personal injury lawyer with experience in wrongful denial claims so you always understand what’s happening during the process, and you can rest assured that your lawyer has your best interests in mind.