What Reasons Can The Insurance Company Use to Deny My Claim?
In theory, the reasons that an insurance company can use to deny a claim are as limitless as the imagination of the creative adjuster. So long as there is some factual basis for the denial, there are no limitations. Most insurance companies are huge entities with massive resources that dwarf those of the individuals with whom they have a dispute.
There is a code of conduct for insurers regarding the claims practices. Maryland law provides that it is an "unfair claim settlement practice" to: refuse to pay a claim for an arbitrary or capricious reason; misrepresent pertinent facts or policy provisions; or to fail to provide a basis for denials.
Unfortunately for the injury victim, the remedy for a violation of these rules is typically the imposition of an administrative fine against the insurer. That does little to help with injury victim who may be out of work with massive and mounting medical bills.
-This Article was updated by Eric Kirk on 5/20/19.