Top 5 Ways To Protect Your Compensation After a Baltimore Car Accident.

Baltimore personal injury and accident claims, by their very nature, progress through various stages: demand and negotiation, litigation, trial.  Any legitimate injury claim, or case, will of course stand on its own merits, to some extent. There are, though, nuances that can add to the case in a defensive sense. Litigation in serious Baltimore personal injury matters is fraught with opportunities to tarnish, minimize or detract from an otherwise valid claim for personal injury damages. To the extent these pratfalls can be avoided, any financial recovery is preserved, and potentially enhanced.

The following sentence will come as no surprise to any Baltimore injury lawyer.  Insurance companies can deny claims. They can, they will, and they do. There are no numbers that I am aware of, but I would believe it safe to say there are hundreds and potentially thousands of claims in the process of denial at any given time in Baltimore. Moreover, insurance companies minimize claims, undervalue claims, and underpay claims. Here are some common reasons why an insurance company might deny a claim:

Lapsed Policy: If the policyholder hasn’t paid premiums and the policy has lapsed, any claims made during the lapsed period can be denied. In a typical injury case, this could apply to PIP or uninsured motorists’ claims.  The obvious advice here is to keep premiums current.

Policy Exclusions: Insurance policies often contain exclusions detailing what isn’t covered. If the event or damage claimed is on the exclusion list, the claim can be denied. In a common Baltimore uninsured case involving injuries, a denial might be based on an “excluded driver” defense.

Coverage Limits: If the amount claimed exceeds the policy’s maximum coverage, the excess amount might not be paid. The amount of insurance available comes up in a variety of personal injury cases. A classic scenario in a Baltimore personal injury claim is one in which the policy limits of “at-fault” or negligent motorist are not sufficient to cover the losses. One implication is that an uninsured [here: “underinsured”] claim arises if there is applicable in-force coverage. Sufficient and in-effect Maryland automobile insurance with the full coverage afforded under Maryland law, which would include uninsured coverage, is recommended.

Misrepresentation or Fraud: If the policyholder has provided false information either when buying the insurance or when filing a claim, the insurance company can deny the claim. Insurance Fraud can occur in many settings, and this is one. We do not handle cases involving insurance fraud, but I can say it is a significant reason for many Baltimore insurance claim denials.

Late or Inadequate Notification: Many policies require the policyholder to notify the insurer within a specific timeframe after an incident. Failure to do so can result in a denied claim. The law deems some failures to act promptly to be so prejudicial, that they can lead to a claim denial. In any Maryland uninsured motorist claim seeking damages for personal injury, it is vital to cooperate fully with your insurance company.

Failure to Document Properly: If a claimant doesn’t provide all required documentation or provides inadequate documentation, the claim might be denied.

Not a Covered Event: If the event leading to the claim isn’t covered by the policy, the claim will be denied. There are typically a host of scenarios involving Baltimore personal injury cases against uninsured drivers, e.g. does Maryland uninsured motor vehicle insurance coverage exist, and apply?

Violation of Policy Conditions: If the policyholder has violated any conditions of the policy, such as illegal activities or not following prescribed steps after an incident, the claim might be denied. In the context of first-party claims, this frequently arises when an insured person fails to comply with their duties after loss under the policy. An example here might be the failure to attend a mandatory examination.

Pre-existing Conditions: For health insurance, if a condition existed before the policy was purchased and it wasn’t declared, claims related to that condition might be denied. The major uninsured motorist coverage insurance companies are State Farm, GEICO, Liberty Mutual, Progressive, Nationwide, Allstate, USAA and Erie. These insurance companies frequently defend uninsured motorist claims on the grounds that the injuries in fact predated the date of loss.

Lack of Medical Necessity: Some insurance policies require treatments to be medically necessary. If a treatment isn’t deemed necessary, it might not be covered. PIP providers frequently deny payment alleging such reasons.

Intentional Acts: It should be self-evident,  but if an insured person intentionally causes harm or damage, that claim can be denied.

Failure to Mitigate Damages: Policyholders are often required to take steps to prevent further damage after an incident. If they fail to do so, additional damages may not be covered.

If an insurance company denies a claim, Maryland law requires it must provide a written explanation for the denial. Policyholders who believe their claim has been wrongfully denied have several recourses:

Internal Appeals: Many insurance companies have an internal appeal process where the denial is reviewed. This process is unavailable to  those seeking compensation under the liability provision of a Maryland insurance policy.

A policy could potentially provide for external review whereby, assuming the internal appeal is unsuccessful, policyholders might have the right to an independent external review, which means a third-party review of the insurer’s decision.

Legal Action: In some cases, policyholders may choose to take legal action against the insurance company. There are typically two actions filed in Baltimore in the first party, uninsured motorist, or personal injury protection claims: Breach of contract and declaratory judgment. I handle both types of these cases. A contract action seeks monetary damages for the insurance company’s failure to provide payment under the policy, whereas a declaratory judgment action seeks a determination that there is [or is not] coverage under the policy itself.