What Happens When the Insurance Company Denies My Claim?
Does the insurance company have to have a reason to fight or deny my claim?
That’s another question any seasoned Maryland car accident lawyer has heard hundreds of times, and most will tell you the practical answer is “No”, they don’t. The Maryland Insurance Code tells us it is unlawful for an insurer to deny a claim for “arbitrary” or “capricious” reasons. Any experienced lawyer is too well ware that one man’s caprice is another man’s well-reasoned approached. As many victims can attest, claims are denied, frequently. Unfortunately, we’re given little guidance on what “arbitrary” or “capricious” reasons look like -as there are only a few  decisions discussing this provision.
Most insurance companies are huge entities with massive resources that dwarf those of the individuals with whom they have a dispute.
Experienced Maryland car accident lawyers Attorney Eric T. Kirk is aware that 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 car accident or injury victim, the remedy for a violation of these rules is typically the imposition of an administrative fine against the insurer. Some states have chosen to adopt a detailed set of “ethical rules” that govern the conduct of claims handlers. [e.g. Florida; https://www.flrules.org/gateway/ RuleNo.asp?id=69B-220.201]. Under an ethical rule in effect in another jurisdiction, “[a]n adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise.” F.A.C. 69B-220.201. Unfortunately, Maryland has no such requirements. But it’s certainly a fair request that accident victims may wish to inquire as to the claims adjusters’ medical and vocational expertise, training and experience prior to settling their Baltimore personal injury claim.
Here is some good news. Maryland insurance companies have an obligation to settle negligence claims.
If an insurer refuses to settle a claim within policy limits in ‘bad faith’ they are liable to their insured for any additional amounts recovered by an injured party as a result of a trial. A skilled personal injury attorney will know how to make sure that this right of the insured is transferred to their client, so that any excess verdict can be recovered directly from the insurance company.
Whatever the reason for the claim denial, no matter how outlandish, the claimant really has little choice. The person who has been offered pennies on the dollar, or blatantly insufficient compensation, the options are really the same. An injured person, or one who has suffered a loss, can either accept what the insurance company says, or they can fight.