When an accident happens in New Jersey, and you need insurance coverage, you will likely turn to your insurance company for help. However, even your own insurance company is not necessarily your friend and might deny your claim without good reason. Additionally, the insurance company of the party that caused the may also wrongfully deny your claim.
When an insurance company denies your claim, our team can help you determine the best ways to get the compensation you deserve. Insurance companies in NJ have a legal duty to act in good faith, meaning they must approve reasonably justified claims. Denying a claim without citing a reason or acting in a way that affects a denial, like ignoring your claim, is considered “bad faith,” and insurance companies can be held liable for it in court. While we might be able to appeal the denial through the insurance company, a lawsuit is typically the best option to get the benefits you are entitled to.
For a free evaluation of your claim with our New Jersey personal injury attorneys, call Agrapidis & Maroules, P.C., at (201) 777-1111.
What Can I Do if My Own Insurance Company Denies My Claim in New Jersey?
When shopping for insurance providers for our cars, homes, and lives, most people in New Jersey try to select a company that will honor the policy they make. Unfortunately, virtually every insurance company will look for a reason to deny your claim. After all, they are businesses that aim to make money for their shareholders. If all insurance companies aimed to protect people and treat them fairly, we would not need laws protecting you and other claimants from their bad faith conduct.
Most insurance will have valid reasons for denying a claim, as doing so without one would open them up to legal action. Other insurance companies have developed practices and methods to deny claims that skirt the line of fairness or completely cross it into illegal conduct. Our NJ bad faith insurance lawyers can explore a few options with you to get justice if your insurance company has wrongly denied your claim. Sometimes, a solution is to file an appeal with the insurance company to address any shortcomings in the original claim. If the denial was not an error, we could file a lawsuit against them for acting in bad faith.
Appeal the Denial
Not every claim denial is the result of bad faith. In many cases, insurance companies deny claims for reasons that can be easily corrected. For instance, if you filed a claim with your provider after being injured in a car accident but did not provide proof of the accident, like a police report, they will likely deny the claim since they only have your word. During an appeal, we can submit evidence that definitively shows your accident occurred.
Many claims are denied because claimants do not submit proof of their injuries and damages. Our team can gather medical records, bills, and proof of lost wages to substantiate the damages you are claiming. When your claim is reexamined on appeal, your insurance company will have an accurate estimation of your losses.
Some people file an appeal on their own. However, we recommend reaching out to us before appealing. We can identify why your claim was denied and gather evidence to fill in the gaps. You might already be the victim of bad faith, making an appeal useless. In these situations, a lawsuit will be the best option for justice.
File a Lawsuit
There is one type of lawsuit allowed under a statute, but it is limited; however, there is a broader lawsuit allowed under court precedent as well.
Under the New Jersey’s Insurance Fair Conduct Act, lawsuits for insurance company bad faith can only be filed for unfair denials of uninsured and underinsured motorist (UM/UIM) claims. These are claims you file with your provider after a hit-and-run, or the other driver does not have insurance or not enough to cover your damages. N.J.S.A. § 17:29BB-3(a) prohibits insurance companies from unreasonably denying these claims in bad faith.
However, UM/UIM claims represent a small minority of the claims filed in NJ, meaning you will need another route to file a lawsuit in other situations. Fortunately, you can file a lawsuit for breach of contract against your insurance company for breaching the terms of your agreement. You enter into a contractual relationship with the insurance company when you purchase a policy, and you can almost always sue the other party for violating a contract.
According to the Supreme Court of New Jersey in Pickett v. Lloyd’s, insurance companies have a duty of good faith to their policyholders to administer claims fairly. For example, they must not misrepresent the facts of your case or the terms of the policy to deny your claim, as per § 17:29B-4(1). They could also be held liable in court if they ignored your claim altogether or gave false information to justify their decision. § 17:29B-4 of the Unfair Claims Settlement Act lists many other grounds that can be the basis of a lawsuit.
What Happens if Another Party’s Insurance Company Denies My New Jersey Claim?
The legal situation is very different if another party’s insurance company denies your claim. Accident victims often have to file insurance claims with an insurance company they do not have a policy with, such as when someone slips and falls in a restaurant or needs to file a third-party claim for a car accident. An insurance company that does not do business with you will not want to pay on a claim and might unfairly deny it.
Fortunately, you have recourse against a third-party insurance company if they unreasonably deny your claim. While you can only assert bad faith after being denied a UM/UIM claim, you can file a lawsuit if the insurance company violated their duty of good faith, as described in Pickett. Alternatively, we can file a lawsuit directly against the person or business responsible for your injuries.
Call Our NJ Bad Faith Insurance Lawyers for Help with Your Claim Today
Call Agrapidis & Maroules, P.C., at (201) 777-1111 for a free and confidential case review with our Bayonne, NJ personal injury lawyers.