I would like to know what can be done if a company’s insurance company is refusing to address a claim?

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I would like to know what can be done if a company’s insurance company is refusing to address a claim?

4 months ago I was at a store and had a bad fall on their grounds. I tripped in a hole in the grass which was a drainage thing covered by grass. I sprang my right ankle. They offered me a $25 gift card. I refused. An adjuster called me and said he had to research. After about a month he told the lawn service was responsible. I called them and they denied it. I called adjuster again and he told me a consulting company hired the service so they were responsible. They denied it and told me to call adjuster again but now adjuster won’t return my calls.

Asked on October 20, 2011 under Personal Injury, Washington

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 9 years ago | Contributor

Your option is to sue. An insurer's determination is NOT the last word. All the insurer's denial means is that the insurance company thinks their insured is not responsible or that you don't have a good case; they could be wrong, and you have an absolute right to go to court and try to prove that the store--or one of the other parties--is liable and financial responsible.

Before suing, decide if it's worth it: the most you could recover would an amount equal to your medical costs (if any), lost wages (if any), and *possibly* some pain and suffering for a sufficiently serious and long-lasting injury; pain and suffering is usually related to medical costs, though, so if the medical costs are minimal, pain and suffering recovery would almost certainly be minimal, too. Therefore, depending on your injuries, it may not be worth suing.

If you think it is worth suing, then  you should name not just the sotre, but the lawn service and consulting company, too. Sue them all, and if you  prove liability (that someone was responsible for your fall), they can fight it out as to which one actually pays the bill.


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