Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

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UPDATED: Feb 24, 2020

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If you or your child suffered a traumatic brain injury at the hands of another party, if there is evidence of fault, that parties insurance should cover the cost of rehabilitation. If your insurance carrier has denied or short paid a claim, leaving you to cover the costs of your brain injury, you can challenge the company’s decision.  Disputing an insurance decision is a complicated matter, and an experienced attorney can go a long way to getting the money you deserve.

What Happens When an Insurer Refuses Coverage?

When an insurer refuses to pay a claim, the reasons for denial will be stated in the denial letter. Reasons for denial range from claiming that you filed too late, to saying “fault” was not clearly defined. This is where a lawyer will come in handy. You will need to be patient and collect all required evidence to refute the insurer’s claims, no matter how ridiculous they seem. This back-and-forth may continue for some time, with your lawyer and the lawyers of the insurance company trading information and attempting to reach a settlement, ideally without having to go to trial.

Bad Faith

If none of this works and the insurer still refuses to pay, they are essentially breaching their contract with you. Insurance is meant to provide the customer with protection against losing personal assets in the event of an incident in which they are at fault. In this case, the injury was your fault and your insurer is leaving you high and dry, and ultimately financially responsible.

If an insurance company does this, .i.e. breaches its contract with you by refusing to pay for a reasonable claim, they are, in legal terms, acting in bad faith. It’s generally understood that they need to act in your best interest in a situation such as this, and their refusal to do so is a clear violation of that understanding. If your situation turns into a bad faith case, you will likely end up in court and possibly suing your insurance company – if they choose to let it go that far without settling first. Remember that help from a skilled lawyer is crucial throughout this entire process.