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What Counts As An Unreasonable Denial Of Insurance Benefits?


The process of pursuing a personal injury claim can be full of obstacles and challenges. One of the most frustrating challenges you may face is when your insurance company denies your claim.

If you have been injured in an accident, you probably expect your insurance company to provide the necessary benefits to help you get back on your feet. The insurer may deny your claim, whether it’s reasonable or not.

When a claim is denied, you need to understand what counts as a reasonable or unreasonable denial of insurance benefits to know whether or not to appeal the decision. Our Seattle insurance bad faith lawyers at Emerald Law Group can investigate the denial of your claim and help you determine your best course of action.

Valid Reasons an Insurance Company May Deny Your Personal Injury Claim

Insurance companies may have strict policies or requirements to approve a personal injury claim, making it challenging to get benefits if you fail to meet their criteria. Not all denials are unreasonable. Here are some valid reasons your insurance company may deny your personal injury claim:

  • You missed the deadline. Some insurance companies require you to file a claim within a specific period. If you miss the deadline, the insurer may deny your claim.
  • You did not report the accident on time. Your insurance company may deny your claim if you failed to report the accident or injury as soon as possible.
  • You had a pre-existing condition. If the injury you sustained is related to a pre-existing condition, your insurance company may deny your claim.
  • Your injury is not covered. Your insurance company may deny your claim if the injury or damage is not covered under your policy.
  • Your claim is fraudulent. If your insurer suspects that your claim is fraudulent, they may deny your claim or even terminate your policy.

Typically, the insurance company will send you a denial letter that contains the reason for denying your claim.

What Counts As an Unreasonable Denial of Insurance Benefits?

Washington law prohibits unreasonable denials of insurance benefits under RCW § 48.30.015. An unreasonable denial of benefits is when an insurance company denies your claim without a reasonable cause, breaks the law, or fails to follow good-faith practices.

Here are five signs that your insurance claim was denied in bad faith:

  1. Your insurer did not investigate your claim properly. Your insurance company should conduct a thorough and proper investigation before denying your claim. If they failed to investigate, that may be a sign of an unreasonable claim denial.
  2. Your insurance company ignored the evidence. If your insurance company overlooked critical pieces of evidence that could have changed the outcome of your claim, they may have acted in bad faith.
  3. Your insurer engaged in unfair negotiation tactics. If your insurance company offered you a low settlement or used intimidation tactics to discourage you from pursuing your claim, you may be able to take legal action against the insurer for bad faith practices.
  4. Your insurer did not provide a valid reason why they denied your claim. If you were denied insurance benefits without a valid reason, that could be a sign of bad faith.
  5. Your insurer did not provide any documentation of their decision. Your insurance company should give you a written notice explaining why they denied your claim. If they failed to provide any documentation, that may be a sign of bad faith.

If you suspect that your insurance company acted in bad faith by unreasonably denying your benefits, you may have the option to appeal their decision.

Consult with an Insurance Bad Faith Lawyer

If your claim was denied, you might want to consult with a lawyer to evaluate your case and determine if the insurance company denied your claim in bad faith. Our lawyers at Emerald Law Group have the expertise and experience to stand up for your rights and ensure that you are getting the benefits you deserve. Call 206-826-5160 to schedule a case review.

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