Fighting Insurance Companies:
Everything You Need To Know
At The Law Office of Christopher Jackson, we understand insurance denials and how frustrating it can be when an insurance company fails to come through with fair coverage after a serious accident.
Chris Jackson is there for his clients when this happens. Years of litigation experience, unwavering commitment, and a proven record of success are evidence of the trustworthy advocacy our firm offers for every personal injury case.
insurance claim denial, insurance claim denied
Fighting Insurance Denials
Insurance Denials – An accident causing injuries can suddenly shed new light on life’s challenges. If the insurance company denies your claim, harsh new reality comes into focus: how will you pay for your medical bills or lost wages? Your best interests are surely not the same as the insurance company’s best interests — even though you have probably paid premiums for years to your own insurance company. It is not fair, but quality legal representation can level the playing field.
We Hold Insurance Companies Accountable
As an experienced litigator in insurance denials and disputes as well as bad faith claims, Attorney Jackson has the knowledge, resources, and ability to pursue your full and fair compensation in and out of the courtroom. He has built his reputation on his record of proven success because he understands how important those results are for his clients.
He is a trial lawyer who is ready to help you resolve your insurance denial or dispute in cases involving claim reductions or denials for your:
- Auto accident coverage insurance denials
- PIP or no-fault coverage insurance denials
- Policy exclusions
- Health insurance denying payments for medical bills
- Homeowners insurance denying unwarranted fraud claims
- Uninsured and underinsured motorists claim insurance denials
- Life insurance policy denials
The primary job of an insurance company is to make money for its shareholders. Our primary job is to make sure you get the maximum benefit you are owed. Whether you have suffered an injury in a car accident or you have lost a home to a fire, if you believe that you aren’t getting a fair deal from an insurance company, we can help you take control of your case.
Call us for a free case review of your insurance denial.
Bad Faith Insurance Issues
Did your insurance company deny your claim?
Or have you been treated unfairly by an insurance company?
Dealing with insurance complexities is time-consuming. You deserve to have a knowledgeable legal advocate working on your behalf. Insurance companies have an obligation to act in good faith when dealing with those who make a claim.
At The Law Office of Christopher Jackson, our attorneys fight to pursue the compensation you are owed when you have been mistreated by an insurance company.
What Is The Law For Insurance Company Claims?
Under the law of most jurisdictions in the U.S., insurance companies must provide good faith and fair dealing to the persons they insure. If an insurance company violates this rule, the policyholder may sue the insurance company on a tort claim and a standard breach of contract claim.
Is Your Insurance Company Not Paying You For Your Claim?
Few people who have a claim denied are able to prove that the insurance company acted in bad faith, but those who can be able to pursue large awards for damages.
Our Attorneys Have The Experience To Fight Insurance Companies
Insurance companies, both large and small, have extensive resources to protect their interests, but when they act from a bad faith position, it is important to understand that the law is ultimately on the side of the victim.
Fighting insurance companies acting in bad faith without the experience of a legal professional is incredibly difficult and can seriously impact the results you get. Our law firm can help you take control of the situation and fight back when an insurance company acts against you in bad faith, such as:
- Denied coverage
- Unreasonable delays
- Underpayment of claims
- Failures to defend
If an insurance company has acted against you in an aggressively unreasonable manner, then you may have an insurance bad faith claim. When your results matter, make sure you work with a law firm that has built its reputation on a record of proven results.
Act Quickly On Your Bad Faith Insurance Claim
Fight back over unfair claims settlement practices. In Kentucky, it is an unfair claims settlement practice for any person to commit or perform any of the following acts or omissions:
- Misrepresenting pertinent facts or insurance policy provisions relating to coverage at issue
- Failing to acknowledge and act reasonably promptly upon communications with respect to claims arising under insurance policies
- Failing to adopt and implement reasonable standards for the prompt investigation of claims arising under insurance policies
- Refusing to pay claims without conducting a reasonable investigation based upon all available information
- Failing to affirm or deny coverage of claims within a reasonable time after proof of loss statements has been completed
- Not attempting in good faith to effectuate prompt, fair and equitable settlements of claims in which liability has become reasonably clear
- Compelling insureds to institute litigation to recover amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered in actions brought by such insureds
- Attempting to settle a claim for less than the amount to which a reasonable man would have believed he was entitled by reference to written or printed advertising material accompanying or made part of an application
- Attempting to settle claims on the basis of an application that was altered without notice to, or knowledge or consent of the insured
- Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which the payments are being made
- Making known to insureds or claimants a policy of appealing from arbitration awards in favor of insureds or claimants for the purpose of compelling them to accept settlements or compromises less than the amount awarded in arbitration
- Delaying the investigation or payment of claims by requiring an insured, claimant or the physician of either to submit a preliminary claim report and then requiring the subsequent submission of formal proof of loss forms, both of which submissions contain substantially the same information
- Failing to promptly settle claims, where liability has become reasonably clear, under one (1) portion of the insurance policy coverage to influence settlements under other portions of the insurance policy coverage
- Failing to promptly provide a reasonable explanation of the basis in the insurance policy in relation to the facts or applicable law for denial of a claim or for the offer of a compromise settlement
- Failing to comply with the decision of an independent review entity to provide coverage for a covered person as a result of an external review in accordance with KRS 304.17A-621, 304.17A-623, and 304.17A-625
- Knowingly and willfully failing to comply with the provisions of KRS 304.17A-714 when collecting claim over-payments from providers
- Knowingly and willfully failing to comply with the provisions of KRS 304.17A-708 on the resolution of payment errors and retroactive denial of claims
Failure to follow the Unfair Claims Settlement Practices Act is a violation of the law, and a bad faith insurance lawyer can help you fight the insurance companies.
Waiting to file your bad faith insurance claim just gives more time to the insurance companies to build their case against paying you the benefits you are owed.
If you even suspect that you may be a victim of bad faith insurance and may need a bad faith insurance lawyer, contact us at The Law Office of Christopher Jackson for a free case review. We will discuss your case for no charge and let you know the next steps. Call us at 859-261-1111 or at 888-811-3247 (toll-free) or email the firm to schedule a free consultation
PIP Insurance Information
No-Fault PIP in Kentucky
Recovering from life-threatening injuries after a bad car wreck is difficult enough without worrying whether your personal injury protection (PIP) coverage is going to cover the medical bills. Through this no-fault benefit covers treatment right after an accident, it is quite limited.
At the Law Office of Christopher Jackson, we can work to help ensure you receive your PIP coverage as well as pursue other avenues for compensation that can assist with high medical expenses. Let us handle the paperwork, so you can focus on what is most important: your recovery.
What Is PIP?
In automobile collision cases, Kentucky is a no-fault insurance state requiring every automobile insurer to provide minimum no-fault insurance benefits of $10,000 per person to cover medical expenses and/or wage loss. These benefits are also known as basic reparations benefits (BRBs) or personal injury protection (PIP) benefits. Most lawyers who regularly handle these cases call it PIP.
Statute of Limitations for Automobile Collisions Occurring In
The statute of limitations in Kentucky for an automobile collision is two years from the date of the accident. KRS 304.39-230(6). However, if PIP benefits are paid, then the statute of limitations is extended to two years after each PIP insurance payment. KRS 304.39-230(6). So, each time your PIP insurance carrier makes a payment, the two-year “clock” starts over for purposes of the statute of limitations.
There are a few caveats. First, the “clock” starts to run upon issuance of the PIP insurance payment, not the date your medical provider cashes the check. Wilder v. Noonchester, 113 S.W.3d 189 (Ky. App. 2003). Second, payments made under your medical payments coverage (example, Kentucky Farm Bureau typically includes Med-Pay on their policies and issues payment from that coverage after PIP is exhausted) are not the equivalent of a PIP insurance payment and does not extend the statute of limitations. Lawson v. Hilton Sanitation, Inc., 34 S.W.3d 52 (Ky. 2000). Lastly, PIP insurance payments and the MVRA do not extend the basic two-year statute of limitations for property damage claims. American Premier Ins. Co. v. McBride, 159 S.W.3d 342 (Ky. App. 2004).
Statute Of Limitations For Commencing An Action For (Or
Collecting) PIP Insurance Benefits
KRS 304.39-230(1) provides that an action for PIP insurance benefits must be commenced no later than two years after you suffer the loss (i.e., incur medical bills and lost wages) and either knows/should have known that the loss was caused by the accident, or not later than four years after the accident, whichever is earlier. Meaning, the statute of limitations for purposes of collecting PIP insurance runs from the date of the medical treatment, not the car wreck. So, if you waited more than two years after the accident, a claim for PIP insurance benefits can be presented for the first time up to four years after the accident. However, you may only collect bills incurred within two years of your first claim; in other words, there is a two-year “look-back” period. Therefore, medical bills incurred more than two years before the suit for PIP insurance benefits cannot be collected. The Kentucky Court of Appeals addressed this issue in State Auto v. Lane, 697 S.W.2d 167, 169 (Ky. App. 1985), stating “recovery may be had (PIP insurance benefits) for prior losses only if they accrued within two years before suit is filed.”
KRS 304.39-230(1) also states that an action for additional PIP insurance benefits must be commenced not later than two years after the last PIP payment. Such an action for further benefits is timely commenced when a request has been made within two years of the last PIP payment, even though the requested payment was not made until after the two-year window. Moore v. Gross, 2006-CA-2039 (unpublished opinion).
This begs the question as to whether you can revive an action against a tortfeasor if the suit was not filed within two years of the accident and no PIP benefits were ever paid, but a PIP claim is opened and benefits are paid within four years of the accident pursuant to KRS 304.39-230(1).
Which Automobile Carrier Pays PIP?
The client is a passenger: If you are a passenger in a car, then the owner’s insurance has to pay your PIP benefits. KRS 304.39-050(1). If the owner does not have PIP, then any other PIP insurance policy under which you are an insured applies. KRS 304.39-050(2). So, if the owner doesn’t have insurance and you have your own policy, then your insurance policy will provide the PIP benefits. If you do not have insurance, then you file a claim through the Kentucky Assigned Claims Plan. KRS 304.39-160.
The client is pedestrian: If you are a pedestrian, then the insurance company for the car that struck you owes the PIP insurance benefits. KRS 304.39-050(1). Same as above, if the striking car doesn’t have insurance, then your insurance policy will provide the PIP benefits.
What Happens To The PIP Lien If The Tortfeasor’s Liability
Limits Are Exhausted?
In cases where you collect the entire liability limits from the tortfeasor’s automobile carrier, the PIP lien is automatically extinguished. The MVRA gives priority to recovery to the injured person over the PIP insurance carrier. KRS 304.39-070(4) read together with KRS 304.39-140(3). See also State Auto Mut. Ins. Co. v. Empire Fire & Marine Ins. Co., 808 S.W.2d 805 (Ky. 1991).
Out-Of-State Clients Injured In Kentucky
If you live in another state but were injured in Kentucky, then you are entitled to collect PIP insurance
benefits. KRS 304.39-030(1).
As recently as 2007, the Kentucky Court of Appeals succinctly stated the general rule that “out-of-state insurance companies [that do not do business in Kentucky] are not required to comply with Kentucky no-fault requirements for their insureds who are not Kentucky residents but who are involved in motor vehicle accidents in Kentucky.” Stephenson v. State Farm, 217 S.E. 3d 878 (Ky. App. 2007) citing State Farm Mut. Auto Ins. Co. v. Tennessee Farmers Mut. Ins. Co., 785 S.W.2d 520 (Ky. App. 1990). The court went on to explain that only out-of-state insurance companies that are registered to do business in Kentucky are required to pay PIP insurance benefits to insureds residing out of the state who are involved in an automobile accident in Kentucky. Stephenson at 880.
If your out-of-state automobile carrier does not do business in Kentucky, then your client must collect PIP insurance benefits through the Kentucky Assigned Claims Plan. KRS 304.39-160. The required forms can be found on the Kentucky Department of Insurance website located at http://insurance.ky.gov/PPC/static_info.aspx?static_id=24&Div_id=15
Directing PIP Payments
You can direct the PIP insurance carrier on how to use your PIP insurance benefits, such as reserving them for lost wages or designating which medical providers to pay first. However, this must be done in writing. KRS 304.39-241. In more serious cases, you should direct PIP insurance to pay wages and medical bills. Use your health insurance to process all medical bills, and use PIP insurance for copays, deductibles, and noncovered items. Later, we can negotiate a reduction on the subrogation health insurance lien. Another option is to send the PIP carrier $10,000 worth of unpaid medical bills and direct the PIP insurance carrier to send you the entire PIP insurance benefits made payable to you and your client. Then, you can deposit the $10,000 in PIP insurance benefits in our escrow account, which you can hold to cover the above items and use to negotiate any health insurance subrogation claim.
Injured Party Does Not Control PIP’s Subrogation Claim
You do not have control over PIP’s subrogation claim and, therefore, cannot extinguish this claim by signing a release. Likewise, the signing of a release does not affect your right to collect future PIP insurance benefits (assuming PIP insurance benefits remain). See Ohio Casualty v. Ruschell, 834 S.W.2d 166 (Ky. 1992) and Holzhauser v. West American, 772 S.W.2d 650 (Ky. App. 1989).
Motorcycles And PIP
PIP insurance is available for motorcycles, but it is an optional coverage that must be separately purchased. Your automobile PIP insurance will not cover injuries on a motorcycle. KRS 304.39-040(4). This provision applies to both operators and passengers of motorcycles.
Injured Plaintiff Is Uninsured
If you were uninsured at the time of injury, then you cannot recover PIP
insurance benefits, nor can you bring a direct tort claim for damages that fit
within the definition of “basic reparations benefits.” KRS 304.39.310(2) & Bartlett v. Prime Ins. Syndicate, 156 S.W.3d 299 (Ky. App. 2004).
PIP Insurance & Work Loss Benefits For Plaintiffs Unemployed
On Date Of The Accident
If you are unemployed at the time of an automobile accident but are offered a job after that accident that you cannot fulfill (or accept) because of a physician’s advice, then you can collect work loss benefits under PIP. Foster v. Kentucky Farm Bureau Mut. Ins. Co., 189 S.W.3d 553 (Ky. 2006)
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Insurance Company’s Lawyer Tactics
Insurance Companies Tactics to Delay or Devalue your Claim
Within the current insurance system, they use insurance company tactics to minimize their risk. A minor injury to soft tissue (M.I.S.T.) resulting from a car accident is often looked over as a legitimate claim. One insurance tactic relies on it being hard to prove pain or injury.
While out of pocket costs for medical treatment are typically easy to prove, verifying pain and suffering presents a greater challenge. Since damages for pain and suffering requires a subjective evaluation by the victim, insurance companies exploit the potential for inadequacies that can result from such evidence. This often prevents policyholders from getting the compensation they deserve, simply because their injuries go beyond a single instance of provable trauma.
Even without this implied scrutiny policyholders must face yet another hurdle, Colossus, a computer program that functions as an insurance company’s primary means of analysis. Colossus removes human empathy and understanding from the equation by relying entirely on categorical numerical input.
Therefore, claims that require adjustments for stress, pain, inconvenience, loss of enjoyment of life, or loss of consortium cannot be calculated by this computer data-driven system.
Among insurance tactics, one factor that often incites questioning and additional attempts at a reduction is when damages to the car are disproportionate to the injuries endured by the victim.
Insurance providers operate from the perspective that if damage to the car is minimal, resulting in human injury must also be minimal. Because of this ideology assertion of pain and suffering that is not entirely authenticated by medical documentation are often refuted and questioned.
The scientific community confirmed this in a study published in the Journal of Clinical Epidemiology in 2001 entitled The Association Between Exposure to a Rear-End Collision and Future Health Complaints, which revealed that whiplash injuries can have a substantial impact on health effects long after the collision, and that car damage is not always an indication of potential for physical injury.
In spite of these findings, Colossus continues to be utilized by insurance companies.
Insurance Tactics to Limit or Deny Claims
- Induce the injured party to agree to a recorded statement and coerce you into saying something that could be used as evidence to reduce your claim.
- Persuade you to take a very low initial offer in order to fast-track your settlement.
- Challenge the extent of liability for the accident by rendering you at fault. (Comparative Negligence: Reduction in damages equivalent to % of your fault)
- Challenge causation and attribute pain to pre-existing injuries.
- Challenge the impact and severity of your injury by asserting that costs were not mitigated due to inaction from the victim.
Don’t fall victim to these lucrative tactics utilized by insurance companies and let the Law Offices of Christopher Jackson assist you in getting the compensation you deserve. Call us at 859-261-1111.
Fighting Your Insurance Company
There are times when you have to fight the insurance company. Insurance companies have an obligation to act in good faith when dealing with those who make a claim.
On Your Side When The Insurance Company Isn’t
Bad faith insurance is not just about getting denied for a claim you feel you were entitled to receive, it is about being treated in a grossly unfair and irresponsible manner. It is about companies that deny claims for no good reason at all and that act in an unfair manner.
Few people who have a claim denied are able to prove that the insurance company acted in bad faith, but those who can be able to pursue large awards for damages. At Law Offices of Christopher Jackson in Covington, Kentucky, our attorneys fight to pursue the compensation you are owed when you have been mistreated by an insurance company.
The Experience to Fight The Insurance Company
Insurance companies large and small have extensive resources to protect their interests, but when they act from a bad faith position it is important to understand that the law is ultimately on the side of the victim. Fighting insurance companies acting in bad faith without the experience of a legal professional is incredibly difficult and can seriously impact the results you get.
Our lawyer can help you take control of the situation and fight your insurance company, fighting back when an insurance company acts against you in bad faith is your right. We can review your claim and take action on issues involving:
• Denied coverage
• Unreasonable delays
• Underpayment of claims
• Failures to defend
If you believe an insurance company has acted against you in an aggressively unreasonable manner, then you may have an insurance bad faith claim. When your results matter, make sure you work with a law firm that has built its reputation on a record of proven results helping clients in Ohio and Kentucky.
Fight Back your Insurance Company Now!
The longer you wait to react against insurance companies acting in bad faith, the more time insurance companies have to build their case against paying you the benefits you are owed. If you even suspect that you may be a victim of bad faith insurance, go ahead and contact our experienced Ohio and Kentucky litigator for a free case review.
Let’s get started today.