Occupational Accident Insurance Policies - Breach of Contract and Bad Faith

Has an Insurance Company denied your claim?

Many South Carolinians protect themselves and their loved ones by obtaining occupational insurance policies which represent that they will pay for medical costs and supplement income should you become injured. Unfortunately, many times these insurance companies refuse to follow through on their contractual obligations providing claimants with no compensation and no explanation for the denial of their claim.

In South Carolina, an insurance company has a duty of good faith and fair dealing. This duty includes an insurance company timely and fairly handling claims as well as providing a detailed and legitimate explanation for the denial of a claim. Failure to adequately communicate and pay claims in a timely manner can lead to the suspension of necessary medical treatment and can leave you in financial ruin. As a result, payment under the policy and damages resulting from the insurance company’s refusal to pay your claim may be recoverable.

Insurance policies, and specifically occupational insurance policies, can be tricky to navigate and understand. It is difficult to know whether there is coverage when there are some many endorsements, exclusions, and exceptions to exclusions that can make your head spin. However, when the language of the policy is ambiguous, as they often are, our courts have construed them in favor of coverage and the claimant. Further, our courts have held that it is bad faith on the part of an insurance company to misrepresent to an individual there is coverage, when in fact there is none.

Many occupational insurance policies have several layers of coverage, some of which are only triggered by the claimant’s ability to qualify as disabled. It is bad faith on the party of an insurance company to sell an individual a policy that they could never possibly qualify for. This misrepresentation only provides what is known as “illusory” coverage because in reality the policy covers little, if anything, that it claims.

Do you believe that you have had an occupational or other insurance claim that has been wrongfully denied? If so, Finkel Law Firm LLC can advise you of your rights and potential claims against your insurance company. Please do not hesitate to contact us to schedule a consultation.