Medical malpractice insurance can be a lifesaver for physicians accused of malpractice. However, getting your insurance company to cover a claim can sometimes be challenging.
In this blog post, we will discuss why your insurance company might refuse to cover your claim and what you can do about it.
The reasons why an insurance company might refuse to cover a claim
When a doctor is sued for medical malpractice, their insurance company usually provides coverage. However, your company may refuse coverage if:
- There’s an allegation of fraud. If the insurance company says you misrepresented yourself or the scope of your practice, that could be a problem.
- The policy expressly excludes coverage for the type of claim made. For example, some policies exclude coverage for claims arising from cosmetic procedures.
- There’s an allegation of reckless behavior, gross negligence or deliberate malfeasance. Some policies will only cover you for mistakes made through ordinary negligence.
Before you take any legal action, it’s important to understand why your insurer denied your claim. If you believe the denial was unfair, your first step should be to contact the insurance company and ask for an explanation in writing.
If you’re still unsatisfied, you can file an appeal with the insurance company. This will allow you to present your case again and provide additional evidence or testimony.
If the appeal is unsuccessful, your next option is to file a civil lawsuit against the insurance company. This is a more complex process, but if successful, it could result in the insurance company paying out your claim plus damages.