Insurance companies deny coverage for any number of reasons. However,the fact that you have received a denial of your insurance your claim should not be the end of your fight. Insurance companies are often wrong in their assertions of no coverage,and there are several legal rules which may help your case.
One of the most powerful rules that can help people fighting an insurance company on coverage is the doctrine of ambiguity. Simply put if the language of the insurance policy is ambiguous it must be construed by a court in favor of the insured (the policy holder or beneficiary) rather than in the favor of the insurance company. The reasoning behind this rule arises from the fact that insurance companies use form contracts that they write and issue,so if a dispute is over their failure to make the contract clear then they are the ones who should bear that burden.
As a result of this rule many lawsuits over coverage focus on whether or not an ambiguity exists in the policy. Generally speaking a policy is ambiguous if there is doubt about its meaning,duplicity or uncertainty about the language as applied to the facts of the case. This rule has also been expressed as a contract that promises something in one section and then takes it away in another.
It is also possible that an ambiguity may arise from a document other than the actual contract language such as the application for coverage. The important thing to remember is that when your coverage claim is denied you do not have to accept the insurance company’s position. There are legal rules that help policy holders,which may apply in your particular circumstances. Consultation with an attorney regarding your particular situation may turn a denial into a recovery.