≡ Menu

What Happens If The Defendant’s Insurance Company Denies Coverage For My Injury?

The vast majority of New Orleans personal injury lawsuits involve the pursuit of damages through a defendant’s insurer. While the defendant named in the lawsuit may be the individual or entity that caused the injury, in most cases the defendant’s insurer has the greatest involvement, both financially and legally, in actually defending the case.

The responsibility of the insurance company to provide financial coverage for the conduct that led to an injury usually is clear and is usually not at issue in a personal injury lawsuit. Occasionally, however, an insurance company may claim that an injury resulted from actions by the defendant that were outside the scope of the insurance policy and, therefore, there is no coverage. While there is no bar to an injured party proceeding directly against the defendant regardless of insurance coverage, it is usually in the best interest of the injured person for the insurance company to be involved because of the additional financial resources available.

The laws surrounding when an insurance company may deny coverage are complex, and whether coverage legally should be available hinges on the specific facts of the case. Defendants who are denied coverage frequently will challenge that determination, as it is also in their interest to have the insurance coverage available. When determining whether the insurer is required to cover a defendant’s actions that led to injury, the courts will analyze the insurance policy. Under Louisiana law, this review generally must include a determination of the common intent of both the insurer and the insured and their reasonable expectations when enacting the policy. Where the language of the policy is clear, it must be construed as written. Where it is not, the policy, as a whole, must be considered in determining the meaning of any ambiguous language.

Insurance companies are allowed to impose limitations and conditions upon their liability. When there is a question regarding coverage, the court also may determine whether a limitation or condition set forth in the policy conflicts with Louisiana Law or public policy. If it does, it cannot be used to deny coverage.

If you have suffered a personal injury and have any questions regarding this topic, we can be reached at 504-581-6411 or 855-GERTLER.