Find Answers to Your Questions Regarding an Insurance Claim Denial
If you’ve received an insurance claim denial letter after an auto accident, don’t panic. U.S. auto insurance claims are often denied immediately following a crash while the insurance company gathers evidence and conducts its own investigation into the circumstances surrounding the wreck. A claim denial doesn’t necessarily mean that you won’t get paid, and there are steps you can take to move the process along in your favor.
Here are answers to some commonly asked questions following an insurance claim denial, along with reasons an insurance company might deny a claim, and what you can do to try to reverse the decision.
What should I do if my car accident claim is denied?
Following a motor vehicle accident, you have a lot on your plate. You may be healing from catastrophic injuries, arranging for alternative transportation and looking for a new vehicle, or even grieving the loss of a family member. Receiving an insurance claim denial notice can feel like one more difficult thing you have to work through.
First, call the insurance company right away and ask why your claim was denied. Understanding the reason for the claim denial is the first step to knowing how to move forward to correct it. Be sure to take notes while you speak with the claim agent. Consider hiring a car accident attorney who can intervene on your behalf.
Why was my car insurance claim denied?
There are several reasons that an auto insurance company might deny an auto claim, including:
- The vehicle wasn’t covered by insurance at the time. Most states require drivers to purchase liability insurance to legally operate a vehicle. If the at-fault driver was uninsured or allowed their policy to lapse, your claim will be denied. Avoid this scenario by purchasing an uninsured or underinsured auto policy to protect yourself.
- The claim amount exceeds the limits allowed by the insurance policy. Your insurance policy covers up to a certain amount in medical bills, property damage, and other liabilities. Once a claim has reached that threshold, the insurance company is not required to continue to pay out.
- Additional evidence is needed to make a decision. The insurance company will conduct an independent investigation into the circumstances of the accident. It may look at police reports, accident reconstruction documents, photos, and medical records to determine how much the case is worth before accepting your claim.
- The driver isn’t covered under the terms of the policy. A licensed adult driver with the owner’s permission to operate their vehicle is covered in most states under the owner’s auto policy. However, an insurance company may refuse to cover damages caused by an unlicensed driver, a teen driver not on the policy, any driver under the influence of drugs or alcohol at the time of the accident, or in cases of vehicle theft.
- An investigation determines the damages aren’t covered by the policy. Providing false information or turning in claims for pre-existing damage can be grounds for an insurance company to deny a claim. Depending on the type of insurance policy you’re dealing with, damage involving animals, weather-related events, stationary structures, vandalism, or theft may not be covered. It’s important to read the terms of all insurance policies in your name so that you understand their limitations.
- Failure to report the accident immediately. Insurance companies can deny your claim if you don’t notify them of an accident within a reasonable timeframe.
Are some types of claims denied more often than others?
According to the National Association of Insurance Commissioners, which serves insurance regulators across the United States, denial of claims is the second-leading cause of consumer insurance complaints. While insurance companies are required to deliver on the products they sell, many are looking out for their bottom line. This can make getting paid a challenge, especially when a settlement is expected to be very large, as in the case of wrongful death.
Claims filed against your own insurance policy are typically approved more readily since the company has a contractual obligation to you. Third party claims, which are filed against another driver’s auto insurance policy, are more likely to be denied, especially if there are questions about which driver is at fault for the accident. A decision may be delayed or denied pending an investigation.
What is the next step after my auto insurance claim is denied?
In some cases, the insurance company cites a lack of evidence as the reason for denial. If so, you can submit additional evidence in support of your claim, including police reports, photos, repair estimates, and medical bills and records.
You may also choose to write a letter and file an appeal with the insurance company stating why you believe the denial should be reversed.
When should I involve an attorney in my auto insurance claim denial?
Insurance companies employ lawyers who are skilled at finding loopholes in policy language that allow them to deny a claim. It’s advantageous to have a legal team of your own to examine the policy in question and to advocate for your interests. Legal counsel is often the difference between receiving the settlement you deserve or walking away with nothing. Hiring an attorney is particularly important if the case goes to trial.
While the vast majority of car, bus, motorcycle, and truck accident cases will settle outside the courtroom, trial attorneys prepare for the possibility that they will need to fight in court for their clients. Hiring a personal injury attorney as soon as you receive an insurance claim denial letter allows them to examine your case from the very beginning so they can prepare for a potential trial.
Conclusion
There are a few things you can do to help ensure insurance coverage in the event of an accident:
- Avoid a lapse in auto insurance by paying your premiums on time
- Allow only individuals covered under the policy’s terms to drive your vehicle
- Report accidents to the insurance company immediately
- Consider upping the limits of your policy to adequately cover your assets
- Preserve evidence of any damages you plan to claim, including photos, medical records, and police reports
Even when you do everything right, an insurance company may still find a reason to deny your claim. Remember that an auto insurance claim denial is not a final decision and can be challenged in court.
Sources:
- Bankrate https://www.bankrate.com/insurance/car/insurance-claim-denied/
- U.S. News & World Report https://www.usnews.com/insurance/glossary/liability-car-insurance
- National Association of Insurance Commissioners (NAIC) https://content.naic.org/consumer/auto-insurance.htm
- National Association of Insurance Commissioners (NAIC) https://content.naic.org/cis_agg_reason.htm
- Progressive https://www.progressive.com/answers/third-party-claim/
