As soon as you get out of the car accident, the last thing on your mind is how much it will cost. We all know that car accidents can be very bad for both the person who gets hurt and the person who is at fault. This is why getting car insurance is often reiterated to us. Car insurance exists in order to help lower costs by covering most of the damages and expenses.
After a bad car accident, the next step is usually to file a claim with the insurance company of the person who caused the accident. Insurance companies typically settle the disputes as very few car accident cases go to trial. However, not everything goes the way we plan it. Sometimes, car accident claims can get denied.
Find out what to do if your car insurance claim is turned down and why claims are usually turned down. If you know why your claim was denied, you can take better steps when you file your car accident claim to make sure the process goes smoothly.
Get help from a San Luis Obispo personal injury lawyer who can not only represent you in accidents but also help you get the most money possible after an accident. You should get your quality of life back in the best way possible, and one of the best ways to do that is to get help from a lawyer.
Dealing with a denied car insurance claim can be extremely frustrating. After an accident, you likely expect your insurance company to cover the damages. But if they send you a denial letter instead, it can leave you stressed and confused on what to do next.
Don’t worry – you still have options if your auto insurer rejects your claim. While the process takes time and effort, you may be able to successfully appeal the decision.
In this comprehensive guide, I’ll walk you through exactly what to do step-by-step if your car insurance company denies your claim. Here’s what I’ll cover:
- What is a claim denial letter and why you may get one
- Common reasons for a denied auto insurance claim
- Your options for appealing a rejected claim
- Steps to take to dispute your insurance company’s decision
- How to strengthen your appeal case
- When you may need to involve an attorney
- What to do if your appeal is unsuccessful
Let’s get started!
What is a Claim Denial Letter?
After submitting a claim to your insurance provider, they investigate the details of your accident and damage. The claims adjuster then decides whether to approve or deny your claim based on their findings
If they determine your situation is not covered under your policy, the insurance company sends you an official letter explaining why they rejected your claim This is known as a claims denial letter
Just because you receive a denial does not necessarily mean you have no recourse. You have the right to appeal your insurance provider’s decision if you disagree with it. The first step is understanding why they denied your claim in the first place.
Common Reasons for a Denied Car Insurance Claim
There are a few key reasons your auto insurance company may reject your claim. Some top examples include:
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Lapsed policy – If you forgot to pay your premium and your coverage lapsed, your insurer can deny any claims that occur when you don’t have an active policy.
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Policy exclusions – Damage or situations that your policy specifically does not cover can lead to a rejected claim. For example, an accident caused by you without collision coverage.
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Insufficient coverage – If your liability limits are too low and don’t fully cover the damages, your insurer may only pay up to your policy maximum. Any amount above your limits can be denied.
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Uninsured motorist – If the at-fault driver is uninsured and you don’t carry this coverage yourself, your insurer may reject your claim.
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Other insurer denied claim – If the at-fault driver’s insurance company denies your 3rd party claim, your own insurer may then reject your 1st party claim as well.
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Pre-existing damage or condition – Damage that occurred before your policy started is not covered and can lead to a denial.
Carefully read your claims denial letter to fully understand the exact reason provided by your insurance company. This will help determine your next steps.
Your Options for Appealing a Denied Insurance Claim
Just because your claim was initially denied does not mean the process ends there. You have options, including:
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Request a review – Ask your insurance company to re-review your claim and provide additional information that supports approving your claim.
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File a formal appeal – Submit an official appeal request in writing disputing the denial and provide evidence to back up your case.
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Submit a complaint – File a complaint with your state insurance department if you believe your insurer acted in bad faith or wrongly denied your claim.
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Hire an attorney – Consider legal help to navigate the appeals process and compel the insurance company to reimburse your damages.
I’ll provide more details on how to pursue these options below.
Steps to Dispute Your Car Insurance Claim Denial
Follow these steps if you want to appeal your denied auto insurance claim:
Step 1: Review the Denial Letter
Carefully read through the entire denial letter from your insurance company. Make sure you understand all the reasons they provide for rejecting your claim. Look for any reference to specific policy language, exclusions, or investigation details.
If you’re not clear on any aspect of the denial, don’t hesitate to call your insurance company and ask for clarification. Document who you spoke with and what additional details they provided about the claim denial.
Step 2: Gather Documentation
Collect any evidence you have related to your accident and claim that helps demonstrate it should be covered:
- Police report
- Eyewitness statements
- Photographs
- Video footage
- Medical reports
- Repair estimates
- Receipts for expenses incurred
- Policy documents
- Anything else related to the accident/damages
Make copies of everything and keep the originals for your records. You’ll submit copies with your appeal.
Step 3: Draft Your Appeal Letter
Write a formal letter of appeal to your insurance provider. Include:
- Your policy number, claim number, and date of loss
- A summary of your accident/claim details
- A plain statement that you are appealing the denial of your claim
- Reasons why you disagree with the denial
- References to specific policy provisions that support your claim
- Copies of all supporting documentation & evidence
Stick to factual information. Avoid emotional language or assigning blame. Be clear and concise in explaining why you believe the claim should have been approved based on your policy and the facts of your situation.
Step 4: Submit Your Appeal
Send your appeal letter and documentation to the insurance company via certified mail. This provides proof of delivery in case the documents are lost. Keep a copy of everything for your records.
The insurer typically has 30-60 days to respond to your appeal. Continue paying your premiums on time so your coverage doesn’t lapse during the process.
Step 5: Follow Up if Needed
If you don’t receive a response after the stated timeline, follow up via phone and in writing. Reiterate that you are awaiting a response to your claim denial appeal.
If the insurance company upholds the denial, request a 2nd review if that option is available. Continue providing additional information and evidence that supports approval of your claim.
How to Strengthen Your Appeal Case
Your appeal letter is your chance to make arguments as to why your claim is valid and should have been approved. Some tips to help build a strong appeal case include:
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Quote relevant policy sections – Reference parts of your policy that specifically cover your type of loss. Use the insurer’s own words against them.
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Cite state insurance laws – Research your state’s regulations about claim handling and denial appeals. Quote the laws if the insurer violated any.
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Point out contradictory info – If the denial letter contradicts police reports or the insurer’s initial communications, highlight this.
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Dispute investigation facts – If you disagree with any of the insurer’s “findings”, refute them point-by-point with countering evidence.
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Demonstrate financial hardship – Explain how the claim denial has caused significant financial and personal hardship. Insurers may reconsider if a payout denial seems unfair.
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Request an impartial review – Ask for your claim to be reviewed by a different, unbiased adjuster without knowledge of the case.
The more compelling arguments and evidence you can provide, the better your chances of success.
When You May Need a Lawyer
You can proceed with the appeals process on your own. But consider involving an attorney if:
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Your claim was denied due to disputed liability or negligence.
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The claim is complex with many parties involved.
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There are large damages exceeding your policy limits.
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You believe the insurer acted in bad faith.
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Previous appeals have failed.
An experienced attorney can review your case and deal with the insurance company directly on your behalf. While hiring a lawyer costs money upfront, they may be able to successfully compel the insurer to reimburse your damages.
What to Do if Your Final Appeal is Denied
If you exhaust the appeals process and the insurance company upholds their denial, you have a few final options:
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Request arbitration – Some insurers have arbitration processes defined in their policies to settle unresolved disputes.
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File a lawsuit – Take legal action against the insurance company to recover your damages. The threat of a lawsuit alone may lead them to settle.
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Submit a complaint – File a formal complaint with your state insurance regulator about how the insurer handled your claim.
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Switch providers – Change to a new insurance company once your policy is up for renewal after such poor service.
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Accept the denial – If all else fails, you may need to cover the costs yourself if the damages are minor or find another liable party.
What Not to Do in Car Insurance Claims
Now that you know the most important things to keep an eye out for when filing a car accident claim, make a list of the things you should never do. When filing a claim, don’t say anything on tape or in writing until you fully understand the coverage. Also, don’t agree with the insurer’s estimate of your losses. Some insurers can lowball you in terms of estimator’s repairs.
Avoid signing releases and contracts until any legal advice is given to you. Talk to a personal injury lawyer in San Luis Obispo before signing any papers. You might find yourself caught up in an inadequate settlement. Avoid accepting checks with “final payment” on them until you are ready. Also, be mindful of time limits on your policy.
To keep track of time, you should call your lawyer if your claim hasn’t been settled 11 months after the claim was made. You could lose your right to sue if you ever plan on going to court.
Making claims on your car insurance can be hard, and there are a lot of terms that can be hard to understand. Get help from an experienced personal injury lawyer to avoid confusion and get the most money for your medical bills and even lost wages.
Car Insurance Claims: What You Have to Know
Before we talk about the main reasons why car accident claims are turned down, it’s important to know what they are. Accident victims file car insurance claims to help settle their claims for damages with an insurance company so that the case doesn’t have to go to court. Maintaining proper communication with insurance companies is essential when filing car insurance claims.
Upon getting into an accident, call your insurance agent and inform them of the incident. Make sure you know what your coverage is and write down everything your agent says. Remember to take pictures and save evidence from the accident scene. Since being honest is always the best policy and lying can get your claim turned down, be truthful when you talk about the accident and go over every detail.
It is important to understand the terms and conditions of your coverage. Know the difference between replacement coverage and depreciated or actual cash value. Replacement coverage requires you to replace the lost items prior to getting full reimbursement. Also, don’t forget to keep receipts for everything you buy related to your car accident claim until the final settlement.
What to Do if Your Car Insurance Claim Is Denied | Attorney911
FAQ
How do I deal with a rejected insurance claim?
How do I respond to a denied insurance claim?
What happens if an insurance claim gets denied?
How do I argue an auto insurance claim?
What should I do if my insurance claim is denied?
The stress of an accident or a home repair is bad enough without having to worry about a claim denial. In the event of a claim, remember to document everything, review your policy thoroughly and keep all your paperwork in order. Discover the most common reasons for your insurance claims get denied and what you may be able to do to fight back.
What if my car insurance claim is denied?
If your car insurance claim is denied, it’s probably because there’s legitimate doubt as to liability or damages. Or sometimes the insurance company just makes a mistake. But in limited instances, the insurance company might knowingly deny a valid claim. If this happens, it could constitute a bad faith insurance denial.
What should I do if my car accident claim is denied?
Provide medical records or police reports regarding a car accident so that a claims adjuster can reevaluate. Consider an external review. If the internal review process ends with the same conclusion—claim denied—and you suspect bad faith, you can make an external appeal, typically through your state insurance commissioner. Speak to an attorney.
What if my insurance company denies a claim?
If you do not agree with your insurer’s claim denial, you have the right to appeal the insurance company’s decision. If your insurance denies a claim, the reason for the denial will influence how you should go about the appeals process. Answer a few questions to see personalized rates from top carriers. Are you currently insured?