How to Appeal a Denied Car Insurance Claim

Getting into a car accident can be stressful enough. But when your car insurance company denies your claim for compensation, it can feel like adding insult to injury. If your auto insurer rejects your claim, don’t give up right away. You have options to appeal the decision and get the benefits you deserve.

Appealing a denied car insurance claim takes some persistence and know-how. But by understanding the process and taking the right steps, you can successfully overturn the denial and get the payout you need to cover repairs, medical bills, and other losses from the accident.

Overview of Appealing a Car Insurance Claim

• You have the right to appeal if your car insurance claim gets denied. The standard auto policy includes an appeals process.

• There are several common reasons insurers reject claims, including lapsed coverage, undisclosed drivers, wording technicalities, and more.

• To appeal, notify your insurer and cite evidence that contradicts their denial. Provide documents, photos, statements, etc.

• If the internal appeal fails, you can file a complaint with your state insurance department.

• Consulting a consumer insurance attorney can significantly help your appeal chances.

• If appeals fail, you can file a lawsuit against the insurer to recover damages from the accident.

Top Reasons Car Insurance Claims Get Denied

In order to successfully appeal a denied claim, you need to understand why it was rejected in the first place. Here are some of the most common reasons auto insurers deny claims:

Coverage Lapsed at the Time of the Accident

For your insurer to cover damages, your policy needs to be active at the time of the loss. If your coverage lapsed due to non-payment, they can legally deny claims. Ensure you renew policies on time and there are no gaps.

Driver Who Caused Accident Wasn’t Listed

Standard auto policies only cover drivers specifically named on the policy. If an excluded driver wrecks your car, the insurer can reject a claim. List all household members who may drive your vehicles.

Dispute Over Who Was At Fault

Insurers will investigate who caused the accident. If they decide you were primarily at fault based on evidence, they can deny your claim. Provide proof the other party was liable.

Damage Falls Under Policy Exclusion

Every auto policy lists exclusions where the insurer won’t pay claims. For example, some exclude coverage if you use your car for ridesharing or delivery driving. Read exclusions closely.

Questionable Claim Details

If insurers suspect fraud or misrepresentation, they can reject the claim. Stick to the facts and avoid exaggeration when describing the accident to avoid this.

Pre-Existing Damage Claimed

Insurers won’t pay for damage your car already had before the accident in question. They may accuse you of claiming pre-existing damage. Prove the damage was new with photos, witnesses, etc.

Policy Limits Exceeded

If the total value of damages exceeds your coverage limits, the insurer only owes up to the limit amount. For example, just $25,000 for property damage. Applicable limits are listed on your policy.

Technical Policy Wording Not Met

Insurance policies have strict notification windows for reporting claims and specific claim filing procedures. Failing to follow the letter of these details can allow the insurer to deny a claim.

As you can see, insurers have multiple avenues to reject a claim. That’s why appealing the decision is so important to exercise your rights to the coverage you purchased.

Step-by-Step Guide to Appealing a Denied Insurance Claim

Follow these key steps when you need to appeal a car insurance claim denial:

1. Review the Denial Letter Carefully

Your insurer must send you a letter explaining exactly why they rejected your claim. Read this very closely to understand their reasoning. Look for any erroneous facts or opportunities to contradict their denial.

2. Gather Documentation

Collect evidence like accident photos, police reports, witness statements, receipts, and any documents that counter the insurer’s denial. Medical records can document injuries. Have documents ready to attach to your appeal.

3. File Your Appeal

Formally dispute the denial in writing within the time frame outlined in your policy. Provide all documents that show evidence the insurer is wrong to reject your claim. Cite relevant policy provisions that support your case.

4. Participate in the Appeal Process

The insurer may request additional recorded statements from you or re-inspect damaged property. Fully cooperate with these requests but avoid volunteering unnecessary new facts. Have an attorney review appeal documents.

5. Negotiate a Settlement

If the appeal succeeds, the insurer should make a fair settlement offer. Negotiate firmly for full compensation. Get help from a lawyer if the offer seems unreasonably low.

6. Take Additional Legal Action

If the internal appeal fails, file a complaint with your state insurance regulator documenting the improper denial. Consult a lawyer about suing the insurer or the at-fault driver.

Tips for a Successful Appeal

Follow these tips when disputing a car insurance claim denial to boost your chances of getting the insurer’s decision reversed:

• Act quickly – Start the appeals process as soon as possible. Most policies have short time limits.

• Send appeal letters certified mail – This documents the insurer received your dispute. Get receipts.

• Keep detailed records – Note all conversations and document exchanges. These can support bad faith allegations later if needed.

• Avoid delays – Respond promptly to all insurer requests for additional statements or documents.

• Consult an attorney – Having expert legal advice can really increase your odds of a successful appeal.

What Happens After a Failed Appeal?

If you exhaust the internal appeals process and the insurer upholds the denial of your claim, you still have options:

• File a complaint with your state insurance regulator documenting the improper denial.

• Consult a consumer insurance attorney about filing a lawsuit against the insurer alleging “bad faith” denial. You can sue for damages beyond the policy limits.

• Sue the at-fault driver directly for negligence to recover your accident-related costs. Their liability insurer would defend them in court.

• Rely on your own collision coverage (if purchased) or medical payments coverage to help pay for some accident expenses, minus your deductible amounts.

• Negotiate directly with the at-fault driver if damages are low. Have them voluntarily pay your expenses. Get any payment agreements in writing.

Don’t just give up if the insurer denies your appeal. A qualified attorney can assess your options and fight to get your car accident claim paid.

Why Hiring a Lawyer for Your Appeal Is a Smart Move

Appealing a denied insurance claim can feel like an uphill battle. Having an experienced personal injury lawyer on your side helps level the playing field. An attorney can provide valuable assistance including:

• Reviewing your policy to identify relevant provisions the insurer has breached.

• Collecting and presenting evidence and documents that support overturning the denial.

• Communicating urgent appeal deadlines and guiding you through insurance protocols.

• Drafting a compelling and compliant appeal letter citing applicable laws.

• Negotiating fair claim settlements within policy limits.

• Evaluating potential “bad faith” misconduct allegations against the insurer.

• Determining viable legal action if the appeal fails.

• Representing your interests in court if necessary.

Don’t let a denied claim derail your car accident recovery. An attorney understands insurance regulations and can fight to get your appeal approved.

Alternatives If the At-Fault Driver Has No Insurance

One worst-case scenario is getting in an accident caused by an uninsured driver. Without insurance to pay an injury or property damage claim, consider these options:

• File a claim through your own collision coverage and/or uninsured motorist coverage for injuries. This pays minus your deductible and policy limits.

• Sue the at-fault driver directly to obtain a court judgment ordering payment. But collecting can be difficult.

• Discuss a voluntary payment plan directly with the liable driver if damages are low and they take responsibility. Get payment agreements in writing.

• Seek compensation through your own health insurance or disability insurance if you have applicable coverage.

• For a severe injury, consult an attorney to investigate options like suing the driver, their employer, the vehicle owner, or other liable third parties.

• If you can’t recover significant losses any other way, ultimately you may need to cover repair bills and medical costs yourself.

Having insurance of your own is the best protection in these situations when another motorist causes damages but lacks adequate coverage.

Other Frequently Asked Questions

What is the time limit to appeal a claim denial?

Most auto policies require you to appeal a denied claim within 1 year from the date of loss. Some states may extend this to 2 years. Act immediately to preserve your appeal rights rather than waiting until the deadline.

Can I still get a rental car if my claim is denied?

Unfortunately, the insurer won’t pay for a rental car or other benefits like towing once they have denied your overall claim. You need to pay rental costs yourself or rely on transportation alternatives until the claim situation gets resolved.

What should I do if the insurer denies my claim after an accident with an uninsured driver?

File a claim through your own uninsured motorist bodily injury coverage and collision coverage if purchased. If damages exceed your limits or the insurer rejects your claim, consult a lawyer about taking legal action against the liable driver directly.

What happens if I accept the claim denial payout but later realize it wasn’t enough?

Accepting a claims settlement generally waives your right to seek additional compensation from the insurer. Think very carefully before accepting an amount you feel isn’t fair compensation for your total damages.

Can I sue the claims adjuster who denied my claim?

You cannot sue the individual adjuster. Your legal action options are suing the insurer for bad faith denial or suing the liable driver who caused the accident for negligence. Name the appropriate defendant in the lawsuit.

My claim was denied due to late reporting. What can I do?

Appeal the denial, explaining any extenuating circumstances for the reporting delay. Offer evidence that you gave prompt verbal notice even if filed paperwork late. Cite your past good claims history with the insurer.

Getting your car insurance company to overturn a wrongful denial and pay your rightful claim requires perseverance and a methodical approach. But with diligent appeals and legal help if needed, you can successfully win the compensation you deserve after an auto accident. Don’t take a denial at face value – fight back and get what you’re owed.