Getting into a car accident can be scary and stressful enough on its own. The last thing you want to deal with is your car insurance company denying your claim. Unfortunately, denied claims are fairly common, as insurance companies look for reasons not to pay out. If your auto claim gets rejected, don’t panic. You still have options to fight the denial and get the compensation you deserve.
This comprehensive guide covers:
- Common reasons car insurance claims get denied
- Step-by-step instructions for appealing a denied claim
- Hiring an attorney to dispute a rejected claim
- Key strategies for overturning a denial
- Getting your car insurance company to re-evaluate
- Understanding your options if the appeal fails
Arm yourself with the right information to stand up to the insurance company if they wrongly deny your claim. With persistence and evidence on your side, you can successfully appeal the decision.
Common Reasons Car Insurance Claims Get Denied
Insurers will dig for any excuse to avoid paying out on a claim. Here are some of the most frequent reasons auto claims get denied:
Lack of coverage – Your policy didn’t include collision, comprehensive, or enough liability coverage for the damages.
Policy lapse – There was a gap in coverage due to missed premium payments.
Excluded driver – The policyholder let an excluded or unlisted driver operate the vehicle.
DUI or criminal activity – The accident occurred when the driver was under the influence or committing a crime.
Lack of cooperation – You did not provide requested claim documentation in a timely manner.
Pre-existing damage – The damages claimed existed prior to the accident.
Misrepresentation – The insurance company suspects fraud or false information was provided.
Disputed fault – The insurer disagrees with your version of who caused the accident.
Don’t get discouraged if you receive a denial letter. This is just the first step in appealing the decision.
Step 1 – Review the Denial Letter Thoroughly
The first thing to do upon receiving a claim denial letter is to review it very closely. The letter will outline exactly why the insurance company is rejecting your claim.
Look for specifics like lack of certain coverage, failure to provide documentation, disputed facts about the accident, or anything showing the damages aren’t covered. Understanding the exact reason for denial will help you gather the right documents and evidence to appeal the adjuster’s decision.
Make sure to note the date by which you must appeal the denial, which is usually specified in the letter. Missing this deadline could cause you to forfeit your right to fight the decision.
Step 2 – Review Your Policy and Coverages
Now that you know why your claim was denied, closely review your policy documents. This includes your policy declarations page, your coverage limits, exclusions, and any endorsements.
Compare the policy language against the denial reason given by the insurance company. For example, if they said damages weren’t covered, check your collision coverage limit and deductible. If they disputed who was at fault or whether someone else was driving, check the authorized driver and liability sections.
Identifying a discrepancy between your coverage and the claim denial is the key piece of evidence you’ll need to appeal.
Step 3 – File a Formal Written Appeal
With evidence of a wrongful denial in hand, you’ll want to file a formal appeal. This is typically done by submitting an appeals letter – make sure to do so by the deadline stated in the denial letter.
The appeal letter should:
- State you formally dispute the denial of your claim
- Specify the claim number, date of loss and policy number
- Outline exactly why the denial was unwarranted based on your policy coverages
- Include copies of any evidence supporting your argument
Having a clear paper trail is crucial to overturning the decision on appeal. Keep your letter factual, detailed and focused solely on disputing the denial reason cited by the insurer.
Step 4 – Hire a Car Accident Attorney
Appealing a wrongful denial is complex and insurance companies frequently reject the first appeal attempt. Hiring an experienced car accident attorney can give you the legal expertise needed to be successful.
A lawyer will be able to:
- Identify any bad faith in how the insurance company handled your claim
- Request additional evidence like accident reports from legal channels
- Determine if you have grounds for a lawsuit should the appeal fail
In many cases, a stern letter from an attorney succeeds in getting the claim denial overturned. Their expertise can make all the difference.
Strategies for Overturning a Denial
Here are some of the most effective strategies auto accident lawyers use to fight claim denials:
Prove you had the right coverage – Demonstrate your policy declarations, limits and deductibles clearly covered the type of damage you claimed.
Dispute facts of the accident – If the insurer disputes who caused the accident, provide alternate evidence like eyewitness statements or accident reconstruction data.
Prove damages – Make sure you have detailed estimates, repair invoices and inspection reports documenting the full extent of damages.
Show breach of contract – Illustrate how denial of your covered claim represents a breach of the insurance policy contract.
Point out red flags – Note any mistakes in the claims process, unusually quick denial, ignored evidence or denial without proper investigation.
Send demand letter – Have your attorney send a letter detailing grounds for bad faith and demanding the claim denial be overturned.
With the right evidence and legal arguments, you can poke holes in the insurer’s reasoning for rejecting your claim.
Getting the Insurance Company to Re-Evaluate
If you’ve exhausted the formal appeals process and continue to be denied, there are still some options to get the insurance company to re-open or re-evaluate your claim:
File a complaint – You can file a complaint against the insurer with your state’s Department of Insurance andFinancial Services to have them investigate.
Pursue mediation – Request mediation to resolve the claim denial – this may lead the insurer to become more reasonable.
Initiate litigation – As a last resort, taking legal action through an auto accident lawyer opens the claim up to the court system.
Request a supervisor review – Ask to have a supervisor or manager at the insurance company review your denial.
Consult an attorney – Have a lawyer review your case and send a demand letter insisting on further review.
Bringing greater scrutiny to the improper denial through complaints, litigation or regulatory bodies often succeeds in getting claims paid out.
Options If Your Final Appeal is Denied
If you’ve gone through the full appeals and review process and your car insurance claim continues to get denied, all hope isn’t lost. Here are your options at that point:
File a claim through your own policy – If the at-fault driver’s insurer won’t pay, submit a collision or UMPD claim with your insurer.
Explore bad faith claim – Consult with an attorney to determine if you can recover damages from the insurer for acting in bad faith.
Negotiate a settlement – The insurer may offer a settlement or compromise to close your claim and avoid legal action.
Pursue arbitration/mediation – You may be able to resolve your disputed claim through arbitration or mediation.
Take legal action – You can sue the insurance provider for breach of contract and wrongful denial of your rightful claim.
Even after an exhaustive appeals process, refusing to take no for an answer can result in getting your car accident claim paid.
The most important thing is not to give up if you truly believe the insurer wrongly denied your collision claim. Do your homework, lean on auto accident lawyers for advice, and persistently dispute the denial through every means possible.
Dealing with a denied car insurance claim is frustrating. But understanding the proper steps after receiving a denial letter can help you successfully appeal the decision:
Carefully review the denial letter and understand the exact reasons given.
Compare your actual policy coverages against the denial justification.
Formally dispute the denial through a written appeals letter.
Hire an auto accident attorney to provide legal expertise and demand proper payment.
Use effective strategies to prove the claim denial was unwarranted.
Exhaust all options to get your auto insurer to re-evaluate the wrongful denial.
With the right evidence and perseverance, you can ultimately get improperly denied car insurance claims overturned. An experienced attorney levels the playing field against the insurer’s team of lawyers. Don’t take no for an answer until you achieve a fair resolution.
What to Do if Your Car Insurance Claim Is Denied | Attorney911
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