When an insurance company denies your car accident claim, it can cause an array of emotions, from confusion to anger to contemplating their audacity. Fortunately, having an insurance claim denied isn't always the final outcome. You may have a legal right to appeal depending on your state's statute of limitations and the insurer’s reason for denying your claim. Schedule a free case evaluation with a car accident lawyer to explore your legal options.
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What to Do After an Insurance Company Denies Your Car Accident Claim
After an insurance company denies your car accident claim, you'll want to understand their reason and determine possibilities for appeal. You'll start by carefully reviewing your claim denial letter before gathering any missing documentation and consulting a car accident attorney.
Review Your Claim Denial Letter
The insurance company will send you a claim denial letter to inform you of their decision. The letter will outline the specific details of why your claim was denied. Review your letter, noting references to policy terms and exclusions. Comprehending why an insurer denies your claim is critical for understanding how to handle the appeal effectively.
Gather Relevant Documentation
Reviewing your claim denial letter may provide insight into further documentation needed for your appeal. Strong evidence is the foundation for getting claim approval. Relevant evidence you should gather includes:
- Police reports
- Witness statements
- Vehicle and property repair estimates or receipts
- Photos of your injuries and accident scene
- Medical records and bills
If you hire a car accident lawyer, they do much of the gathering on your behalf. You may sign a medical record release regarding your injuries and treatment, which they can obtain from your provider. They will also collect further evidence to cement liability, such as video evidence of the accident from traffic cameras, dashcams, witness cell phones, and security footage from residential and commercial buildings.
Consult a Car Accident Attorney
You should speak to a car accident lawyer to discuss the merit and strategy for your appeal. They will happily review and clarify if you want or need further understanding of your claim denial letter. Once an attorney determines why your claim was denied, they can prepare your appeal based on their discovery.
Reasons an Insurance Company Denies Claims
There are several legitimate reasons insurance companies deny claims and many illegitimate reasons to counter. Common reasons for car accident claim denials include incomplete or inaccurate information, lack of documentation, pre-existing conditions, lapsed policies, insufficient coverage, and policy exclusions. Issues arise when claims involve uninsured motorists, liability disputes, or when an insurance company implements bad faith tactics.
Incomplete or Inaccurate Information
For the claims process to run smoothly, forms must be filled out meticulously without error. If information is missing or inaccurate, insurance companies will deny claims. This can be frustrating because it slows the claims process down. However, missing information is not a viable reason to deny a claim entirely. These cases can easily be appealed with the help of an experienced attorney.
Lack of Documentation
Insurers require detailed documentation of accidents, injuries, and damages—including police reports, witness statements, photographic and video evidence, and medical records. Insufficient or improper documentation of evidence supporting your car accident claim can be another reason for denial.
Lack of Medical Documentation
Lack of medical documentation is a significant factor in car accident claim denials. If you do not go to the doctor for injuries, there is no way to prove you sustained them. Insurance companies will review medical documentation and question things such as:
- Why didn't you take an ambulance from the scene of the accident?
- Why did you have minimal complaints immediately following the accident that have evolved into significant ones? What changed?
- Why did you miss several doctor and rehabilitation appointments?
- Why are there apparent gaps in your medical treatment?
Missing treatment appointments, especially several, does not bode well with liable insurers. It gives the appearance of feeling recovered enough not to need medical care. However, there may be legitimate reasons for not taking an ambulance and changing your complaints as time progresses.
There are several injuries commonly associated with car accidents that can take days and even weeks to present symptoms. Often delayed injuries include whiplash, concussions, traumatic brain injuries, spinal cord injuries, and psychological trauma such as post-traumatic stress disorder (PTSD).
Your lawyer can ensure you have proper documentation of your treatment for your appeal. They may also have referrals to healthcare providers who can examine and document your injuries. These medical professionals work with car accident victims through their recovery, knowing they won’t be paid until the accident case settles. These arrangements take the pressure of medical bills off of injured parties so that they can focus on their recovery and health without the overwhelming weight of debt.
Pre-Existing Medical Conditions
Alternatively, insurance companies with access to your medical records may scrutinize them for prior accidents, illnesses, and injuries that they can dismiss as being responsible for current symptoms. You are not obligated to release your complete medical history to insurers. A car accident attorney will advise you not to and will fight to ensure they only access records relevant to your injury to avoid this cause for claim denials.
Policy Exclusions
Insurance companies write many exclusions into their policies, requiring a sincere understanding of coverage. Your claim will be denied if your car accident falls under one of these exclusions, such as using your vehicle for commercial purposes or driving while under the influence.
Lapsed Policies and Insufficient Coverage
Your or an at-fault driver's policy may lack sufficient coverage for certain accident types or damages. Lapsed policies are a problem. The company is no longer liable if the at-fault driver's insurance policy lapses because they've officially uninsured the at-fault motorist.
Uninsured or Underinsured Motorists
Your car accident claim can be denied if you are involved in car accidents with uninsured or underinsured drivers and lack uninsured or underinsured (UM/UIM) coverage. UM/UIM is optional in many states. If you do not have UM/UIM coverage, your lawyer can explore other avenues, including personal injury protection (PIP)—provided you carry it—to recover your losses.
Liability Disputes
Liability disputes are a primary reason why insurance companies deny insurance claims. If the insurer believes you are at fault for the collision, they will deny your accident claim. In cases involving multiple-vehicle collisions or multiple liable parties, they may deny liability by placing the blame onto other insurers responsible for the crash.
Bad Faith Tactics
Unfortunately, many claimants experience claim denials due to an insurance company's bad faith practices. Bad faith tactics are actions taken by insurers to delay or deny claims or offer undervalued settlements. Typical examples of bad faith practices are as follows:
- Unreasonably delaying car accident claims
- Denying valid car accident claims
- Refusing to pay claims without conducting an investigation
- Failing to settle claims promptly when liability is clear
- Altering company records
- Misplacing claim file documents
- Accusing claimants of being uncooperative because they hired a lawyer
- Misrepresenting facts and insurance policy provisions relating to coverages
- Making endless requests for unnecessary documentation and paperwork
- Making threatening or intimidating statements to claimants
- Failing to acknowledge and act promptly concerning communications about claims
If you are a victim of bad-faith insurance practices, you can file a complaint with your state's insurance administration and file an additional insurance claim. Speak to a car accident attorney to explain the circumstances surrounding your experience with bad-faith insurance practices. They can report it to the proper authorities and file your bad-faith practice insurance claim.
How Car Accident Lawyers Help With Insurance Claim Denials
The insurance appeals process can involve many challenges and be tough to win without a lawyer. Car accident attorneys lend their extensive knowledge of law and experience with insurance claims and the legal system to secure financial compensation on your behalf.
Their services include identifying the issue, strategizing your appeal, communicating with insurers, building a strong case, valuing your claim, negotiating a settlement, and representing you in court.
Identifying the Issue and Strategizing Your Appeal
Bring your review letter to your free case evaluation. Your potential car accident attorney will identify the reason for denial and immediately begin strategizing your appeal if you choose to retain their services.
Communicating With the Insurance Company
An invaluable service and significant stress reducer, your lawyer will take over all communications with the insurance company. Having them handle communications protects you from them pressuring or harassing you to settle too soon and for insufficient compensation for your claim. It also shields you from predatory bad-faith practices that some insurers resort to—to deny claims and minimize company losses.
Building a Strong Case
To build a strong case, you need a foundation of solid evidence. Your car accident attorney will build your case by completing the following:
- Gathering Evidence: Evidence is the center of your case. Your lawyer will gather police reports, photos documenting your accident scene and injuries, video footage of your collision, relevant vehicle debris, weather, and road condition reports.
- Interviewing Witnesses: Witness testimony confirming the sequence of events and at-fault parties helps prove liability. Your attorney will interview witnesses to verify statements and gather new facts about your case.
- Reconstructing Accidents: Accident reconstruction is a scientific method that recreates accidents using mathematics, physics, and other scientific principles to pinpoint negligence. They can determine events leading up to the crash, the speed of all vehicles involved, the force of the collision, the angle of impact, and other factors that outline who is at fault in a car accident.
- Consulting Expert Witnesses: Expert testimony is critical after an insurance company denies your car accident claim. Lawyers may consult economists, vehicle safety experts, medical professionals, mental health specialists, and vocational and occupational therapists to establish liability, the extent of your injuries, and damages.
The length of your investigation depends primarily on the severity of your injuries, the length of treatment, and the amount and strength of the evidence in your case. Ask your attorney to clarify an anticipated timeline for your claim appeal. However, understand they can’t guarantee a definitive date.
Valuing Your Claim
The damages in your claim consist of economic or monetary losses and non-economic damages, known as pain and suffering. Your economic damages can be calculated by their paper trail and may include:
- Medical bills for emergency services, hospitalizations, evaluations and follow-up care, medical devices, physical therapy, rehabilitation services, mental health care, and future medical costs
- Income losses from missing work
- Vehicle-related damages, including repairs, replacement, rental car, and rideshare
- Property damages for any personal items destroyed in the collision
Your pain and suffering damages include chronic pain, sleep loss, decreased quality of life, loss of companionship and society, disability, and disfigurement. This is not an exhaustive list of damages. However, your attorney will thoroughly investigate all possible damages based on the specifics of your case.
Negotiating a Settlement
Once the insurance company receives the demand letter, they will counter with a lowball offer. It's standard practice and serves as a starting point for negotiations. You should never accept the first offer, and your lawyer will advise the same thing. Car accident attorneys are skilled negotiators who can confidently navigate multiple rounds of negotiations before securing a reasonable settlement.
Representing You in Court
Most insurance companies and car accident lawyers will do anything to avoid filing lawsuits and litigating car accidents. Lawsuits are time-consuming and can draw out the process. However, your lawyer may discuss filing a civil lawsuit when appeals are rejected or negotiations are at a standstill.
In that case, your car accident attorney will represent your car accident case in front of a judge and jury. While less common, when car accident cases go to trial, a jury may decide to award punitive damages. Punitive damages are rare and only punish defendants whose acts were particularly heinous.
Contact a Car Accident Attorney Today
Contact a car accident attorney if you need to know what you can do if an insurance company denies your car accident claim. They can provide better clarity after understanding the specifics of your case. They can determine if you have a shot at appealing and help recover compensation for your claim. Schedule a free case evaluation.