Top 3 Reasons Why Your Insurance Claim Got Denied

Apr 15, 2019 | Insurance Information

You thought you had the right of way in that intersection, but apparently, the owner of the pickup truck in the other lane disagreed, and now your small sedan has been totaled and medical bills are stacking up. This frightening event has left you injured and with a totaled vehicle. You documented your injuries and the vehicle damage and filed a claim with the other driver’s insurance.

You’re sure you were obeying all traffic laws and fully documented what you needed for your claim, or so you thought. Now, the other party’s insurance has inexplicably denied your claim. Do you have any recourse?

An Overview of Reasons Your Claim Might Have Been Denied

There are lots of reasons for a claim to be denied. Most claim denials fall into two basic categories: the insurer genuinely believes that your claim doesn’t have any merit, or the insurer is banking on the fact that you’ll get discouraged and won’t pursue a settlement. If there’s no official police report, the insurer might also find that some evidence, like other witness accounts and the account of their client, conflict with your version of the events that led to the accident.

Here are a few other reasons a claim might be denied:

Exclusions in the Policy

All policies have exclusions to coverage. If the insurance company believes that one of the policy exclusions is the actual cause of the accident, or that it influenced the situation to the extent that their client is not actually at fault, your claim will be denied.

Lapsed Policy

Sometimes people get behind on their insurance policy payments. If the other motorist did not pay the insurance premium, the insurance company can argue that the motorist was not covered at the time of the accident. If so, you’ll need to make a claim with your own insurance company under the uninsured motorist coverage or file a lawsuit against the motorist.

Failure to Notify Insurer in Time

There are all sorts of time limits involved in filing claims, including the limits on how soon an accident needs to be reported and how fast the claims need to be filed. If you have fallen outside of these time limits, your claim may be denied on that basis.

Next Steps: After the Other Party’s Insurance Denies Your Claim

If your claim has been denied, the very first thing you need to do—if you haven’t already—is contact a lawyer that specializes in auto accidents. Insurance companies will be consulting their own legal team to obstruct you at every turn. You need someone who understands these tactics and strategies and is on your side. Often, you can have a free or low-cost initial consultation with an attorney to determine if you have a claim.

There’s another reason to hire an attorney: Insurance companies are more likely to resolve the case if you have your own lawyer because they know that you can drag out the process more effectively with your own legal representation. They’re well aware that claimants without lawyers give up more easily.

Send a Demand Letter

One of the first things your attorney will do is send the insurance company a demand letter. A demand letter is a formal request for compensation that includes:

  • Details of the accident/incident
  • Property damage being claimed
  • Personal injuries
  • The reasons proving that the insurance company’s driver caused the accident
  • An amount to settle your claim

The insurance company may ignore the letter or deny your claim, but more often, they will make a counter settlement offer (usually some portion of the damages you’ve requested).

Make a Formal Appeal

Most insurance companies have a formal appeals process. Your attorney will be able to use this process to open up new opportunities for negotiation. Arbitration and mediation are often part of this process and provide an unbiased neutral party to review the facts and damages and offer an opinion on the merits of your claim.

While not all insurance companies want to provide a formal appeals process, they may be legally required to in your state—New Hampshire, for example, requires all insurers to facilitate a formal appeals process if they deny a claim.

When Should You File a Lawsuit?

If the insurance company denies your claim or does not offer you sufficient compensation for your damages, your option is to file a lawsuit. Talk to a lawyer before filing a lawsuit, however, because the process can be overwhelming. The attorney will know whether filing a lawsuit against the insurance company is likely to be fruitful. They can also help you determine whether the compensation you are likely to receive in the lawsuit justifies the cost of the litigation.

Get Legal Assistance

Any time you’re in a vehicular accident, it’s stressful, frightening, and expensive. That’s why we always recommend hiring experienced legal representation to protect your interests.