What if the Insurance Company Denies My Claim?

If you are involved in an incident where the negligence of another party results in injuries and other damages for you, you may be looking to obtain financial compensation. However, what can you do when the insurance company of the other party denies your claim? Though it may feel like hope is lost, you still have other options when it comes to filing a personal injury claim and holding alleged responsible parties accountable.

Table of Contents

What are the Common Reasons an Insurance Claim is Denied?

One of the first things to review after an insurance company denies your claim is the initial denial letter. Try to see what may have been the reason your claim was denied. It may be the insurance finds your claim allegations to lack merit. They may believe you will not pursue the matter any further. The insurance may also be relying on an eyewitness on behalf of the other party if there is no police report to examine. Other reasons why a claim may be denied include:

Policy Exclusions: The insurance policy may have specific exclusions that state certain types of accidents or damages are not covered. For example, if the policy explicitly excludes coverage for accidents that occur while the insured vehicle is being used for commercial purposes, a claim arising from such an accident could be denied.
Lack of Coverage: The policyholder may not have the necessary coverage for the specific type of claim being made. Different types of coverage, such as liability, collision, comprehensive, or uninsured/underinsured motorist coverage, have different claim requirements. If the policy doesn’t include the relevant coverage, the claim may be denied.
Failure to Pay Premiums: If the policyholder has not paid their insurance premiums and the policy has lapsed or been canceled, the insurance company may deny any claims made during that period of non-payment.
Policy Violations: If the policyholder violated the terms and conditions of the insurance policy, such as driving under the influence of alcohol or drugs, using the vehicle for illegal activities, or providing false information, the insurance company may deny the claim.
Late Reporting: It’s important to promptly report an accident to the insurance company. Delayed reporting could lead to a denial, as it may be difficult to investigate the claim properly or determine the extent of the damage.
Misrepresentation: If the policyholder provided false or misleading information when purchasing the policy or filing the claim, the insurance company may deny the claim based on misrepresentation.
Pre-existing Damage: If the insurance company determines that the damage being claimed existed prior to the accident, they may deny the claim.
Lack of Sufficient Evidence: If there is insufficient evidence to support the claim or if the evidence suggests that the accident did not occur as described, the insurance company may deny the claim.

What Should I Do If My Car Accident Claim Was Denied?

If your car accident claim is denied by an insurance company, here are some steps you can take:

Review the Denial Letter: Carefully review the denial letter from the insurance company. It should outline the specific reasons for the denial. Understanding the grounds for denial will help you determine your next course of action.
Understand Your Policy: Familiarize yourself with your insurance policy to ensure that the denial is consistent with the terms and coverage outlined in the policy. If you believe the denial is unjustified based on your policy, gather supporting documentation to back up your claim.
Contact the Insurance Company: Reach out to the insurance company to discuss the denial. Ask for a detailed explanation of the reasons behind the denial. This conversation may help clarify any misunderstandings and potentially resolve the issue.
Provide Additional Information: If you believe the denial is due to missing or incomplete information, provide any necessary documentation to support your claim. This could include accident reports, medical records, repair estimates, or any other relevant evidence.
Request Internal Review: Inquire about the insurance company’s internal review process. Many insurers have an appeals process that allows you to request a reconsideration of the denial. Submit a formal appeal, including any additional information or supporting evidence you have gathered.
Seek Legal Advice: If your attempts to resolve the issue directly with the insurance company are unsuccessful, or if you believe the denial is unfair or in violation of your policy, consult with a lawyer who specializes in insurance claims. They can provide legal advice and guide you through the dispute resolution process.
File a Complaint: If you believe the insurance company has acted in bad faith or violated insurance regulations, you can file a complaint with your state’s insurance regulatory agency. They will investigate the matter and potentially take action against the insurer if necessary.

Should I Consult an Attorney if My Insurance Claim is Denied?

If the other party’s insurance has denied your claim, the next step is to sit down with an expert personal injury attorney. A personal injury attorney will consult your case, hear your claim, and advise you on what the next steps could be. With an attorney, you can be reassured you are getting the right guidance when it comes to understanding if your case does have a legal basis to continue. Many attorneys offer initial free consultations, so you can sit down with a view and see which legal expert may be the right fit for you.

What Can My Personal Injury Attorney Do?

If you are going to fight against the insurance claim denial, you will definitely want a personal injury lawyer at your side. With a lawyer, you can go a few different routes. Some of the steps you and your attorney can take when it comes to claim denial include:

Demand Letter

Your lawyer may first seek to draft a demand letter, which is a formal claim for compensation that includes your side of the story, why the other driver was at fault, and emphasizes a reward amount for compensation. With a demand letter, an insurance company may reverse its decision or reward a reduced amount of compensation. However, this is not always the case.

Formal Appeals Process

Some insurance companies have a formal appeals process, which you and your attorney may decide to apply for. This process may provide a better opportunity for your personal injury attorney to negotiate compensation for you. However, just like with the demand letter, going through the process will not always mean you will get the amount you may be looking for, or your appeal may be denied as well.

Lawsuit

Filing a lawsuit can be the final option when it comes to obtaining compensation. If you are dealing with an insurance company that does not want to hold the other party liable, then it may be time to take the matter to court. The process of filing a lawsuit claim can push some insurance companies to settle a negotiation before going to court, so long as there is sufficient evidence justifying your claim and proving negligence on behalf of the other party.

What Can I Do To Help My Insurance Claim?

Filing a new lawsuit with a personal injury lawyer? You’ll want to be sure to pay attention to detail and be as thorough as possible. By building up a strong claim, you are making it possible to obtain the most compensation. How can you help your personal injury claim? Though your lawyer will be working to build your case, you can provide some further aid by helping to:

Gather Evidence

If your initial insurance claim was denied due to insufficient evidence, as you prepare to file a personal injury claim with your lawyer, be prepared to gather all the right evidence. Whether it’s photos or videos of the incident scene, eyewitness reports, medical records, and more, make sure to have plenty of solid evidence that could support your claim. Working alongside your personal injury lawyer will ensure you are knowledgeable on what further evidence may be needed to strengthen your claim. This is also why it is always recommended you call the police and get a written report after the incident, as well as waste no time in going to get yourself checked out for any injuries. Small steps like these can be vital to any personal injury claim.

Be Upfront with Your Lawyer

If you are working with a personal injury lawyer for the first time, the best thing you can do for yourself and your claim is to be completely upfront about the claim. Your lawyer needs to know the ins and outs of the incident and what happened. It is best not to hold anything back from your lawyer. They are in your corner after all. Be sure to keep constant communication with your lawyer, and when it comes to talking to the insurance company, let your lawyer speak on your behalf.

What Can a Successful Settlement Look Like?

If you file a lawsuit and present the proper evidence during the discovery process, the insurance company that had initially denied your claim may reverse their decision. They will find it harder to deny your claim this time when there is concrete evidence supporting your side of the story.

What does this mean for you? Having the insurance company want to negotiate can mean you do end up settling on the compensation you were looking for to help with any injuries and further damages resulting from the initial incident.

The financial compensation you receive from the other party’s insurance can be used to cover a variety of expenses, such as:

Medical expenses, including treatments, future care, medications, ambulance transportation, and more.
Loss of wages, especially if your injuries have left you unable to return to work in the distant future.
Repair costs, such as repairing your vehicle, motorcycle, etc.
Household expenses, including in-home care and other daily costs of living that you may be depended on for.
Pain and suffering, such as if you suffered mental anguish, decreased quality of life, disability, and more.

The amount of compensation may look different than what you initially thought it would be. The important thing is to consult with your attorney throughout the negotiation process and be content with the amount offered.

Don’t let an insurance company’s claim denial keep you down. Consult with an expert San Diego personal injury lawyer to discuss your case and see what your next steps are. Financial compensation does not have to be withheld from you by the other party’s insurance. Give us a call today!