You may have been in an automobile accident in which you were injured or your car was damaged.
You’re not the party at fault, and you’ve gone through all the proper channels in filing a claim and complying with your insurance company in any investigation taking place.
Now, your insurance company has denied your claim. They’re saying the other party wasn’t at fault, and as a result, they’re not covering your expenses.
If this situation has happened to you in the past or is happening now, you know how frustrating and worrisome it is. It can put incredible strain on your finances, not to mention all the time you spent filing the claim and dealing with your insurance company.
When you receive that claim rejection letter or notice, you may not know what recourse you have at your disposal. In fact, many people believe that this is the last word in the matter, that they have no further options. This couldn’t be further from the truth. By consulting with experienced attorneys in the field of car accidents, you can discover a range of possible ways to make yourself whole.
Reasons for Denying a Claim
If an insurance company denies your claim, it’s likely going to cite under one of the below reasons.
If denying a claim because of disputed liability, an insurance company is claiming that the other party wasn’t at fault, or that the damages or injuries you’re claiming didn’t come as a result of the accident.
If you aren’t up to date on your insurance payments as of the time of the accident, an insurance company may decline to cover a claim.
A Failure to Notify
Your insurance policy stipulates that you must inform your insurance company of any accident, leading to a claim in a timely manner. If you don’t meet their standard of timely notification, they may deny your claim.
There are a number of events that your insurance policy doesn’t cover. One of the biggest ones is any act deemed to be an intentional action.
Options at Your Disposal if Your Claim is Denied
Once your insurance claim is denied, you have a handful of options for disputing a claim, with the most severe being filing a lawsuit against your insurance company. Before resorting to litigation, you will probably want to avail yourself of the appeals process.
Appealing your Claim Denial
Most insurance companies have some form of internal appeals process for when a customer believes that their claim was incorrectly denied. Even if your claim to accident benefits are denied, Dairn Shane of Preszler Law Firm explains that you can still dispute that decision under the Statutory Accident Benefits Schedule. This may involve going to third party arbitration, or else appealing directly to your insurance company.
In arbitration, both you and your insurance company will present your case and evidence to a trusted third-party decision maker. This person will weigh the respective cases and make a ruling. Arbitration is a common practice within many types of contracts, and is frequently used in the insurance industry.
In this type of situation, it’s beneficial to have the services of a lawyer specializing in insurance claims. They will be able to help you through the entire process, from collecting and sending any necessary documents to contacting the right people at every step of the way.
In order to win an appeal, you’ll need to address the reason your insurance company cited for denying your claim. You’ll need to demonstrate to them that their reasoning was incorrect. If the insurance company or arbiter agrees, you can receive a settlement covering the cost of your injuries or repairs.
Suing Your Insurance Company
It may be that you’re unsuccessful in appealing, or your insurance company may not offer an appeals process. If you feel your insurance company is not acting in good faith, you can file a lawsuit to recoup the cost of the denied claim.
If filing a lawsuit, it’s absolutely essential that you retain the best legal services you can. If you’re able to demonstrate a strong case from the onset with competent representation, an insurance company may be motivated to settle with you rather than drag the proceedings out in court. If the lawsuit does proceed, you’ll need professional and competent lawyers in your corner to have a chance of winning.
If your suit is successful, you can recoup the money your claim should have paid out, as well as costs related to filing and litigating the court case.
Regardless of why your claim was denied, you should be aware of your rights as an auto insurance customer. It’s possible that your claim was denied in a way that will make overturning that judgment impossible. But many times, you may have some hope of a favorable judgment.
The key to getting a good outcome in a situation like this is knowing your options, making informed decisions and carefully documenting your case.