Dealing with the aftermath of a car accident is never easy. The stress of managing injuries, repairing your vehicle, and handling insurance claims can be overwhelming.
Unfortunately, one of the most frustrating experiences is having your insurance claim denied. If you find yourself in this situation, it’s essential to understand your options and take proactive steps to address the denial effectively.
One of the most important steps following a claim denial is seeking legal help from a San Jose car accident attorney. A lawyer has the skills, tools, and experience to address the root cause of the denial and actively pursue a more favorable outcome on your behalf.
Types of Auto Collision Insurance Claims
First and foremost, it’s essential to understand how your state handles insurance claims following car accidents. The type of claim you’ll file depends on whether your state follows no-fault or at-fault rules.
In a no-fault state, you will file a first-party insurance claim with your own insurer, regardless of who caused the accident. These states require drivers to carry their own personal injury protection (PIP) insurance to cover their damages after a collision. Additionally, you can file a first-party claim if you were in an accident with an uninsured or underinsured at-fault driver, should you have the proper coverage.
Most states are at-fault states, and in these states, fault matters. Therefore, you will file a third-party insurance claim with the at-fault party’s insurance company.
If you’re unsure what type of claim to file, speak with a car accident lawyer for direction and assistance.
Which Claims Get Denied More Often?
Generally, third-party claims get denied more often than first-party claims.
When you purchase insurance, your policy is essentially a contract between you and your car insurance company. When you’re in a collision and file a first-party claim with your insurer, your insurance company has promises to fulfill under your policy.
However, when you file a third-party claim with the other driver’s insurance company, there is no agreement between you and this insurer. Instead, that insurer has obligations to protect its policyholder, not you.
Still, regardless of whether you file a first-party or third-party claim, if you receive a claim denial, it is well worth discussing it with a lawyer. An attorney can determine whether the basis for the denial was accurate and take legal action if necessary.
Filing an Insurance Claim Following a Car Accident
After an auto collision, you should file your insurance claim as soon as possible. Every insurance company is different and has varying requirements for filing a claim. Regardless, it’s best to file your claim right away to avoid potential issues.
Whether you file a first-party or a third-party claim, initiating a claim is usually the same. You should contact the insurance company and notify them of what’s occurred. The insurance representative can collect details concerning your accident, resulting injuries, and property damage to start the claim. Then, you’ll get an insurance adjuster assigned to your claim.
Insurance adjusters play a vital role in the claims process. They handle various aspects of your claim, including investigating the accident, assessing vehicle damage, and facilitating repairs. The adjuster also makes decisions regarding your claim, including whether to approve or deny it and how much it is worth.
If your claim is approved, they can provide a monetary figure to settle it. If you agree, the claim is over, and you’ll receive your money. However, if your claim is denied, the insurance company considers it closed and over.
It’s essential to note that even if the insurance company denies your claim, it doesn’t necessarily mean this is the end of the road for you. You may have additional options to discuss with a skilled car accident attorney.
Understanding the Challenges with Insurance Companies
Before filing an insurance claim for your car accident, it’s helpful to understand how car insurance companies work and the tactics they employ with many claims.
Car insurance companies are in the money-making business. Not only do they want to make money, but they also aim to keep as much of it as possible. Therefore, seeking compensation from a car insurance company can be more challenging than you may think.
Auto insurers utilize many strategies to limit their liability and avoid paying out for insurance claims. When successful, insurers can get away with paying little to nothing for a valid claim.
Some of the schemes insurance companies use to result in a claim denial include:
- Requesting a recorded statement: The insurance company may ask you for a recorded statement to get your side of things. While this seems like no big deal, it can be. The insurance company is fishing for something they can use against you, and if successful, they can use your words as a basis for a claim denial.
- Obtaining medical records: It’s important not to give the insurance company access to all of your medical records. When they get ahold of a victim’s records, they look for past injuries or conditions and claim the injuries they sustained in the current accident are not new.
- Disputing liability: Insurance companies often look for anything they can use to dispute liability. Their goal is to shift liability onto you and deny your claim.
In addition, some insurance companies deny claims in bad faith. The insurer may simply deny your claim without doing their due diligence and without a valid reason at all. In a situation like this, you might have a claim for bad faith against the insurer.
Receiving a claim denial is difficult but not surprising in many cases. This is one of the primary reasons why it’s so helpful to have a car accident lawyer on your side to protect your rights and fight the insurance company.
Why Insurance Companies Deny Car Accident Claims
Many times, it’s difficult to understand why the insurance company has denied your claim. You filed a legitimate claim, so why might they choose to deny it instead of approving it? This can happen for many reasons, some valid and some improper. It’s necessary to get to the bottom of it to determine what your next steps should be.
Insurance companies may deny a claim for numerous reasons, including, but not limited to:
- Lack of coverage: Your policy or the other driver’s policy might not cover certain types of accidents or damages. The other driver’s insurance may have also lapsed, leaving them uninsured.
- Policy exclusions: The accident might fall under an exclusion in the policy, such as driving under the influence or using the vehicle for commercial purposes, if the policy doesn’t cover such activities.
- Fault dispute: The insurer may argue that you were at fault for the accident and, thus, not eligible for compensation.
- Incomplete information: A lack of necessary documentation or information may result in denial.
- Failure to report promptly: If you don’t notify the insurer about the accident promptly, your claim could be denied.
When the insurance company denies your claim, you have the right to know the reason. Be sure the insurer provides a detailed explanation of their decision, which can help you determine what to do next.
What To Do After a Collision Claim Denial
You may be confused and unsure what to do if you've received a claim denial. The situation can be particularly frustrating, and you may believe there’s nothing else left to do. However, the following steps can help you pursue a better result.
Review Your Denial Letter Carefully
The first step is to thoroughly review the denial letter from your insurance company. This letter should outline the specific reasons for the denial. Take note of any references to the policy terms, exclusions, or details related to your claim. Understanding the insurer’s reasoning is crucial for addressing the denial effectively.
Gather Supporting Documentation
If you haven’t done so, compile all relevant documentation supporting your claim. This may include:
- Police accident reports
- Medical records
- Repair estimates
- Witness statements
- Photos
When fighting a claim denial, strong evidence can significantly help strengthen your claim.
Contact Your Insurance Adjuster
Reach out to your insurance adjuster to discuss the denial. If you haven’t received an explanation, request their reasoning and ask for additional information and documentation.
Seek Legal Assistance from a Car Accident Attorney
For best results, get help from a car accident lawyer. An attorney can review the claim denial and all pertinent evidence and documentation to determine what to do next. They can also provide peace of mind by addressing your questions and concerns.
Taking Action After a Denied Car Accident Claim
Many insurance companies get away with claim denials because claimants don’t realize they might have other options. Taking action after a claim denial can put pressure on the insurance company and help you get the outcome you deserve.
Filing a Formal Appeal
Depending on your state and insurance company, there may be a certain process for appealing denied claims. A lawyer can determine whether there is a formal process and take steps to file a timely appeal on your behalf.
Sending a Demand Letter
When the insurance company denies a claim, your car accident attorney can draft and send a demand letter. A demand letter is a formal letter asking the insurance company to settle your claim for what your claim is worth.
Within the demand letter, your lawyer can include:
- Information about the accident.
- Details about your injuries and property damage.
- Reasons why their insured is at fault.
Your attorney will include a monetary figure at the end of the letter representing the value of your claim.
Upon receipt of the letter, the insurance company has options. They can accept the request for settlement and pay out what you requested, or they can attempt to negotiate with your lawyer. The insurer can also refuse to settle, at which point your attorney can take further legal action.
Filing a Lawsuit
Should the insurance company still refuse to settle your claim after receiving the demand letter, your lawyer can file a car accident lawsuit. By filing a lawsuit, you’re essentially asking the court to intervene and help you pursue fair financial compensation.
The Lawsuit Process
Filing a lawsuit against the insurer can seem stressful and intimidating, but when you have a lawyer on your side, you don’t have to worry. Your attorney will handle all aspects of your case as they pursue the best possible result.
Initiating the Lawsuit
Your legal claim begins by drafting and filing a formal petition with the court to open your case. Once all documents are filed and appropriate fees are paid, the opposing party is served with copies of court documents notifying them of the impending case. The opposing party has a set number of days, usually 21 to 30, to file their response to your petition in court.
Engaging in Discovery
Discovery is usually the most important and time-consuming part of a lawsuit. During this time, both sides have the opportunity to request and obtain evidence to strengthen their cases. Certain legal tools, including interrogatories, requests for production, and depositions, can help with this objective.
Settling the Case
Once discovery is done and both sides have the necessary information, they can revisit settling the case. Both sides work together during settlement negotiations to find a mutually beneficial agreement. Your attorney can advocate for your best interests and strive to get you the settlement you deserve.
Going to Court
When a case cannot settle, you can take the case to trial. During trial, both parties present their cases in front of a judge (and sometimes a jury), who will then render the decision based on presented arguments, evidence, and testimony.
After Receiving a Claim Denial, Do Not Wait to Consult with a Lawyer
Having your car accident claim denied can be a most frustrating experience. While the situation may seem bleak, do not give up. Speak with a car accident attorney right away to discuss your rights and options. A personal injury lawyer in San Jose can protect your rights throughout the process and do everything necessary to turn the situation around.
Robert Bohn, Jr.
Attorney
For more than 40 years, the lawyers at Robert Bohn, Jr. has dedicated their practices to personal injury law, representing people who have been injured or damaged due to the negligence or carelessness of others. For most people, handling a personal injury claim can be complicated and stressful.
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