When you have been in an auto accident and have filed a claim with your insurance agency, you may be expecting to receive the check so that you can pay for your car repairs and medical bills. Unfortunately, it doesn’t always work out that way and you may find that your insurance claim is denied. That means no car repair, no medical bills paid, no money. When this happens, it helps to have an experienced, knowledgeable attorney helping you.
From the beginning, though, it is very advantageous for you to know why an insurance company may deny a claim. It also helps to know what you can do about it when it happens to you.
Common Reasons an Insurance Claim Is Denied
An insurance claim can be denied for a number of reasons. Some of the more common ones include:
- The injured party’s medical records do not indicate evidence of an injury or pain. If you don’t have any medical records that show you were injured in the accident, then the insurance company is very likely to reject your claim.
- The accident could have been avoided. If you could have avoided the accident or if you did something that caused it or led to it (even if you weren’t ticketed), your insurance company could deny your claim.
- The injury is a pre-existing condition. – If you have a condition that is pre-existing, your insurance company can argue that your injury was not caused by the accident, but by the condition.
- The injured party did not complain of injuries to seek treatment when the accident occurred. – When you are involved in an accident and there is a possibility that you may be injured, you need to seek treatment as soon as possible. If you don’t, the insurance company can say that your injuries were not caused by the accident. Going to the hospital immediately gives you much firmer footing.
Other reasons that your claim may be denied include:
- The policy has lapsed
- The policy has exclusions that rule out your claim
- You did not notify the insurer or file your claim within the prescribed time
Bad Faith Denial
When you and an insurance company come to an agreement that the company will provide insurance, both sides have certain duties that are expected of them. One of these is that the insurance company will deal in good faith.
An insurance company that tries to avoid meeting its prescribed obligations to the insured, it is said to be acting in bad faith. In a bad faith denial, the insurance company will try to deny the claim without any valid grounds, will not investigate the accident properly, will not value the property correctly, or they will outright refuse to pay the claim.
When this happens, there are two legal actions that may take place: breach of contract and a tort. Sometimes it will be one or the other, while other times it involves both.
- Breach of Contract – This means that the insurance company has not adhered to the terms of the policy, the terms it promised to uphold. In your policy, your insurer promised to indemnify you if you were in an accident. By refusing to hold up their end of the bargain, they are in breach of contract.
- Tort – A tort in these cases is a civil wrong. When the insurance company refused to pay your valid claim, they violated their duty to you, causing economic injury.
How to Appeal a Claim Denial on Your Car Accident
Most car insurance companies have a process in place for people who want to appeal their denied claims. Ideally, you will have an attorney who can initiate the appeal for you. If not, you need to talk to the claims adjuster to find out what you need to do to formally dispute the decision.
If you choose to appeal your claim denial, you should follow these steps:
- Find out exactly why the company denied your claim.
- Review all the documentation that you submitted when you filed the claim (you should always keep copies of everything)
- Write a letter to the insurance company that explains why the insurance company’s decision is wrong. You have to do more than tell, though. You have to show with solid evidence such as eyewitness reports, photos of the accident, medical records, police report, and other solid evidence. You want to make a clear connection between your argument and each piece of evidence.
- If you are not comfortable disputing the decision or appealing the denial on your own, contact an attorney.
If your claim has been denied, let the experienced, knowledgeable attorneys at Johnstone & Gabhart take over. We will review your case and determine if the insurance company was justified in their denial. If they were not or if they are acting in bad faith, we will fight to get you the compensation you deserve.
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