Why An Insurance Company May Deny Claims and How Can You Avoid Them

Why An Insurance Company May Deny Claims and How Can You Avoid Them
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Car insurance is one of those things that we all hope we will not need to use, whether filing a claim with our own policy or through someone else’s in an attempt to collect damages. When you file a claim for a car accident, you expect that your losses (whether related to property or injuries) will be covered.

However, no matter how legitimate your claim, there’s always a chance that it will be denied. If this happens to you, it’s important to know why insurance companies may do this and what you can do to reverse their decision.

Reasons The Insurance Company May Deny Your Car Accident Claim

Insurance claims adjusters, or the people who investigate insurance claims for the company may deny your car accident claim for a variety of reasons, including any of the following:

Lapsed Insurance Policy

Your claim may be denied if the policyholder’s coverage has lapsed, meaning the premiums for that policy have not been paid, or if the insured had already canceled the insurance plan prior to when the accident occurred. To avoid a lapse in coverage, it’s important to keep up with payments on your own policy or to opt into a SUM coverage plan which could offer you vital relief in the event you’re involved in an accident with a driver who has lapsed coverage. 

Policy Limit Is Exceeded

Every auto policy has limits assigned on how much can be paid out in the event of an accident. If the claim is higher than the coverage limits, you could be stuck paying the excess (which is why SUM coverage is a great idea to have). For example, if you’ve exceeded the no-fault limits on your own plan and are filing a claim for additional medical expenses at $40,000, but the at-fault driver’s policy only covers $25,000, you could be liable for the $15,000 difference. 

Policy Exclusions or Violations

An insurance company may deny a claim if there is proof that the actions of you or the liable driver are excluded from coverage. For example:

  • Driving under the influence of alcohol or drugs
  • Driving with an expired or suspended license
  • Filing a claim under your personal auto insurance if the vehicle was being used for commercial purposes at the time of the accident
  • An excluded driver was operating the vehicle at the time of the accident

Additional Reasons for Denial

An insurer can also deny your claim on grounds that they believe the claim may be fraudulent. These items may raise red flags for the adjuster and therefore lead to a claim denial:

  • The accident could have been avoidable.
  • The accident was not reported to police or your insurer in a timely manner. 
  • Medical attention was not sought immediately after the accident occurred.
  • The reported injuries or damages were pre-existing.
  • False information was provided to the insurance company when your policy was purchased. 

What To Do If Your Claim Is Denied

Your claim can either be denied by your own insurance company or the other driver’s insurance company.  If you receive a claim denial letter from the insurance company, all hope is not lost. There are steps you can take to continue seeking relief despite that initial denial.

Submit Additional Evidence

If your letter of denial from the insurance company says that you did not provide enough evidence to support your claim, then you might provide additional evidence such as:

  • Medical records, bills, or prescriptions related to your injuries
  • A police report
  • Witness video or photographs
  • Pictures or video taken by yourself

An attorney can help evaluate what evidence is relevant and helpful to your claim.

File An Appeal

If you feel as though you have submitted sufficient evidence, or you are not able to provide any additional evidence, consider drafting an appeal letter to the insurance company. In your appeal letter, be sure to include the following:

  • Your name and policy number
  • Date of denial letter, what was denied, and the cited reason for denial
  • Why you believe this decision should be overturned
  • Evidence to support your request, such as medical records, video/photo, doctor’s recommendations for treatment, and any police reports
  • Anything else that supports your request for coverage

An attorney can assist you with this process.

Seek Legal Counsel To Fight The Denial

An experienced auto accident attorney understands New York’s no-fault and personal injury liability coverages and will be able to assist you in filing for an appeal from either your insurance company or a third party. The sooner you seek legal assistance after an accident, the better.  Nevertheless, for most claims, a skilled personal injury attorney can be of significant assistance at any stage of the claims or appeal process. 

How To Avoid Claim Denial

To avoid a dispute with the insurance company over your claim, it’s important to remember that there is no such thing as “too much evidence.” Here are a few things you should keep in mind that may significantly narrow the chances of your claim being denied:

Information Gathering At The Scene

The immediate aftermath of a car crash can be hectic, overwhelming, and stressful, but it’s important to keep as calm as possible and collect the following information for your claim:

  • Police report: Call 911 to report the accident and any injuries at the scene. The police will complete a police report which will include a synopsis of the accident (including any parties involved), a diagram of the accident and damages, and any witness statements. 
  • Take photos and video: While at the scene, and if it is safe to do so, take as many photos and videos of the accident as possible. This can include photos of road conditions, damage to either vehicle, any road defects that could have caused the accident, and any injuries to yourself.
  • Get insurance information: Exchange insurance and contact information with the other driver. If you were involved in an accident with a commercial vehicle, be sure to get the vehicle number. While talking to the driver, do not admit fault or apologize for the accident.
  • Talk to witnesses: If there were witnesses to the accident, speak to them and get their contact information if they are willing to give a statement regarding the accident. 

Seek Immediate Medical Attention

Even if you do not feel as though you need medical attention after an accident, it’s important to visit a physician or urgent care center for an evaluation. Small injuries like bruises, bumps, or headaches may reveal themselves to be more serious over time, so having a medical record that treatment was sought after the accident is helpful when filing a claim for injury. 

Of course, following up with your medical provider’s recommended treatments and/or specialist visits will only help to strengthen the validity of your claim. 

Understand Your Insurance Policy 

Understanding what is, and is not, covered under your own insurance policy can be extremely helpful if you’re in a position where you need to file a claim. When reviewing your insurance agreement, it’s important to review your policy limits and coverages in the event that you need to use them. 

If you are involved in an accident and have filed a claim either with your insurance company or a third party, be sure to understand filing deadlines so you are not denied coverage.

Claim Still Denied?

If you believe you have a valid insurance claim after being injured by another driver, but are having difficulty getting insurance to accept your claim, reach out to a trusted personal injury attorney for assistance. A good personal injury attorney understands the ins and outs of New York’s auto insurance laws and why insurance companies may deny a valid claim. 

At Cellino Law, our attorneys have decades of experience working to help car accident victims recover just compensation for their injuries. If you have been injured in a car crash where another driver was at fault and your claim was denied by insurance, contact our team for a free case consultation with a member of our legal team at 888-888-8888.

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Content checked by the personal injury attorney Ross Cellino. As a family man and a trial attorney, I pride myself on winning cases and serving the community. With over 35 years of experience, I understand the function of a jury, how juries arrive at conclusions, and the role that the jury plays in administering justice. I know how to win cases. You can find us in Manhattan, Buffalo, Melville, Rochester, Brooklyn, The Bronx, Queens and other locations throughout New York.



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