What Happens If Insurance Denies My Claim?

What Happens If Insurance Denies My Claim?
Calendar icon April 28, 2023

Car accidents are stressful to begin with, but can become even more of a headache if you have to grapple with the insurance company over a denied car accident claim. Even if you were not responsible for the accident, you may still receive a letter of denial from the insurance company, which may leave you thinking, “how is this possible?”

Let’s take a look at why your claim may be denied and what you can do to appeal the decision.

What Is A Claim Denial Letter?

Once you file an insurance claim after a car accident, an insurance adjuster will be assigned to your claim and document all of the available details regarding your accident. After reviewing the facts surrounding your accident and any relevant evidence, the adjuster may request additional information, but will ultimately make a determination on whether the claim will be accepted or denied.

If the insurance company completes its investigation and determines there are no grounds for granting any coverage for your claim, it will send you a denial letter disclaiming its obligation to pay for any incurred damages.

However, a denial letter does not necessarily mean the end of your claims process. If you disagree with the insurance company’s decision to deny your claim, you have the right to appeal that decision.

Why Would Insurance Deny My Claim?

Insurance companies deny claims for many different reasons, but in general, they will only deny a claim if they think they can make an arguable case under their policy and the law why they are entitled to do so. Below are some common grounds on which insurance companies deny claims.

There Is A Liability Dispute

It is important to understand the terms and coverage that fall under an auto insurance policy when filing a claim for damages after a car accident. If a driver acted negligently or in a way that caused another person harm, e.g., texting and driving or driving under the influence, then that driver will likely absorb most, if not all, of the liability for the accident.

Since New York State is a comparative fault state, even if you are partially at fault for the accident, you may still be able to recover damages with an insurance claim—but only for the percentage you were found not to be at fault for the accident. For example, if you are found to be 40% responsible for the accident (with the other party or parties 60% responsible), you would only be entitled to recover 60% of your damages, e.g., for every $100 in damages you incurred, you could only recover $60. If the insurance company argues that you are fully at fault for the accident, your claim may be denied.

A Medical Evaluation Was Not Completed

Many drivers will not see a doctor after an accident, as they feel their injuries are minor and do not require an examination. However, aches and pains can become more severe in the weeks after an accident. Without a record of a medical examination, filing a personal injury claim can be much more difficult, and a lack of medical records may result in a denied claim.

If an injured party waits too long after an accident to seek medical care, the insurance company may argue that the injuries were not a direct result of the accident and refuse to pay any benefits.

Not Enough Coverage

Insured drivers in New York State are required to carry sufficient insurance coverage to account for any bodily injuries or property damage that they may incur. The statutory minimum is $25,000/$50,000, which provides $25,000 in coverage per injured person, and a total of $50,000 in coverage for all passengers per accident. Thus, as an example, if an accident occurs where a serious, non-fatal injury occurs resulting in $60,000 worth of medical expenses, and the at-fault driver carries New York’s required minimum of $25,000, insurance pay the allotted coverage, but will deny the claim to the extent that it exceeds the policy limit. At that point, having exhausted the at-fault driver’s policy limits, the injured driver may be able to seek further coverage under their own SUM coverage.

The Insurance Company Was Not Notified In Time

Drivers have the responsibility to notify the insurance company as soon as possible after an accident occurs. In New York State, any motor vehicle accident must be reported within 30 days of the accident to be considered a valid claim. If you fail to notify the insurance company of your accident and any resulting injuries before that deadline, you risk your insurance claim being denied. Moreover, you are required to cooperate with insurance after filing a claim; an attorney can assist you in ensuring you are meeting this requirement, while simultaneously protecting your claims.

What Is A “Bad Faith” Claim Denial?

If your claim was denied, there may be a legitimate reason. Nevertheless, there are some circumstances where the insurance company may knowingly deny a valid car accident claim – this is known as a “bad faith” claim denial.

In New York State, a bad faith insurance claim denial refers to the insurance company’s unreasonable refusal of coverage which is due under an insurance policy. You may know you have a bad faith insurance claim denial if the insurance company:

  • Refuses to pay a legitimate claim
  • Refuses to reasonably investigate your claim
  • Does not provide adequate reasoning for denial
  • Knowingly deviates from state regulations concerning the claims process
  • Purposely ignores information or evidence that supports your claim

 

If you believe you have received an insurance claim denial in bad faith, you should consider contacting an attorney as any insurer that acts in bad faith may be liable for damages.

How To Appeal A Car Insurance Claim Denial

The appeals process may vary depending on the circumstances of your accident and related insurance claim. But regardless, it is always advisable that you get any reasons for claim denial in writing from the insurance company. It is important to move quickly after a denial to avoid waiving any rights. An attorney can help you navigate the appeals process.

Gather Additional Evidence

If the insurance company cited that you did not provide enough evidence to support your claim, do your best to provide any pieces of missing evidence that you can. These pieces of evidence may include a police report, photographs of the accident scene and damages, eyewitness information, medical records, or other supporting documents. Be sure to make copies and keep record of all evidence submitted.

Draft Your Appeal Letter

If you’re unable to provide more evidence, or you simply do not agree with the insurance company’s decision to deny your claim, consider filing an appeal with the insurance company. Draft a letter (or have your attorney do so), outlining why you do not agree with the insurance company’s decision, providing as much detail as possible. When writing an appeal letter to the insurance company, make sure you explain each piece of evidence that was or was not submitted, as well as referencing any policy information that was included in the original claim denial letter. An attorney can furnish appropriate case law or relevant policy language to bolster your claim why the company’s denial was improper.

Consider Working With An Attorney

If you’re not comfortable taking the aforementioned steps, or you feel as though you’d like an expert’s opinion, it may be a good idea to consult with a trusted car accident attorney in your area. An attorney will be able to review your case and use any supporting documents that you have to draft a demand letter, requiring the insurance company to respond with a defense of their claim denial. Attorneys are also skilled persuasive writers, who may be able to assist with the appeals process.

Get Help With Your Denied Car Accident Claim

Receiving a letter of denial for your car accident claim can be extremely frustrating. To the insurance company, your claim is just a transaction, but the compensation you receive from a claim can make the world of a difference. Fortunately, an initial denial is not always the end of a claim.

If your claim was denied and you’re not sure where to start, don’t hesitate to reach out to the attorneys at Cellino Law. Our team of attorneys has decades of experience working with car accident injury victims to help them recover the maximum compensation for their injuries – even if insurance initially denies their claim.

For a free case consultation with a member of our legal team, contact Cellino Law at 888-888-8888.

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