If you suffered injuries in a car accident, there’s a good chance you’ll turn to insurance to cover at least some of your expenses and losses. You might carry auto, health, or long-term disability insurance. And the party who caused your car accident may also carry liability insurance that covers you.
Getting money an insurance company owes you should be straightforward, but often it’s not. Insurers are notorious for partially denying car accident claims, leaving crash victims like you in personal and financial difficulty.
Here’s an overview of what you can do if an insurance company denies your claim. (Spoiler alert: it’s all about hiring the right car accident lawyer.)
Insurance Companies in Car Accident Cases
Numerous types of insurance usually play a role after a car accident:
- Auto insurance typically covers damage to your vehicle and personal property in a crash. It might also cover you against medical and other injury-related expenses.
- Your health or long-term disability insurance may cover your medical expenses, costs of rehabilitation, and some of your lost income from missing work.
- Workers’ compensation insurance might cover your medical expenses and lost wages if you get hurt in a car accident while working.
- Someone else’s liability insurance may cover the expenses listed above and, in addition, your non-economic losses like pain and suffering, inconvenience, and loss of quality of life.
This is not a complete list, and the point is that many insurance policies could play a role in paying for the harm you suffered in a car accident. Your challenge is ensuring you take full advantage of every policy available.
Car Accident Insurance Claim Basics
Generally, you (or someone acting for you) must submit a claim under a company-issued policy to get money from an insurance company after a car accident. A claim is simply a demand for payment of a specific expense or loss you believe is covered by the policy.
How you submit a claim largely depends on the type of insurance involved. For instance, you can usually submit a claim to your auto insurer for vehicle damage through an app or phone. A doctor’s office will usually submit claims to your health insurer in your name. And when someone has legal liability for your injuries in a car crash, it usually pays to have a lawyer prepare and submit a claim for damages on your behalf.
Whatever the method of submitting a claim, once it’s received, the insurance company will continually evaluate it and decide whether it should be accepted or denied. This evaluation and decision process is known in the insurance industry as claims adjustment. The insurance company employee or contractor tasked with completing that process is called an adjuster.
The means of adjusting a claim can vary by the type of insurance involved. Many insurance companies (especially health insurers) leave it to computer software to adjust routine or low-dollar claims. But human adjusters usually handle higher value claims and claims involving complex facts or legal issues; car accident claims often fall into this category.
An adjuster will typically investigate to gather information relevant to deciding whether a claim is valid and covered by a particular policy. Generally, the breadth and depth of the investigation will depend on the amount of the claim. For instance, an adjuster might spend an hour or less reviewing photos and a car accident report for a $5,000 vehicle damage claim. They might devote weeks of effort, hire expert investigators, and dive deep into the claimant's medical records to evaluate a $5 million crash-related spinal cord injury claim.
Upon investigation completion, the adjuster either decides or recommends whether the claim should be paid or denied to the insurance company. By law, the insurance company must communicate that decision to the claimant in writing.
Reasons an Insurance Company Might Deny a Car Accident Claim
Insurance companies find lots of reasons some valid, some not to deny car accident claims. The larger the claim, the more incentive the insurance company has to find justifications for a denial.
Common factors an insurance company might cite when denying your car accident claim include:
- Outside the scope of the policy. An insurer might dispute that the claim you’ve filed falls under the insurance policy’s terms, such as because the accident occurred outside the policy period or involved events excluded from coverage.
- Delay notifying the insurance company of the car accident. Some insurance policies require you to notify the company soon after an accident to preserve your right to submit a claim in the future.
- Delay submitting a claim. Insurance companies may fault you for taking too long to submit a claim, arguing that you missed a deadline under the terms of the policy.
- Delay getting medical care. If you do not seek medical care immediately after your accident, an insurer may question whether the crash caused the injuries you claim.
- Liability disputed. Insurance companies may deny that their policyholder has liability for causing your car accident.
- Damages disputed. Insurance companies may deny that you suffered the damages you claim.
- Excluded driver. If someone not covered under the insurance policy drove at the time of the accident, the insurance company may refuse to pay for damages in the accident.
Sometimes, these are valid reasons for denying a claim. But sometimes they’re not. And even if they have some truth, they may not spell the end of your claim.
You might still have the ability to force the insurer to pay compensation if you have an experienced car accident attorney on your side fighting for your rights.
What You (Through a Lawyer) Can Do About a Denied Car Accident Claim
You do not have to accept a denied car accident claim. If any insurance company yours or someone else’s denies your car accident claim, speak with an experienced car accident injury attorney immediately to learn about your options.
Here are some ways a skilled lawyer might still be able to get you the compensation you need to pay your bills and recover from the trauma of your crash.
Fixing the Problem
Sometimes, you can fix the problem that led to the claim being denied. If this is an option, the letter denying your claim will usually say so and give instructions on how to proceed.
For example, you might be able to fix a problem and get the insurance company to reverse its decision by:
- Supplying information the company believes is missing from your claim file;
- Giving the insurance company access to information held by third parties like medical providers, auto body shops, or law enforcement
- Re-submit your claim to a different department within the insurance company or under a different insurance policy provision.
Unless the problem needs minor fixing, it’s almost always a good idea to let a skilled attorney handle the process on your behalf. An attorney can speak with an insurance adjuster on your behalf and streamline the process of getting your claim file to receive the money you need.
An attorney can also ensure you do not make mistakes or fall into traps while trying to fix a problem. For example, sometimes an insurance company might ask for more information, only to use the information you provide to come up with a new reason to deny your claim. A lawyer representing your interest knows what the insurance company needs and how to avoid mistakes.
Appealing the Denial
In many cases, you have the right to appeal a claim denial. Depending on the type of insurance involved, the terms of the policy, state laws, or both can define the scope and nature of your appeal rights. Typically, the appeal is made directly to the insurance company, requesting a review of the decision to deny your claim.
Always hire a lawyer to handle an insurance appeal for you. The policy terms or laws governing the appeal often impose strict requirements for when, how, and to whom you may appeal. Make one mistake in this process, and you can lose your right to appeal altogether.
A skilled lawyer can navigate the appeal process on your behalf, giving you the best chance of convincing the insurance adjuster to reverse the decision and pay you the money owed.
Suing for Damages
You might also have the option of suing for damages if an insurance company denies your car accident claim.
You could sue:
- The insurance company, for denying your claim in bad faith, which is illegal and may require the insurer to pay you enhanced damages
- The insurance company's policyholder, if the policyholder caused your car accident and the adjuster refused to pay your claim.
Without exception, you will need a skilled car accident attorney representing you if you want to succeed in a lawsuit against an insurer or the at-fault party in your car accident. An attorney evaluates your case, collects evidence, files court paperwork, presents legal arguments, and appears on your behalf in court proceedings.
If successful, your lawsuit might secure payment for your:
- Medical and other accident-related expenses;
- Lost wages and future income;
- Pain, suffering, inconvenience, and lost quality of life; and
- Statutory damages (in the case of a bad faith claim denial)
Time limits may apply to suing for damages, so speak with a lawyer today to learn about your rights and options.
3 Things to Keep In Mind if an Insurer Denies Your Car Accident Claim
The actions you take after receiving a denial of a car accident-related insurance claim can significantly impact your legal rights and financial future. Here are three key considerations to keep at the front of your mind after an insurance company denies your compensation claim.
There’s Always Risk Involved in Giving Information to an Insurance Company
Insurance adjusters want you to give them information about your car accident, injuries, and financial losses. On the one hand, this is normal and appropriate you can’t expect an insurance company to send you money without first verifying your claim. On the other hand, it’s dangerous because insurers are vested in finding reasons not to pay you the amount you’ve demanded or any money at all.
So remember, no matter how friendly and helpful the adjuster seems, every request for information comes with risk attached to it. The more information you provide, the greater the danger of the insurer finding a justification for partially or denying your claim.
This rule applies to every category or format of information an adjuster might ask for, including especially requests for:
- A recorded interview with you;
- Your medical information and access to your medical records;
- Your financial information and access to your bank or credit card records;
- Your employment-related information;
- Information about your spouse or family members.
In many cases, the insurance adjuster has no right to demand this information but will still ask, hoping that you will consent to hand it over. Don’t risk making a mistake. An experienced car accident attorney knows what information the insurer truly needs and what you can (and should) refuse to provide.
The Adjuster Can Use Social Media Against You
Insurance adjusters have discovered that social media often contains a treasure trove of information about a claimant. The adjuster examining your claim will likely check the major social media platforms for information about you. So it pays to be careful about what you post there.
Yes, this might feel like an invasion of privacy, but it happens daily. No law prohibits insurance companies from scrolling through the information you allow the public to see. And it doesn’t stop them from trying to “friend” you or your acquaintances to see the information you might keep semi-private.
The less you post to social media after getting hurt in a car accident, the better. Never post about your accident; remember that even a smiling selfie can make it look like you aren’t as hurt as you claim. Insurance companies can and will try to twist anything they find into a reason to deny your claim, so be careful.
Quick Settlement Offers Undervalue Your Claim
Sometimes, insurance companies especially those who issued liability policies to the party at fault for your car accident—recognize that they owe you compensation. In those cases, they may try to offer you a quick settlement of your claim. Be cautious if this happens to you. What seems like quick, easy money could constitute a tactic to trick you into giving up valuable rights for a fraction of what you deserve.
Anytime an insurance company extends a quick, unsolicited settlement offer to you directly, it’s safe to assume the amount offered falls well short of what you have a right to receive. Tempting as it may feel to take the money, in virtually every case saying “no” and hiring an experienced car accident attorney to negotiate on your behalf will get you a better outcome.
Claim Denied? Contact a Car Accident Attorney Today.
Car accident attorneys work to get you the maximum amount available for your crash-related injuries and losses.
Contact a car accident attorney today to learn about your rights and options after an insurance company denies your car accident claim.