You’re absolutely sure it was your turn to go after coming to a stop sign at a four-way intersection, but another motorist saw things differently. this resulted in his vintage vw beetle being struck by the other driver’s van. luckily you only got a bruised knee (although you were pretty shaken up), but your car was wrecked. took some photos, took detailed notes, and called the other driver’s insurance company to file a claim.
You followed the rules of the road and insisted the other driver was at fault, but unfortunately the other party’s insurance company denied your claim. what now?
Reading: Insurance denied my claim now what
reasons an insurer might deny your claim: overview
There are many reasons why the at-fault party’s insurer may have denied your claim, even if their version of the incident appears to be incorrect. The reasons generally fall into one of two main categories: the insurer’s claims adjuster believes her claim lacks merit, or the insurer simply hopes she won’t pursue the claim. The adjuster may also rely on an eyewitness or choose to believe their client’s version of what happened in the absence of an official police report.
Other possible reasons for a claim denial by the other party’s insurance company include the following:
- policy exclusions: if an insurance policy excludes so-called “acts of god” (natural events), for example, an insurer can dispute your claim if you believe that such an act (a sudden hail storm, for example) was the true cause of the accident and not the negligence of the other driver.
- Policy Lapsed: If the other party failed to pay premiums, allowing their policy to lapse, the insurer can claim there was no coverage at the time of the accident; in which case you would have to rely on uninsured motorist coverage for compensation.
- Failure to notify insurer on time: Policies generally dictate how soon an accident must be reported to be covered. That’s why it’s important to notify the other party’s insurance company as soon as possible.
what to do after the other party’s insurance denies your claim
If your claim is denied, no matter how valid you think it is, you will most likely need to hire an attorney if you decide to contest the denial. After all, insurers make a profit by receiving more money in premiums than they pay out in claims. however, a lawyer’s claim will usually carry more weight and may be taken more seriously by the insurer.
the demand letter
Your attorney may first draft a demand letter, which is a more formal claim for compensation detailing your side of the story, the dollar amount of vehicle damage and/or bodily injury sustained in the accident, and why the other driver was at fault the insurance company will most likely feel compelled to provide a specific reason why the claim was denied, or they will reverse their decision entirely. it can also offer only a portion of the required damages.
and if you (or your attorney) suspect that the insurer engaged in any improper claims practices prohibited by state law, an additional claim for those reasons may be brought to your attention in a letter of claim. for example, illinois statute (215 ilcs 5/154.6) lists numerous prohibited acts as improper claims practice, including refusal to pay claims without making a reasonable investigation based on all available information.
formal appeal processes
If the insurance company has a formal appeal process, and many do, then your attorney may have a better chance of negotiating a settlement, rather than a one-sided lawsuit for damages. this may include the use of arbitration to resolve the matter. Some states, including New Jersey, require insurers to provide a formal appeal process for denied claims.
When does it make sense to file a lawsuit?
If the insurer denies your attorney’s claim, you may want to consider filing a lawsuit against the insurance company. but keep in mind that her attorney won’t want to go to great lengths on a claim that has little chance of success or where she suspects she hasn’t told him the whole story (or is outright lying). In some cases, the cost of a lawsuit can exceed the amount of damages, which means that even a victory in court could end up costing more than doing nothing.
get legal help for your insurance claim
Car accidents are never pleasant, whether they result in catastrophic injuries or simply a scratched bumper. But if the other party’s insurance denies your claim, even though you weren’t at fault, things can go from bad to worse. If you need help deciding what to do, consider getting legal help from an attorney experienced in car accident law.