Why It’s Common for You to Be Denied Coverage after Filing a Car Accident Claim

Experiencing a car accident is a jarring ordeal, and seeking compensation through an insurance claim is a common course of action. You file the paperwork, recount the incident, and hope for approval that would assist in covering medical expenses and necessary repairs. But what if your claim is denied?

Insurance claim denials can compound an already stressful situation. In this informative blog, we delve into the world of car accident insurance claims. 

We will explore the typical reasons insurance companies cite for denying claims, shed light on the right way to file a car accident claim to maximize its chances of approval, and discuss the appeal process if your claim is rejected.

The Most Common Reasons For Coverage Denial

When it comes to insurance claims, understanding the reasons behind denials is key to ensuring a successful process.

Familiarizing yourself with these grounds can help you take proactive steps to avoid them. These are the most common reasons you might be denied coverage after filing a car accident claim:

Waiting Too Long to File a Claim

To ensure a smooth claims process, timely reporting is paramount. Many insurers mandate reporting accidents within a specific timeframe, often 24 hours. Review your policy terms for precise deadlines. 

Failing to promptly file a claim might lead to denial, implying the incident was not severe, underscoring the importance of immediate reporting to expedite your claim and validate its seriousness. 

Understanding and meeting these reporting obligations can significantly influence the outcome of your claim.

The Policy Does Not Cover Damage

An essential aspect of insurance claims involves understanding policy exclusions. If the damage isn’t covered based on your policy terms, insurers will reject your claim. 

For instance, if your policy excludes “acts of God” like floods or natural disasters, damages from such events won’t be compensated. It’s crucial to thoroughly grasp your policy’s scope and limitations to anticipate scenarios where coverage might not apply. 

Being well-informed about policy exclusions helps you make informed decisions and potentially prevent claim denials.

Claiming Too Much in Damages

Claiming damages exceeding the other driver’s policy limits can lead to denials. For instance, California Vehicle Code Section 16056 mandates minimum liability coverage, such as $15,000 for property damage and $30,000 for bodily injury to an individual. 

If the other driver has minimal coverage and you claim, say, $70,000 for medical expenses, the insurer may deny the excess beyond policy limits. 

Familiarizing yourself with these policy limits and aligning your claims accordingly is crucial to ensure smoother claim processing and avoid unnecessary denials.

Not Providing Enough or Accurate Information

Ensuring a successful car accident insurance claim involves several vital steps. First, promptly submit all required medical records and accident reports to your insurance company. 

Then, maintain a cooperative approach with insurance adjusters throughout their investigations. Lastly, substantiate your claim by presenting compelling evidence showcasing the physical, emotional, and financial hardships endured due to the accident. 

Your attentiveness and thoroughness in these aspects significantly enhance the chances of a successful insurance claim, securing the compensation you deserve for the challenges you’ve faced.

Being Responsible for the Accident

Your insurance claim could face denial if you’re found at fault for the accident. For instance, if an adjuster uncovers that you were texting while driving, this could jeopardize your claim. 

Many states operate under a comparative negligence system, potentially barring you from recovering damages if you’re majority at fault (typically 50% or more). 

Given insurance companies prioritize their interests, having a skilled attorney advocate on your behalf becomes pivotal in ensuring a fair resolution. An experienced legal professional can effectively present your case, striving to mitigate liability and improve the likelihood of a successful claim.

Breaking the Law

Your insurance claim can face denial if you violate state or federal laws. For instance, in California, driving without a valid license (Section 12500 of the CVC) is prohibited. 

Additionally, offenses like driving under the influence (DUI) constitute serious violations. If the police report reveals these violations—lack of a valid license or involvement in a DUI incident—your insurer may refuse your claim. 

Adhering to legal requirements is crucial not only for safety but also to uphold the validity of your claim in case of an unfortunate accident. Always prioritize legal compliance to ensure your rights are protected in any claim situation.

Repairing the Car Without Informing the Insurer

Following an accident, it’s crucial to wait for a thorough inspection by a surveyor before proceeding with vehicle repairs. 

Repairing your car before this assessment could lead to claim denial, as essential evidence of the damage may be lost. The surveyor relies on this evidence to evaluate the extent of the damage accurately. 

Moreover, choosing a reputable repair shop is paramount. Opting for a questionable repair facility may exacerbate damages, and if the adjusters determine you’re at fault for worsened damages, your claim may face reduced compensation or denial. Ensure you take the right steps at the right time to safeguard your insurance claim.

How To Prevent Car Accident Claim Denial

Filing an accident claim requires careful steps to ensure you have the best chance for a successful claim. Here’s a breakdown of what you should do:

• Document the scene. Capture photos and videos of the accident scene, any injuries sustained, and damages to your property.
• Call 911. Alert emergency responders to the scene, ensuring medical assistance is provided, and the police can swiftly create an essential accident report.
• Exchange information with the other drivers. Obtain contact, insurance, and vehicle details from the other involved drivers, crucial for the claim filing process.
• Notify your insurance company. Reach out to your insurer promptly, providing comprehensive accident details and adhering to their instructions for claim submission.
• Notify the Department of Motor Vehicles (DMV). Comply with your state’s rules for reporting accidents to the Department of Motor Vehicles (DMV) to prevent potential license issues.
• Compile evidence. Organize and submit all relevant evidence, including photos, videos, medical records, police reports, and receipts, essential for supporting your claim.
• Contact an experienced lawyer. Seek advice from a seasoned personal injury attorney well-versed in claim procedures and timelines to ensure you navigate the process effectively.

How To Appeal a Denial

If your car accident insurance claim is denied, here are some steps to take so you can appeal the denial and potentially get the coverage you deserve:

• Review the denial letter. Thoroughly review the denial letter to comprehend the reasons behind the rejection and the specifics of your case.
• Understand your policy. Carefully read through your insurance policy, focusing on the terms, conditions, and coverage details related to your claim.
• Gather additional evidence. Collect any missing or additional evidence that could support your claim, addressing the concerns stated in the denial.
• Contact the insurance company. Reach out to your insurance company’s claims department to discuss the denial and seek clarification on the issues.
• Ask for legal advice. Consider seeking advice from a qualified personal injury lawyer experienced in insurance claim appeals to guide you through the process.
• File an appeal within the time limit. Prepare a formal, well-structured appeal letter addressing the denial points and presenting your case along with the new evidence.
• Follow up regularly. Stay in consistent communication with the insurance company, ensuring they receive and process your appeal in a timely manner.
• Consider alternative dispute resolution. If the appeal is unsuccessful, explore mediation or arbitration to resolve the dispute before taking legal action.
• Consider filing a case against the insurer. If all else fails, consult with your lawyer to file a lawsuit against the insurer to fight for the compensation rightfully owed to you.

Strengthen Your Auto Accident Claim

It’s frustrating to have your claims denied, but don’t let that stop you from getting the compensation you deserve.

At Adamson Ahdoot, our experienced car accident lawyers can handle your case with the attention to detail needed for personal injury cases. We also offer consultations in both English and Spanish to serve diverse motorists. Moreover, our civil litigation law firm has more than 100 years of legal experience, which can be beneficial to your claim. 

Contact us at (800) 310-1606 or visit our website for a free consultation.