The Other Party's Insurance Denied the Claim, Now What?
You're absolutely certain that it was your turn to go after complying with the stop sign at a four-way intersection. But another motorist saw things differently. This resulted in your vintage Volkswagen Beetle getting t-boned by the at-fault driver's pickup truck. Thankfully you only suffered a bruised knee, but your car was totaled. You gather evidence by snapping a few pictures, jotting down contact information, and calling the other driver's insurance company to make a claim.
You followed the rules of the road. You insist the other driver was at fault. Still, the other party's insurance company denied your car accident claim. Now what? If you've been involved in a car accident and your insurance claim has been denied, this guide is for you.
Reasons an Insurer Might Deny Your Claim
There are plenty of reasons why the at-fault driver's insurer may have denied your car insurance claim.
Usually, the reasons fall into one of two main categories. Either the insurer's claims adjuster believes your claim lacks merit, or the insurer simply hopes you won't pursue the claims process further. The adjuster also may be relying on an eyewitness. Or it is choosing to believe its client's version of what happened in the absence of an official police report. Also, if there is a police report and the officer reports that who was at fault is undeterminable, then the insurer's claim adjuster may also deny your claim.
Other possible reasons for a claim denial by the other party's insurance company include:
- Exclusions in the policy: If an insurance policy excludes so-called "acts of God" (natural events), for example, an insurer may dispute your claim if it believes such an act — a sudden hailstorm, for instance — was the real cause of the accident and not the other driver's negligence.
- The policy has lapsed: If the other party failed to pay premiums, thus allowing their policy to lapse, the insurer may claim there was no insurance coverage at the time of the accident. In this case, you would need to rely on uninsured motorist coverage for compensation.
- Failure to notify the insurer in time: Policies typically dictate how soon an accident must be reported in order to be covered. This is why accident victims need to notify the other party's insurance company as soon as possible.
What To Do After the Other Party's Insurance Company Denies Your Claim
If you've received an insurance claim denial, you'll need to hire an auto accident attorney if you choose to fight the denial. After all, auto insurers make a profit by taking in more money in premiums than they pay out in claims. A claim presented by a personal injury lawyer, however, will usually carry more weight. It may be taken more seriously by the insurance adjuster.
Your attorney might first draft a demand letter. A demand letter is a more formal claim for compensation. It details:
- Your side of the story
- The dollar amount of the vehicle damage and/or bodily injuries sustained in the accident
- Why the other driver was the at-fault party
The insurance company will most likely provide a specific reason why the claim was denied. Or it will reverse its decision outright. It also may offer just a portion of the damages demanded.
You (or your lawyer) may suspect that the insurer engaged in improper claims practice prohibited by state law. If so, an additional claim on those grounds may get their attention in a claim letter. For instance, an Illinois statute (215 ILCS 5/154.6) lists numerous acts prohibited as improper claims practice. It includes the refusal to pay claims without conducting a reasonable investigation based on all available information. Your state may have a similar law for bad faith insurance claims.
Formal Appeals Processes
If the insurance company has a formal appeals process in place, this could provide your attorney with a platform for negotiation. This could potentially lead to a more favorable settlement compared to situations where only a unilateral demand for damages is possible. This may include the use of arbitration to resolve the matter. Some states, including New Jersey, require insurers to provide a formal appeals process for denied claims.
Dealing With Bad Faith Insurance Practices
Bad faith practices by an insurance company might manifest in several ways. These include:
- Unreasonable delay in handling your claim
- Denying a claim without a valid reason
- Not conducting a fair and thorough investigation into the accident
If you believe the insurance company is acting in bad faith, your attorney might take steps to file a bad faith claim on your behalf. Successful bad faith claims can result in the court awarding you additional damages beyond what was initially claimed. This is a way to penalize the insurance company for their behavior. In some cases, this may also include legal fees and interest on unpaid benefits.
Recovering Medical Expenses
Medical expenses can quickly mount following an accident. They can include:
- Hospitalization costs
- Doctor's visits
- Prescription medication
- Physical therapy
- Long-term care
These are often the backbone of your claim. You should document all your medical expenses meticulously. Share this information with your attorney. Your lawyer can use these detailed records to demonstrate the financial burden you've endured as a result of the accident. Medical payments are quantifiable proof of injury, making them invaluable in arguing your case and seeking just compensation.
Claiming Lost Wages
Lost wages, a common consequence of serious car accidents, can be claimed as part of your compensation. This includes not just immediate wages lost due to time off work for recovery but also future earning capacity if your injuries prevent you from returning to your previous line of work. To make this claim, you need evidence, such as pay stubs or tax returns, to establish your normal wage. You also need a doctor's note or medical records to verify the time needed off work for recovery. This information is used to quantify the amount of income you've lost as a direct result of the accident.
Ensuring a Fair Settlement
A fair settlement is one that compensates you adequately for both your tangible and intangible losses. While medical expenses and property damage are easier to quantify, other losses like pain and suffering or loss of enjoyment of life are subjective and harder to determine. In cases where the insurance policy's limits are insufficient, your attorney may suggest other potential compensation sources, such as your own underinsured motorist coverage.
Using Medical Records as Evidence
Medical records serve as crucial evidence in any personal injury claim. They document the extent and severity of your injuries, connect your injuries to the accident, and show your prognosis and future care needs. Your attorney will likely request complete access to your medical records and medical bills. They might even consult medical experts to understand the implications of your injuries better. All this helps build a strong case that links your injuries directly to the accident.
Proving Property Damage
Proving property damage is separate from your personal injury claim. When making a claim for your property damage, you should include photographs of your damaged vehicle from different angles, estimates for repair costs, towing costs, and the valuation report if your car was totaled. In some cases, your attorney might recommend hiring an independent appraiser to ensure an accurate valuation. This comprehensive documentation helps in proving the extent of the property damage.
Insurer's Obligation to Policyholders
Insurance companies have a legal obligation to their policyholders. This is often referred to as a "duty of good faith and fair dealing." This duty means that the insurer must:
- Act fairly and honestly towards its policyholders
- Provide timely and accessible communication
- Promptly process claims
Any failure to uphold these standards might constitute a bad faith practice.
Get Legal Advice for Your Insurance Claim
Car accidents are never pleasant, whether they result in catastrophic injury or just a scratched bumper. But if the other party's car insurance company denies your claim, things can go from bad to worse.
If you're uncertain about how to proceed, speak with an experienced personal injury attorney today. Many car accident lawyers offer a free case evaluation, during which they can assess your case and provide guidance.
Before scheduling your appointment, confirm the attorney's policies regarding initial consultations. By doing so, you can better understand the process and prepare for any associated costs. Taking the time to consult with a legal professional could be the first step in achieving a successful outcome in your personal injury case.
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