Being in a car accident is stressful enough, and having your insurance company deny your claim can be even more infuriating. Whatever the basis for the denial, it is vital to remember that a denied claim does not necessarily mean that your case is lost. Determining the grounds for the refusal and how to appeal it effectively is essential.
With the information on what to do, you can protect your rights and stand a better chance of recovering a fair settlement. Knowing the causes of car accidents can also be decisive in apportioning blame and making your case more robust. This article explains the most critical things to do in case your car accident claim is denied and how to go about your case.
Understand the Reason for Denial
Before taking any further action, it’s essential to understand why your claim was denied. Insurance companies must provide a written explanation for the denial, typically called a “denial letter.” The denial letter will mention the real reasons for denial, which may be:
- Lack of coverage: The claim may be denied if the incident is not included in your policy.
- Fault issues: If the insurance company believes you are at fault, they will not compensate for damages.
- Policy exclusions: Your policy can exclude specific accidents or damage from coverage.
- Failure to report within compliance terms: If you did not report the accident within the time frame specified in your policy, this can lead to denial.
Once you find out why your application has been refused, carefully review the details. If you feel that the insurer’s reasons are false or misleading, you may find it worthwhile to appeal against their refusal.
Contact Your Insurance Adjuster
If your claim is denied, the next step is to contact your insurance adjuster for clarification. Sometimes, communication breakdown or miscommunication can lead to a denial, and discussing the matter with your adjuster might clarify things. Be prepared to provide any additional information or proof to substantiate your claim.
- Ask for a second evaluation: If you believe the denial was based on erroneous or incomplete information, request that your claim be re-evaluated.
- Supply supporting documents: If the insurance company lacks some supporting documents or there is new evidence, supply this data promptly to help clarify the issue.
A chat with your adjuster can sometimes lead to a reversal of the decision, especially if the reason for the denial was a technicality or miscommunication.
Appeal the Denial
You can appeal if your issue isn’t resolved after you speak with your adjuster. Most companies have an in-house appeals process, so you can challenge the decision if your claim was unfairly denied.
- Utilize the formal process: Check your insurance policy for steps and deadlines to appeal.
- Gather evidence: Provide any new or supporting evidence, including witness statements, accident reports, medical records, or photographs.
- Know your policy: Read through your policy thoroughly so that you know the terms in your favor. Utilize special conditions to support your case.
- Write a solid appeal letter: Be specific, complete, and persuasive in explaining why the denial was wrong.
A good appeal letter will give you your best chance of having the decision overturned.
Seek Legal Advice
A lawyer can help you understand whether the denial was lawful and whether you have grounds to pursue a lawsuit against the insurance company. Sometimes, you might need to sue the insurance company to claim what is legally yours. Your lawyer can also assist in negotiating with the insurer to settle the case out of court.
Use Alternative Dispute Resolution
If you are unwilling to undergo a lengthy court battle, you can look towards other resolution mechanisms, such as mediation or arbitration. Both give you a time-saving and cost-effective mechanism by which you can settle your dispute regarding your claim with the insurer.
- Mediation: Negotiation between you and the insurance company may be assisted by an impartial third-party mediator for a fair settlement.
- Arbitration: A third-party neutral will decide on your claim after hearing both sides in arbitration.