Responding to an Insurance Claim Denial
Find out why car insurance companies refuse to admit responsibility and reject accident claims. Allowing the insurance adjuster to have the last say is not a good idea.
After an accident, you have a lot on your plate as you strive to recuperate from your injuries and return to work. It might seem outrageous when the other driver’s insurance company rejects blame or refuses to pay your claim.
Adjusters often refuse insurance claims by assigning blame to the victim or claiming that the victim’s injuries are not covered by “available coverage.” Some of these arguments are reasonable, while others are not.
You don’t have to accept “No” as an answer, thankfully. Here, we’ll go through some of the most typical causes for accident claim rejections, as well as your choices for suing the insurance company for reimbursement.
SHARED RESPONSIBILITY FOR THE CRASH
Insurance adjusters are taught to handle car accident claims as soon as feasible and for the least amount of money possible. The amount of money saved by the adjuster determines the adjuster’s year-end bonus.
One of the most typical reasons for an insurance company’s refusal to take responsibility is to blame you rather than accept accountability on behalf of their covered motorist.
Suppose you share any guilt for causing the accident. In that case, they may dismiss your claim under the pure contributory fault rule in Alabama, Maryland, North Carolina, Virginia, and the District of Columbia. You receive nothing if you’re even a tenth of a per cent responsible for the accident.
In most jurisdictions, modified comparative fault laws apply, which means that if you’re equally or more to blame than their insured, the insurance company may dismiss your claim. You may be entitled to a part of your claim’s value if you share less than half of the fault.
Insurance adjusters may incorrectly attribute blame to injured victims, resulting in claims being refused. The victim may have just a tiny fraction of the blame if any at all. Because the adjuster is driven to find a reason to reject your claim, their judgement may be skewed.
NO ONE WAS TO BLAME FOR THE ACCIDENT
The insurance company for the other motorist’s driver may disclaim liability, claiming that no one was to blame for the collision. When responding to a traffic collision, police may choose not to issue a traffic penalty or offer their view of guilt on the accident report.
The officer might not issue a citation to either motorist if there was no clear traffic infraction. For instance, if the roads are extremely ice or snow-covered, if thick fog appears suddenly, or if the other motorist has a medical issue while going.
Even if the police record does not assign blame for the accident, all is not lost if the insurance company refuses to accept liability for its insured.
If you’ve selected optional MedPay coverage, your insurance provider may pay for minor injuries. Similarly, your collision coverage should cover the cost of repairs to your car. In any event, your insurance company will seek repayment from the other driver’s insurance company for the money they paid on your behalf, as well as any deductibles.
You’ll need a personal injury attorney to handle your claim if you’ve sustained more significant injuries. When an accident attorney is engaged, the other car insurance company is more likely to pay the claim, particularly if litigation is possible.
PASSENGER RISK ASSUMPTION
Assumption of risk is a legal notion that states that the victim brought injure to himself. A proper assumption of risk requires that the injured party was aware that they would enter a potentially dangerous situation and decided to proceed nevertheless.
Depending on the circumstances of the collision, insurance companies may refuse injury claims filed by drivers and passengers by claiming assumptions of risk. That does not necessarily imply that the insurance company’s judgement is accurate.
Accidents involving the following often result in allegations of assumption of risk: Drivers or passengers in moving cars who were not wearing seat belts Motorcycle drivers or passengers who were not wearing a helmet Passengers who choose to travel with an inebriated driver.
Jimbo was tested for alcohol at the hospital and found to be barely above the legal limit.
Cletus was in the hospital for two months, including weeks of rehabilitation for brain damage. Cletus’s family filed a personal injury lawsuit against Jimbo’s motor insurance company, seeking
$100,000 in damages.
The insurance adjuster refused Cletus’s accident claim, who claimed that Cletus was entirely to blame for his injuries since he willfully got into the car with a driver he knew had been drinking.
Cletus’s injury claim was handled by a personal injury attorney hired by the family. The attorney inspected Cletus’s medical records, who discovered that his blood alcohol level was quite high when he arrived at the hospital trauma unit.
Another demand was made for the insurance company by the attorney. Cletus had every reason to assume Jimbo would remain sober enough to drive safely, he said. According to witnesses, when the guys exited the bowling alley, Jimbo did not seem to be inebriated.
Furthermore, the attorney cited medical evidence demonstrating that Cletus was drunk when it came time to drive home and could not appropriately assess whether Jimbo was capable of driving safely. He did not make a “reasonable judgement” to take the danger of riding with a possibly intoxicated motorist.
The insurance company withdrew their claim rejection and paid Cletus the $100,000 policy limitations after realizing that Cletus’s attorney might build a strong case against them if they went to court.
SUSPICIOUS VICTIM INJURIES
If the adjuster feels your injuries are unrelated to the accident, the insurance company may refuse your claim. Because the accident did not cause your injuries, the adjuster will claim that their insured is not responsible for your injuries.
Insurance companies often question injuries for the following reasons:
Delay in seeking medical attention: If you don’t seek medical help right away after a car accident or deny medical help at the scene, the adjuster may claim you weren’t hurt.
Prior conditions: If your medical records demonstrate that you have a preexisting ailment or medical condition comparable to your claimed injuries, the adjuster may argue that the car accident did not cause your injuries. Therefore, their insured is not responsible.
Even if the injury is minor, you should seek medical attention right away. There’s a chance you’ve sustained serious injuries that won’t show symptoms for many hours or days.
If you delay treatment, you or your attorney may be able to establish the cause of your injuries using evidence such as witness testimony and medical records.
NO ONE KNOWS WHO IS TO BLAME FOR THE ACCIDENT.
It might be difficult to determine who caused an car collision in certain cases. Multi-car accidents, in which many cars are involved, are an excellent illustration. Each driver’s insurance carrier will very certainly blame the other drivers.
In this circumstance, your best choice may be to submit an injury claim with the other driver’s insurance carrier and wait for the companies to fight it out, most likely in court. In the meanwhile, your claim may be denied by one or more insurers.
Make sure to report the accident to your insurance carrier. Your insurance company will very certainly get many claims.
Unless you escaped a multi-car collision with just a few bruises, you might want legal assistance to get just compensation.
INSURANCE RULES FOR NO-FAULT SITUATIONS
In most situations, if you’re in a car accident and reside in a state with no-fault insurance regulations, you won’t be able to sue the other driver for personal injuries.
You may file a property damage claim against the at-fault driver’s insurance coverage.
You must first submit an injury claim with your insurance provider under your Injury Protection (PIP) policy in no-fault states. Regardless of who caused the accident, PIP pays for your medical costs, out-of-pocket expenditures, and lost income. PIP does not cover the costs of pain and suffering.
Suppose the cost of your injuries exceeds your PIP coverage. In that case, your injuries are debilitating, or you otherwise satisfy your state’s “threshold” for injury claims, you may file an injury claim with the at-fault driver’s insurance carrier.
If the at-fault driver’s insurance company does not agree that you’ve satisfied the threshold, your claim may be denied. Personal injury lawyers should handle injuries that are serious enough to surpass the no-fault threshold.
You have every right to sue the at-fault driver for your losses in areas where conventional fault rules apply. If your damages exceed the driver’s insurance coverage limits, you have the legal right to sue the driver personally for the difference.
INSURANCE THAT HAS RUN OUT OF COVERAGE OR HAS LAPSED
If the at-fault driver is found to be uninsured, your claim may be lawfully dismissed.
Unfortunately, some drive without insurance on the road. These drivers may have had legitimate insurance coverage in the past, but their policies were not renewed, or their policies expired due to nonpayment of payments.
While driving without insurance is legally unlawful, the only consequence is a hefty fine or a suspended driver’s license in most situations.
It’s possible you won’t discover out the driver’s coverage has expired until after you’ve filed a claim with their insurer. Days after making your claim, you may get a call or letter claiming that no insurance is in force.
Even if an at-fault motorist produces what seems to be a legitimate insurance card, the coverage may no longer be legal. There might have been a time gap between when the driver failed to pay the policy payments when the policy was cancelled for nonpayment, and when the insurance card stated the policy’s expiry date.
Uninsured motorist coverage for bodily injury claims is almost always included in your car insurance, as is car damage coverage. A lawsuit against the at-fault motorist is another possibility, albeit it may not be worth your time if the individual has no assets or income.
DRIVERS WHO ARE NOT ALLOWED TO DRIVE ACCORDING TO THE POLICY
If the insurance did not cover the at-fault driver, the claim might be dismissed. The insurance company may claim that, even though your policy was active at the time of your collision, the at-fault motorist was not covered.
When a policyholder let someone else drive their car, they are protected under the policy’s “permissive usage” clause. However, insurance providers may refuse to cover high-risk drivers in the home.
A household member with a suspended license, a terrible driving record, or a DUI history may be expressly excluded from coverage.
You have a few choices if your car accident claim is dismissed because the car’s insurance policy does not cover the driver who struck you:
Take legal action against the uninsured motorist.
File a lawsuit against the policyholder who let a disqualified driver use their car.
Claim your policy’s uninsured motorist coverage and let your insurance company pursue compensation from the other driver or the car’s owner.
YOUR DAMAGES AREN’T COVERED ENOUGH
Some motorists only have adequate insurance coverage to drive lawfully in their native state. Each state has its own set of standards for minimum insurance coverage.
Scrupulous adjusters may attempt to take advantage of critically wounded car accident victims when the claim amount surpasses the at-fault driver’s liability coverage. If the losses exceed the at-fault driver’s insurance limitations, the adjuster may dismiss the claim owing to “insufficient coverage.”
Accepting a total rejection of your claim due to “insufficient coverage” is never a good idea.
Suppose the at-fault driver’s insurance company doesn’t have enough coverage to meet your injury expenses. In that case, they should “tender policy limits,” which means they should give up all available coverage, even if it isn’t enough to cover all of your losses.
You’ll need a qualified car accident lawyer to recover not just the at-fault driver’s insurance company’s policy limitations but also to defend your right to seek underinsured motorist coverage from your policy, if applicable.
INADEQUATE PROTECTION FOR MULTIPLE VICTIMS
In the same way, if several people are hurt in a car accident, there may not be enough money to go around. On most motor plans, bodily injury liability insurance provides two categories of coverage: per person and accident.
If the at-fault driver’s insurance coverage contains bodily injury limitations of $50,000 per person and
$100,000 per accident, this implies that no one individual may recover more than $50,000. However, no matter how many people are injured in an accident, there is only $100,000 in compensation. If three persons are wounded in a car accident, and each has a claim of $40,000 (for a total of
$120,000), there won’t be enough money to go around.
The insurance company may file an interpleader action in court, effectively requesting that the court determine how the available cash should be distributed among the wounded claimants.
While not precisely a denial, if your injuries are not as serious as those of the other victims, you may be left with nothing. You’ll need an attorney to represent you in court and persuade the judge that your claim is more important than others.
WHAT SHOULD YOU DO IF SOMEONE DENIES YOU FAIRLY?
Although your claim may be rejected for a good cause, don’t take the adjuster’s word for it. Suppose you believe your claim was wrongly rejected, regardless of whether you live in a no-fault insurance state or a classic liability state. In that case, you should contact an expert personal injury attorney to discuss your case.
Attorneys should always handle serious injure cases. Insurance companies are known for taking advantage of people who have been seriously hurt and aren’t represented by an attorney.
Most lawyers provide free consultations to car accident victims and agree to work on a contingency fee basis. If your case proceeds, you will not be required to pay anything until the attorney resolves your claim or you get a favorable court judgement.