What Are the Top Reasons for Insurance Denials?
Filing a car accident claim should be a simple process — since California is a fault insurance state, the person responsible for your accident is liable for your damages. However, insurance companies often deny claims for a number of reasons, ranging from questions of fault to bad faith practices. Understanding these common reasons can help you prepare for the claims process and appeal the decision, if necessary.
#1: Unpaid Premiums
The at-fault driver in your accident is responsible for making his or her monthly premium payments each month. If a policyholder does not pay his or her monthly insurance premiums, the company will deny your claim. Under these circumstances, you may file a claim under your own insurance if you have underinsured/uninsured motorist (UM/UIM) coverage.
#2: Late Reporting
After a car accident, there are a few actions you should take. You should call 911 to report the accident to law enforcement, you should seek immediate medical treatment, and you should contact a personal injury attorney to begin to file your insurance claim.
Waiting to report the accident to the insurance company can result in a denial — the company may claim it did not have enough time to investigate. Speak to your lawyer and request a copy of the at-fault driver’s policy to see what your reporting deadline is.
#3: Insufficient Coverage
The at-fault driver’s insurance policy may not have the appropriate coverage to pay for your injuries. All policies have limits on the amount of compensation the insurance company can disburse to victims, and if your damages exceed these limits, the company will likely deny your claim. In certain circumstances, the terms of the policy may not cover your injuries and the company will then deny the claim.
#4: Liability Disputes
Since California insurance claims rely on fault, the insurance company may reject your claim if it is unclear who caused the accident or if it believes you are responsible. The company may dispute the damages you claim, questioning whether or not your injuries are valid, and the treatment costs you claim are necessary. The company may also conclude that you are partially responsible for the accident; if you were at-fault for a portion of the crash, the company may use this information as grounds for denial.
#5: No Medical Records
After an accident, it is vital to seek medical attention immediately, even if you do not feel hurt. Medical expenses not only comprise the bulk of your settlement, but the medical records you receive from your visits are valuable evidence for your case. If you fail to receive medical treatment or wait days or weeks after the accident to see your doctor, the insurance company can use this information to dispute your claim’s credibility.
What to Do If an Insurance Company Denies Your Claim
After an insurance denial, you have two options you can pursue. You can appeal the insurance company’s decision and try to reach an agreement, and possibly file a bad faith claim against the company as well. You can also file a personal injury lawsuit against the at-fault driver in civil court. Different pathways work best for different situations, so speak to an attorney to determine which option is best for you.
From the beginning of your claim to the end of the lawsuit or appeal, you should have an attorney on your side. Lawyers represent the interests of their clients through numerous processes, including the initial claim, any appeals or bad faith actions, and lawsuits. If you haven’t reached out to a Bakersfield car accident attorney, contact a lawyer as soon as possible to discuss your claim.