Insurance Claim Denied? Who has the final say?

When your insurance claim is denied, you might feel disappointed and scared. Just remind yourself that it is not the final word. Some states and insurance companies have appeal processes, which means you can argue your case.

There are a few reasons for denied claims, including incorrect information, unanswered questions on the application, or because of lack of due care (leaving valuable items in your vehicle), which might indicate that you are not covered under the terms of the policy.

When an insurance company denies your claims, there is no need to fear that you will not be able to cover your bills or compensate for your lost wages. You can always appeal that decision.

Denied Claim

The insurance company must give you a copy of their Product Disclosure Statement. The PDS is part of the agreement between the insurance company and you. It sets the circumstances where the insurer might decide to deny the claim to their client.

It might be full of legal phrases and terms you are not familiar with. Make sure you learn what everything means; another option is to hire a car accident attorney who will explain things to you.

If the PDS excludes a claim, there are cases where the insurance company might be required to pay partial or complete claim to their client.

If you did not tell your insurer a detail about the subject of the insurance policy, such as a car, home, or other property, it means that you failed to comply with your duty of disclosure.

Your insurer could deny your claim if the information you offered was not relevant for the company.

Unclear Liability

There are car accident cases that occur under circumstances that make it difficult to tell which party caused the collision. Such is the case with multi-vehicle collisions. Every driver has partial responsibility, but each driver’s insurance company will blame the other drivers. This happens because insurance companies are trying their best to pay less.

If you were involved in a car accident where the liability is not clear, the best thing you can do is file your injury claim with every driver’s insurance company. Then all you can do is wait for the outcome. Be prepared that one or more of the insurers will deny your claim.

If you were injured in the accident (especially if it was severe), you should get compensation. If that does not happen, it is time for you to hire legal help.

If your insurance claim is denied, don’t worry; the adjuster might have the last word, but you and your attorney will appeal the decision and will fight until you get a settlement.

Insurance Policy Might Be the Reason for Denying

Claim adjusters usually deny insurance claims because there was no “available coverage” for the injuries of the client. Some of these policy reasons are legitimate, while others are not.

If you speak to the insurers over the phone, don’t accept the denied claim over the phone. Insist they send you a written explanation with the reasons of why your claim was denied.

What to Do if Your Insurance Claim is Denied

Before you do anything, make sure you read your policy documents. People often read summaries and don’ read every sentence of their policies, which might have the answer. If anything is poorly explained, note it and later ask the insurance company to explain to you better. An insurance company could not deny your claim if you answered every question they asked in the form. In case you forgot to do this, they have the right to deny your claim.

Contact the insurance company and ask everything you want to know. You can also send a complaint in a formal letter.

Writing a formal complaint letter should be done like this:

First of all, put the date on the letter and write down your full name and policy number. Mark the letter “complaint” at the top and include evidence that can support the complaint. Write clearly and with facts about why you are writing the complaint.

Explain why you think their decision is not right and why your claim should not be rejected. Be honest that you are not content with their response and that you will take the matter to a higher instance.

If you have second thoughts and are not sure about the outcome of your denied claim case, hire a personal injury lawyer.

We’re a team of personal injury lawyers near you in Baton Rouge, LA who will help you get your compensation. Call (225) 240-4053 and schedule your free consultation.