What to Do If a Car Insurance Company Denies Your Claim
December 29, 2022
While handling the fallout from a car accident can be a stressful experience, you might take comfort in the fact that car insurance will help you cover your financial expenses and losses. However, you may end up shocked when you receive a denial notice from the insurance company. Here is what you need to know about a car insurance claim denial.
What Happens When the Insurance Company Denies Your Claim
When you file a claim with your car insurance company or the other driver’s insurer, the insurance company will assign an adjuster to the case. The adjuster is responsible for gathering and evaluating evidence and documents from the accident to determine whether the insurance company is liable to pay coverage on your claim, as well as how much compensation you may be entitled to.
If the adjuster determines that your claim is not covered by the relevant policy, the insurance company will send you a formal letter advising you that the insurer is denying your claim and setting forth the reasons why the insurance company has decided to deny your claim. The letter will also advise you of your rights to contest or appeal the insurance company’s decision.
Common Reasons for Claim Denials
There are multiple reasons why an insurance company may decide to deny a car accident victim’s claim. In addition to evidence weighing against your right to coverage, other common reasons for the denial of car insurance claims include:
- Coverage is precluded under a policy exclusion – Common exclusions that lead to denials of coverage include household member exclusions (which excludes coverage for a household member who drives the insured vehicle but is not a named insured on the policy), family exclusions (which prohibits household family members from filing liability claims), and owned vehicle exclusions (which excludes coverage for accidents that occur with a vehicle covered by another insurance policy)
- Exhaustion of policy limits – Insurers may partly or fully deny claims that exceed the insurance policy limits or when the limits have already been exhausted by other claims
- The at-fault driver was not a named insured on a policy – Insurers will also deny claims against drivers who are not named as insured on the relevant vehicle policy
- Lack of serious injury/”full tort” option not selected – In Pennsylvania’s no-fault auto insurance system, an injured car accident victim may not sue an at-fault driver for non-monetary losses unless they have selected the “full tort” option in their insurance policy, or they have suffered a “serious injury” involving impairment of a bodily function, loss of a body part, or serious, permanent disfigurement
- Lapse of the applicable insurance policy due to the failure to pay premiums, failure to renew the policy at the end of the term, or suspension or revocation of the policyholder’s driver’s license or vehicle registration
Read more: Top Three Types Of Car Accident Injuries
How to Appeal a Denied Claim
Because you normally have the right to file an internal appeal to contest the denial of your car insurance claim, the steps you need to take to appeal your denied claim include:
- Gathering any additional evidence not already submitted to the insurance company, including evidence you uncovered after filing your initial claim
- Hiring a car accident attorney who can review the denial letter and help you craft an appeal strategy
- Drafting your appeal letter to identify additional evidence or evidence that may have been overlooked by the insurance adjuster, and to assert your arguments as to why the insurance company may have incorrectly denied coverage
Contact a Pittsburgh Personal Injury Lawyer to Discuss Your Car Accident Case in Pennsylvania
Did you or a loved one sustain serious injuries due to a car accident in Pennsylvania? Don’t let the medical bills pile up while you wait for the negligent party or their insurance company to do the right thing. Right now, you need an aggressive personal injury attorney on your side, fighting to get you the compensation you need, want, and deserve. The skilled attorneys at Goodrich & Geist, P.C. represent clients injured because of car accidents in Pittsburgh and the surrounding Western PA counties. Call 412-837-8426 or fill out our online contact form to schedule a free consultation about your case. We have an office conveniently located at 3634 California Ave., Pittsburgh, PA 15212. Home visits can be arranged in certain situations.
The articles on this blog are for informative purposes only and are no substitute for legal advice or an attorney-client relationship. If you are seeking legal advice, please contact our law firm directly.