Auto Claim Denied? Here’s What to Know

One of the most difficult things for someone to experience after an auto accident is having an auto claim denied by insurance. After an auto accident, you should be compensated for your lost wages from work, damages and medical expenses due to someone else’s actions or negligence. Unfortunately, insurance companies take a close look at every possible angle to decide who was at fault for the accident so that they don’t have to pay the claim.

After you receive notice of a claim denial, you may feel that you have no other choice but to pay for all your damages out of your own pocket and cover any associated losses. However, you do have other options, including appealing the claim with the help of an auto accident lawyer and making a formal demand for the compensation you deserve.

Find out the Reason for the Denial

Before you can take any step to appeal a claim, you need to understand exactly why it was denied. Did you, for example, wait too long to report the accident to the auto insurer? Does the injury fall under the coverage terms of your policy? Are there specific policy exemptions that your injuries are falling under? Is your policy still active? Any of these situations can be used by the insurer to deny a claim. In addition, an insurance company can deny a claim for other reasons, such as:

•       You are found to be at some fault for your injuries
•       Your claim documents have inaccurate information
•       Your health records and/or medical bills have errors
•       The medical procedure(s) you need aren’t covered by the policy or have been labeled not medically necessary

Take a close look at your denial notice to see if the insurer included a reason for the denial. Once you know why a claim was denied, do what needs to be done to prove your case so that your insurance company can’t deny your claim again when you reapply. Keep all notices you receive from your insurance company organized so you have evidence of what’s going on with your claim and why, and forward copies to your attorney as needed.

Send Your Demand Letter

You need to create a formal letter that spells out your case and states exactly why you should receive compensation. This letter should go into detail outlining why you believe the other driver is the one at fault for your injuries and why you are asking for compensation and treatment. You may have additional items, such as photos or documents, that you can send along with the letter to further back up your case. If you have legal representation, they can help create this letter for you.

Start the Appeals Process

Most insurance companies have an appeals process in place. In Washington, it’s worth noting that if you can’t resolve the claim denial via the insurance company’s process, you can use an independent third-party review service.

The length of the appeal process varies by insurer and case. Since the appeals process can seem foreign or confusing to someone who is not familiar with it, it’s a good idea to have an auto accident lawyer help you with it. An experienced attorney will be familiar with the appeals and review processes already, and they can guide you through it and assist you. Your attorney also has legal experience that can give you an advantage that you would not have otherwise.

Any time you feel an insurance claim has been wrongly denied, you should appeal the decision. If that still does not settle the issue, you also have the option of suing the insurance company to get them to honor their half of the insurance agreement.

You should be able to receive compensation when you are hurt in an accident and not at fault. Even if the insurance company denies your claim, that doesn’t mean you simply are not entitled to receive anything for your pain, suffering, and losses. Sometimes, you have to fight to receive what you deserve, but you can hire an experienced attorney to handle the fight for you so you are better able to focus on your recovery instead.

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