If your car insurance claim is denied for any reason, you will receive a claim denial letter from the insurer.
Your claim could be denied because your policy is lapsed, you don’t have enough coverage or for some other reason.
If your claim is denied, you can appeal the decision—a lawyer can help but is optional.
Can your car insurance deny a claim if you’ve been involved in an accident? If you have found yourself in this situation, this question may be important to answer. There are multiple reasons why your car insurance claim might be denied. No matter the reason, if you are facing a denied claim, there are steps you can take to appeal the decision. Bankrate’s insurance editorial team researched some reasons why your claim might have been denied and shares some tips about what to do when car insurance denies your claim to help you decide what to do next.
What’s a claim denial letter?
After you file a claim with your auto insurance company, an insurance adjuster will be responsible for documenting the details of the accident. After analyzing the facts provided, the adjuster will determine whether or not the car insurance claim will be denied or accepted. If the accident is deemed not covered by your auto insurance policy, the insurance company will send you a formal letter stating what factors led to the decision.
A denied car insurance claim doesn’t necessarily mean the end of the claims process. If you do not agree with your insurer’s claim denial, you have the right to appeal the insurance company’s decision. If your insurance denies a claim, the reason for the denial will influence how you should go about the appeals process.
Why did my car insurance company deny my claim?
Depending on the circumstances surrounding your car insurance claim, several factors could lead to your claim being denied. Police reports, eyewitness statements, recreating an accident scenario and more can influence the outcome of a submitted auto insurance claim. In some cases, a claim could even be denied due to bad faith or misrepresentation of the facts, making it important to be truthful and accurate to your car insurance company when reporting your claim.
If you receive a denial letter, read it carefully, as it will typically include supporting evidence for the decision. Some common reasons a claim is denied include the following:
Failure to pay your insurance premium on time can result in a lapse in coverage, meaning you don’t have an active policy to file your claim against. Paying your auto and home insurance premiums on time is the best way to ensure coverage is in force when you have to file a claim. Whether you pay the policy term in full or use auto-pay to prevent missed payments, avoiding a lapse in coverage is crucial. In addition to the likelihood of your claim being denied, a lapse in coverage could also result in fines and other penalties, such as a suspension of your driver’s license and vehicle registration, depending on your state.
When you purchase car insurance, pay attention to the coverages you choose and what they provide financial protection for. For example, you may have an older car and feel comprehensive and collision coverage is not needed. However, if your car is stolen or you cause an accident, the insurance company will not be able to assist without the proper coverage.
When reviewing your claim, the adjuster can see your policy’s inclusions. Filing a claim for damage that you either lack coverage for or that is specifically excluded will result in a claims denial letter being sent by your insurer.
It can be tempting to choose state minimum liability limits to keep the cost of car insurance low. While you may save on your premium, if you are involved in an accident with several injuries to others or hit an expensive car or building, you may exhaust your liability limits and be vulnerable to a devastating financial loss. For example, say you have $25,000 in property damage liability coverage but you total a car worth $40,000. The auto insurance company can pay up to the $25,000 allotted, but deny the remaining $15,000, which could leave you vulnerable to a lawsuit for the remaining amount.
While most states require liability coverage, not all require uninsured motorist coverage. If someone causes an accident with you, provides false insurance information or does a hit-and-run, finding proper insurance details may be difficult or impossible. If you do not carry uninsured or underinsured motorist coverage, your claim could be denied.
In instances where another driver is considered at fault, and their auto insurance company denies the claim, there could be several reasons why. Some examples include providing incorrect insurance details or not having enough or the right coverage. Additionally, if an accident occurs in a no-fault state, you are responsible for paying for your medical expenses up to your policy’s limits.
What to do when car insurance denies your claim
You can appeal the decision if you feel an error has been made in the car insurance company’s claim denial. Most insurance companies have a process in place for you to contest a denied claim. Here are some steps to consider taking in appealing an auto insurance claim decision:
Gather evidence: Review any documentation provided by the insurance company and gather the evidence you need to appeal. This could include police reports, eyewitness information, photographs, medical reports and other supporting evidence. Make copies of everything to provide to the insurance company so you can keep the originals.
Draft an appeal letter: This letter will spell out why you do not agree with the insurance company’s decision. Make sure you explain why each piece of information was provided in step one, such as any police reports. Provide as much detail as possible, referencing policy information and the claims denial letter as needed.
Consider hiring an attorney: If you are not comfortable taking these steps or want an expert’s opinion, it may be a good idea to hire an attorney. They can review the case and supporting documents to draft a demand letter requiring the insurance company to respond and defend its claim denial. While it may cost you money upfront, it could be a worthwhile expense to have the claim denial overturned if you feel your insurer made the wrong decision.
Understanding the claim denial letter and why an auto insurance company decided not to make a payout is the first step in determining the validity of a denied car insurance claim. Most instances of auto claims denials are valid, although others may not be. In this case, appealing the insurance company’s decision can get the decision reversed or an offer made to cover the damages.
Learn more: Compare car insurance quotes
Frequently asked questions
While it is not necessary to have a lawyer draft your insurance claim appeal letter, it all depends on your personal preference. If you don’t want to incur the additional expense, you may consider drafting the appeal letter yourself. When writing, it could be helpful to review your policy in-depth to pinpoint exactly where you disagree with your provider’s decision to deny your claim. Stick to the facts and try to provide as much specific information as possible.
Each insurance provider uses their own unique algorithm to calculate your premium and take factors like your age (in most states), location, vehicle make and model and driving history into account to determine how much of a risk you are to insure. In general, the more high-risk your insurance provider deems you to be, the higher your premium will be. If you are involved in an accident, regardless of whether or not you were found at-fault, the statistics show that you are more likely to be involved in another one. This makes you riskier for your provider to insure.
The best car insurance provider depends on your unique insurance needs and personal characteristics. Location, vehicle type, coverage needs and other factors all play important roles in deciding which provider to go with. Most insurance experts recommend that you compare at least three car insurance quotes from multiple insurance companies (for the same types and amounts of coverage) to determine which company is right for you.
Restrictions on the number of times that you can appeal a car insurance claim denial will vary by carrier and state. Most states have a statute of limitations for appealing a decision rather than a limit on the number of times that you can appeal. You may be able to appeal to your insurance company multiple times based on the evidence you provide. If the outcome is not satisfactory, you can consider contacting a public adjuster to advocate on your behalf or file a complaint with your state’s insurance department to act as an intermediary for the dispute.
