Reasons for Denial
There are a few main reasons an insurance company may deny your claim:
- Policy limits - If the claim exceeds your coverage limits, it may be denied.
- Exclusions - Damage not covered by your policy will be denied.
- Lack of coverage - Without the right coverage, your claim can be rejected.
- Law violations - Breaking laws like drunk driving can lead to denial.
Other common reasons include:
- Avoidable accidents
- Delayed reporting
- Fraudulent claims
Gather Supporting Evidence
If your claim gets denied, your first step should be gathering evidence to appeal the decision. Having documentation to back up your claim is essential.
Some key types of evidence to collect:
- Police reports - Obtain the official police report documenting details like who was at fault.
- Medical records - Gather doctor reports, ambulance records, hospital bills to show injuries.
- Repair estimates - Get written estimates from mechanics detailing damage and repair costs.
Other useful documents:
- Eyewitness statements
- Photographs from the accident scene
- Damage appraisals
- Rental car receipts
Here are some tips for gathering strong evidence:
- Move quickly to get records before they are lost or destroyed.
- Keep original copies for yourself and give insurers only photocopies.
- Highlight relevant sections in documents to make reviewing easier.
- Get multiple repair estimates for accuracy.
- Catalog and organize everything chronologically.
Having solid evidence will help prove your case and show the insurer:
- The accident circumstances.
- The extent of property damage.
- The severity of personal injuries.
- The costs incurred for repairs, medical care and more.
The more documentation you can provide, the better your chances of a successful appeal. Some key points to remember:
- Only submit factual documentation, not assumptions.
- Make copies so you have records as backup.
- Be thorough and detailed with all evidence collected.
- Keep a chronological accident timeline.
By gathering the strongest supporting evidence possible using police reports, medical records, repair estimates and other documents, you lay the groundwork for appealing a claim denial.
File an Appeal
Once you've gathered your evidence, the next step is filing an appeal with the insurance company.
Here are some tips for starting the appeals process:
- Review the denial letter and policy. Know exactly why your claim was denied.
- Follow your policy's guidelines for appeals. There are usually specific procedures to follow.
- Act quickly to meet any deadlines for contesting a claims decision.
- Draft an appeal letter explaining why you disagree with the denial and include supporting documents.
- Provide copies of all evidence collected - police reports, medical records, repair estimates, etc.
- Quote relevant sections of your policy showing what is covered.
- Request a new investigation into the claim and that they reconsider based on your evidence.
- Keep thorough records of all appeal correspondence and confirmation of delivery.
Some other best practices when filing your appeal:
- Be polite, but firm in the appeal letter. Avoid emotional language.
- Send the letter by certified mail for confirmation of receipt.
- Keep a copy of the appeal letter and evidence for your records.
- Call to confirm your appeal was received if you don't get confirmation.
Table 1: Appeal Letter Checklist
| Item | Details | Completed |
|---|---|---|
| Denial letter referenced | Quote denial reference # | [ ] |
| Policy quoted | Cite relevant policy sections | [ ] |
| Evidence provided | Copies of police reports, medical records, etc. | [ ] |
| Timeline of events | Chronological sequence of events | [ ] |
| Request investigation | Ask for claim reevaluation | [ ] |
Filing a thorough, detailed appeal supported by strong evidence gives you the best shot at getting wrongful denials overturned. Be sure to fully understand why your claim was denied and address those points in your appeal. With patience and persistence, you may eventually get a denied claim approved.
Seek Outside Help
If your appeal is unsuccessful, consider seeking outside help from experts.
Hiring an attorney with insurance claim experience can be beneficial for several reasons:
- They have extensive knowledge of state insurance laws and regulations.
- They can review your case details and provide an expert opinion on your options.
- They can represent you in negotiations with the insurance company.
- They may be able to compel the insurer to reinvestigate your claim.
- They can help file a lawsuit against the insurer if necessary.
When looking for the right attorney, make sure to:
- Ask about their specific experience with insurance claim denials.
- Understand fee structures - some work on contingency fees.
- Check reviews and references from past clients.
- Choose someone you feel comfortable working with.
You may also want to contact your state insurance department to file a complaint:
- They can provide information on your rights and options.
- They may be able to intervene or conduct an independent review.
- It creates a formal record of your dispute.
When filing your complaint:
- Find the appropriate contact for your state.
- Provide background details on your claim and denial.
- Submit copies of any documentation.
- Note what resolution you are seeking.
Retaining legal counsel or enlisting your state insurance department are two options to pursue if you are unable to resolve a wrongful denial on your own. They have methods of applying pressure on insurers and getting unjust denials overturned.
An attorney and the insurance commission won't guarantee success, but they can significantly help improve your chances. If you have strong evidence supporting your claim, it's worth exploring outside assistance to fight a denial.
Consider Lawsuit
If your appeal and outside help are still unsuccessful, you may need to consider a lawsuit against the insurer.
Reasons you may want to file suit:
- You have strong evidence of bad faith denial by the insurer.
- A large dollar amount is at stake in the claim.
- The insurer continues to be unresponsive or unreasonable.
Be sure to:
- Consult an attorney experienced with bad faith claims.
- Assess time and costs required to pursue legal action.
- Determine if the potential payoff outweighs the risks.
Lawsuits should not be undertaken lightly. But if you have solid proof of egregious misconduct by the insurer and they refuse to negotiate fairly, legal action may be your only recourse.
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