If an insurance company denies your car accident claim, you can challenge its decision. Start by getting the denial in writing, gathering evidence that addresses the stated reason, and requesting a review or an appeal, if available. A denial does not necessarily end your claim.
At Miracle Law, APC, we work with people who are panicked after a car crash has left them with surprising expenses. Medical bills and car repairs cause stress for many families, who see a drop in income when an injured family member cannot work. You likely thought the claims process would be easy and that you would receive a check in the mail by now. You are probably wondering, Why has the insurance company denied my car accident claim?
Our car accident claim lawyers can help. If the insurer denies your claim, don’t panic. A denial may reflect missing records or disputed facts, not an ultimate determination that your claim is without merit. Contact us for help responding to the denial.
Why Are Car Accident Claims Denied in California?
Insurance companies usually deny claims due to disputes over fault, questions about injuries, or missing information.
The Insurer Disputes Who Caused the Crash
The other driver’s insurer may argue that its insured did nothing wrong. Or it may argue that you caused the accident. Conflicting statements or the absence of witnesses can make fault harder to establish.
Being partly responsible does not automatically bar financial recovery in California. However, it reduces your damages by your percentage of fault. For example, if your damages total $100,000 and you are 20%responsible, your damages after the fault reduction would be $80,000.
You do not have to accept the insurance company’s fault analysis. Instead, you can gather evidence to show how the accident happened.
The Insurer Doubts Your Injuries
A claims adjuster may argue that your symptoms stem from an earlier injury or that you are not hurt. Delays in seeking care or gaps between appointments can raise eyebrows.
Address those questions with accurate medical records. Tell your providers about prior symptoms and explain what changed after the crash. A clear timeline can help explain circumstances that an adjuster might otherwise misunderstand.
Important Documents Are Missing
An insurer may deny your claim because it lacks supporting documentation. For example, missing medical bills can prevent an insurer from calculating the value of a claim. A missing police report might raise questions about when the accident happened.
Ask the insurer what documents are missing. Then confirm where to send them and keep proof of delivery.
The Insurer Raises a Coverage Issue
The insurer might claim the accident is not covered by the policy for various reasons:
- Excluded driver. The driver who caused the accident might not be covered under the policy, leading the insurer to deny the claim.
- Coverage lapse. The policy may have lapsed due to non-payment of premiums, so the insurer denies coverage.
- Prohibited use. The driver might have used the vehicle for a purpose the policy excludes, such as certain commercial activities. The insurer could cite this prohibited use as the reason for the denial.
The precise policy language matters. Ideally, a lawyer should review the policy in question. Request a copy of your policy if your own insurer denied coverage. If another driver’s insurer denied coverage, ask it to identify the exclusion or other policy provision it relies on.
The Insurance Company Argues Notice Was Late
Your own policy may require prompt accident reporting and cooperation with the investigation. An insurer may raise concerns about delayed notice or a failure to provide requested documentation promptly.
Respond honestly and explain why you delayed. For example, you could have been in the hospital, unconscious.
Late notice does not automatically justify denying coverage. For a typical auto policy, the insurer generally must show that the delay substantially harmed its ability to investigate or handle the claim.
What to Do If Car Insurance Denies a Claim?
A denial is a speed bump. It might be possible to challenge a denial and continue to seek compensation from an insurer. Here are the steps.
Request a Written Explanation of the Denial
Request written confirmation for any denial delivered over the phone. California’s claims regulations require written denials.
Some insurers refuse to offer specific reasons for the denial. That should raise red flags. If your own insurer has denied your claim, it must identify its reasons and factual and legal basis, including applicable policy provisions and an explanation of how they apply.
Read carefully. A denial based on disputed fault requires a different response from one based on an alleged coverage exclusion.
Find Evidence That Responds to the Reasons for Denial
The evidence that may help depends on the reason for the denial of your claim:
- Disputes regarding fault. Find copies of the crash reports or witness statements. Share photographs of vehicle damage and any video of the crash.
- Questions about the severity of your injuries. Use medical records to document your injuries and medical bills or insurance statements to prove the cost of care.
- Allegations of preexisting injuries. Seek medical records from prior physicians to distinguish your earlier condition from new injuries or worsening symptoms caused by the crash. Support your claim with statements from friends or family.
- Denials based on lapsed coverage. Find premium receipts or other proof that the policy had not lapsed.
A lawyer can help identify relevant evidence. The key is to support your claim. Although your own testimony is useful, insurers like to see third-party witness statements or documentation.
How Do I Appeal a Denied Insurance Claim?
You should contact the insurer and ask how to dispute the denial. Some companies offer an internal appeal. There is no single universal auto insurance appeal process that applies to all disputes. Confirm the procedure used by the insurance company.
Prepare a focused written response that includes relevant information:
- Claim number,
- Accident date,
- The decision you dispute, and
- The outcome you are requesting.
Explain why the insurance company was wrong to deny the claim. Address each reason given for the denial.
For example, if the insurer says you failed to yield, explain how a witness statement or video supports your account. You might also explain conflicting evidence. A witness might claim you ran a red light, but they were too far away to see what happened.
Keep a communication log with the date, the person you contacted, and a summary of the discussion. After a phone conversation, send a brief email confirming your understanding. This creates a useful record of the communication if disputes arise later over what was said.
Should You Consider a California Department of Insurance Complaint?
You might file a complaint if you believe the insurer handled your claim improperly. The California Department of Insurance regulates insurance companies.
Include the following information or documents:
- A copy of the denial,
- A copy of your written response,
- Supporting records, and
- A concise timeline.
The department provides an online consumer complaint process and a consumer assistance hotline.
A complaint allows the regulator to review the insurer’s conduct. It does not replace a lawsuit or guarantee payment. Continue protecting your legal rights while the complaint is pending.
What Deadlines Apply to a Car Accident Claim?
California generally gives you two years from the injury to file a personal injury lawsuit. Exceptions apply, and claims involving public entities can require earlier action.
Do not assume an insurance appeal stops that clock. Claims under your own insurance policy may also involve separate requirements and deadlines. Have a lawyer identify the deadlines for your situation before spending months waiting for another answer.
How Can a Lawyer Help with a Denied Claim?
Many injured motorists are confused about how to respond to a denial. An experienced lawyer can provide tips on what to do if car insurance denies a claim.
A lawyer can begin by comparing the denial with the available evidence and applicable law. That review helps identify whether the real obstacle is determining fault, missing information, or another reason.
From there, an attorney can obtain supporting evidence. A lawyer can contact witnesses to follow up on what they saw or search for video. A lawyer may strengthen your claim by seeking a medical explanation of your injuries. The goal is to answer the insurer’s objections with documented evidence.
Your lawyer can also document the full extent of your losses, including medical costs and lost income. An attorney might use this information when they appeal a denied insurance claim.
If negotiations fail, an attorney can evaluate a lawsuit against the responsible parties. The lawsuit seeks compensation for losses caused by the crash.
A lawyer can also evaluate a possible insurance bad-faith claim against your own insurer. A denial alone does not prove bad faith, but an inadequate investigation or an unreasonable denial of a covered claim may support a claim of bad faith. Disputes with another driver’s insurer generally require a different legal approach.
Take the Next Step with Miracle Law
Was your car accident claim denied in California? A denied claim doesn’t have to be the end of your case. Gather your denial notice and supporting records, then contact Miracle Law to discuss how to challenge the decision and pursue compensation.
Our firm listens attentively to our clients’ concerns and then finds a path forward to seek accountability and financial compensation. In a free consultation, we can review what steps to take if an insurance company denies your car accident claim.
Contact Miracle Law today to discuss your case.
Legal References Used to Inform This Page
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