APPEALING A DENIED CLAIM BY AN INSURANCE COMPANY

When an insurance company denies your car accident claim, you should follow up. It’s up to you to take action following an initial denial. By the time a claim investigator formally refuses to pay for your bodily injury and/or property damages, he or she has already gathered enough evidence to support a denial position in court. The investigator may be open to negotiation eventually, but he or she will likely do nothing more until you take action. Once the investigator formalizes your liability denial, he or she may expect you to simply give up and go away.Companies reconsider their position only if you provide new facts, additional evidence, or a legal theory that forces them to reexamine their original conclusion. Legally, insurance companies must maintain a reserve on their books, but the person handling your claim simply closes out your active file and waits for the statute of limitations to run. Insurance companies understand that many people choose not to fight back because the issues are complicated and the process is often challenging.


APPEALING A DENIED CLAIM
- It is important to know why the claim was denied (the reasons presented by the insurance company as to why your claim should not be granted). As such, it would be appropriate to request for a written explanation of the details of reason why the claim was denied as an initial step into appealing the denied claim. (ENQUIRE WHETHER THE CLAIMS DEPARTMENT FOR THE INSURANCE COMPANY HAS ISSUED A LETTER EXPLAINING THE RATIONALE FOR THE CLAIM DENIAL. If you didn’t receive a written explanation, contact the claim representative who denied your claim and request a letter outlining his or her decision.)
- It is important to establish whether the car insurance policy includes accident/collision coverage. If YES, the car insurance company should pay the claim.
- It is also important to retrieve the records and receipt that would be appropriate regarding the insurance to support the claim.
o Police report
o Photos at the scene (to establish who was at fault and the possible cause ascertained)
o Witness statements
- It is also important to check the company’s website for appealing process or any forms that are required to appeal a denied claim.
- The next possible option would be the lawyer to draft a demand letter to the insurance company prompting action in the case of failure to fulfill the claim (through a suit).
- Issues to address in liability claim/lawsuit include:
o Insurers must implement proper claims investigation standards.
o Insurers can’t deny a claim without a reasonable investigation.
o Insurers must also acknowledge communications and act promptly.
o The liability coverage was active at the time of the accident.


Note:
When an insurance company suspects you of fraud, it can both insult and frustrate you. Claim investigators are responsible for identifying suspicious claims. They see every claim as potentially fraudulent until they decide otherwise. They look at every injured claimant’s economic situation, income, injuries, and accident circumstances. If they find a combination of circumstances that might indicate fraud, they might deny your claim.
o You can present your case and wait for the insurance company to resolve its suspicions. Unfortunately, when an injured person pushes too hard to have his or her claim resolved quickly, it’s often considered a sign of fraud.


PARTING SHOT: Institute the process of a lawsuit to make the insurance company compensate the client.