Occasionally, insurance claims may be rejected by your insurance company. This may occur for several reasons; while some may be legitimate reasons, others are attempts to get you to drop or lower your claim. However, if your insurance rejects your claim, you can refute the rejection.
Your Insurance May Deny Your Claim If:
- Your claim request exceeds your policy coverage. In this case, your insurance will only reject the amount that exceeds your policy limits; leaving you personally liable for the remaining costs.
- You recently ended your coverage. If you attempt to submit a claim against a policy you no longer have, the insurance company will reject the claim.
- The accident occurred as a result of lawless actions.
- You did not pay your insurance premium on time.
- The insurance company finds that the accident was avoidable.
- Your negligent actions created, or significantly contributed to, the cause of the accident.
- The insurance company believes that your claim is fraudulent. Failing to report an accident to the police immediately after the fact, and/or failing to seek prompt medical treatment can cause an insurance company to believe that a claim is fraudulent.
- You failed to notify your insurance of the accident in a reasonable amount of time. In Utah, you must report an accident “immediately and by the quickest means of communication available”. Furthermore, you must file an accident report with your local law enforcement within 10 days of an accident. Failing to notify your insurance in a timely manner may result in a claim rejection.
What can I do if my Claim Gets Denied?
If you are notified of a claim denial, contact your insurance immediately. This will help you identify and possibly resolve any issues with your claim. If you believe your claim was wrongly denied, you can submit a report to your state’s insurance department; as auto insurance is regulated by each individual state.
You may also appeal the rejection through your auto insurance company’s formal appeals process. In some cases, you may have to resort to mediation or hire an attorney in order to compel the insurance company to negotiate with you on your claim. Furthermore, if you believe their reasons for rejection have no basis in your case, your insurance may have acted in bad faith.
What is a Bad Faith Denial?
A bad faith denial is evidence that the insurer is not living up to their contractual agreement with the claimant. When a person purchases insurance, their policy acts as a contract. The acceptance of this contract is reflected by the insured paying their monthly premium, and the insurance company accepting this monthly fee. Contracted parties have a duty to act in good faith. This means that the insurance company cannot deny a claim unless it violates certain conditions. However, if you find that your insurance company acted in bad faith you may file a lawsuit against them.
What are Other Reasons that My Insurance Company may Reject My Claim?
- You did not wear a seatbelt at the time of the accident.
- Your vehicle wasn’t in good enough condition prior to the accident to warrant compensation.
- Your negligent actions caused the accident.
- You sustained minimal injuries.
- Neither party involved in the accident contacted the police about the accident.
- Your name does not appear in the police report.
- You didn’t take an ambulance to the hospital, or you neglected your treatment by stopping treatment or missing appointments without the doctor’s authorization.
- Your injuries didn’t require any diagnostic testing.
- You have a history of mental illness/emotional difficulty.
- The treatment for your injuries wasn’t necessary for your recovery.
Were you or someone you know involved in a recent auto accident? Call Auto Accident Care Network now at 801-683-1948 to connect with a live care advocate. Our team at AACN can connect you to trusted attorneys and doctors to schedule a free legal consultation, a free thirty-minute massage, and a no-cost medical exam!