Disputing Auto Insurance Claims: Can It Be Done?

When an auto insurance claim is closed, it means the insurance company has finished its review and made a final decision. However, this does not mean it cannot be disputed or reopened. If you believe you are being unfairly blamed for causing a crash, you can dispute the fault finding. This can involve gathering evidence, such as witness testimonies, photographs of the accident scene, and vehicle damage inspections, to build a case that demonstrates you were not at fault. Disputing a fault finding can also include requesting an amendment to the police report or fighting any tickets received in connection with the accident. It is important to notify the insurance company of your disagreement and to utilise their fault dispute processes. In some cases, you may need to involve a lawyer, especially if you plan to take legal action.

Reasons for disputing a closed claim

A closed auto insurance claim can be disputed for several reasons. Here are some common reasons for disputing a closed claim:

• Inadequate payout: The payout from the insurance company may not be sufficient to cover all the damages. Often, the full extent of the damages may not be apparent immediately after the accident, and people may discover additional issues later on.
• New evidence: There may be new evidence that was not considered in the initial investigation. This new evidence could support the claim and potentially lead to a reconsideration of the case.
• Disagreement over fault: There may be a dispute about who was at fault in the accident, especially if another driver is involved and there is a disagreement about the events that occurred.
• Loss of no-claims discount: The policyholder may dispute the loss of their no-claims discount if they believe it was lost through no fault of their own.
• Inadequate repairs: If repairs to the vehicle following an accident are not carried out properly, the policyholder may dispute the claim and seek further action.
• Driver not on the policy: If the person who caused the accident is not named on the insurance policy, the claim may be denied. For example, if a teenager with a learner's permit was driving with a parent and caused an accident, the claim could be rejected.
• Insufficient coverage: If the policy limits are not high enough to cover the expenses associated with the accident, the insurance company may deny the claim. For instance, if the policy has a $50,000 limit in property damage but the vehicle is totaled and worth $80,000, the policyholder would have to pay the difference.
• Lapsed coverage: If the policy is no longer active or has lapsed, the claim may be denied. This could happen if the policyholder missed the deadline to renew their insurance or file a claim.
• Business use of the vehicle: If the vehicle was being used for business purposes without the insurance company's knowledge, the claim may be denied.

Appealing a closed claim

If your auto insurance claim has been closed, it means the insurance company has finished reviewing it and has made a final decision. This could mean they have paid out on the claim in full or in part, or they have offered a settlement amount to resolve the claim.

However, this does not mean the claim can never be reopened. You can appeal the decision by following these steps:

Review your claim denial or settlement offer letter:

Understand the insurance company's stance on your claim. The letter should outline why they made their decision, which can give you a starting point for your appeal.

Research your auto insurance claim rights:

Knowing your rights will empower you to take the right action when appealing your claim.

Write a claims appeal letter:

After reviewing the information in the denial letter, start gathering information to dispute the claim. Outline your case and request a review of the decision.

Provide evidence:

Gather and submit evidence to support your appeal, such as physical and digital copies of documents related to your claim, photos of property damage and injuries, and invoices from medical providers and auto repair shops.

Consult an attorney:

Appealing a claim denial can be complex, and an experienced auto accident lawyer can guide you through the process. They can review your claim denial letter and policy, gather evidence, and represent you in negotiations with the insurance company.

It is important to act quickly, as most insurance policies only provide a limited time frame, often 12 to 24 months, to take action against a claim denial.

The role of a lawyer in disputing a closed claim

When an insurance claim is closed, it means the insurance company has finished reviewing and has made a final decision on the claim. This could mean they have paid out on the claim, offered a settlement, or denied it. If your claim has been denied, a lawyer can help you dispute the decision.

An insurance claims lawyer will protect your interests and ensure you don't make mistakes in your claim. They will review your entire claim file, including policy documents, to identify if the closure has legal grounds and if the adjuster missed any key information supporting your claim. They can also handle all communication with the insurance company, which often results in more thoughtful responses from adjusters, who are more open to settling or reopening disputed claims.

A lawyer can also submit appeals or complaints that may trigger regulatory action, and they can represent you in insurance litigation and lawsuits. Their in-depth knowledge of insurance policies and appeals processes can help you recover adequate compensation after an insurance denial.

If you are disputing a fault finding, a lawyer can help you build a case and present new evidence to the insurance company. They can also advise you on whether it is worth disputing a fault finding, as this may not always be in your best interest.

In addition, a lawyer can review your insurance policy before you file a claim to help you understand the legal jargon and technicalities that may affect your claim. This is especially useful if you have a large or complex case and think a lawyer will be able to get you a higher payout.

Common reasons for claim denial

When an insurance claim is closed, it means the insurance company has finished its review and made a final decision on the claim. This could mean paying out on the claim in full or in part, or offering a settlement amount. However, a closed claim can be disputed and there are several common reasons why an insurer might deny a claim.

• Coverage Limitations: The loss claimed falls under an excluded category not covered under the policy. For example, flood damage may not be covered by a standard homeowner’s policy.
• Disputes Over Cause of Loss: The insurer alleges the damage was caused by negligence or improper maintenance rather than a covered risk like storm damage.
• Pre-Existing Conditions: The insurance company claims the loss stems from a pre-existing issue excluded from coverage. For example, claiming water damage from a pipe that had already rotted.
• Errors or Misrepresentation: Errors in the information provided could allow insurers to claim misrepresentation and deny the claims. Even unintentional mistakes can lead to problems.
• Lack of Cooperation: Failing to provide requested claim-related documents in a timely manner may cause the adjuster to close the claim. This could be anything from proof of repairs to not showing up for inspections.
• Fraud: If the adjuster believes false statements have been made, or that damages have been exaggerated or fabricated, they may suspect fraud. While rare, this can lead to a claim being quickly closed and denied.
• Lapsed Insurance Policy: If you fail to pay your insurance premium on time, your coverage may lapse, meaning you don’t have an active policy to file your claim against.
• Violation of State Law: If you were driving while intoxicated, without a valid license, or without valid auto insurance, your claim may be denied.
• Miscellaneous Reasons: Insurers may deny your claim based on circumstantial evidence or doubt. For example, if you did not report the accident immediately, or did not seek immediate medical attention, leading the insurer to suspect you are claiming for injuries unrelated to the accident.

The process of disputing a fault finding

When an insurance claim is closed, it means the insurance company has finished reviewing and has made a final decision on the claim. This could mean they have decided to pay out on the claim (in full or in part) or offer a settlement amount to resolve the claim. However, this does not mean that the claim can never be disputed or reopened.

If you believe you are being unfairly blamed for causing a car accident, you can dispute the fault finding. Here are the steps you can take:

• Notify the insurance company of your disagreement: Let the insurance company know that you disagree with their finding of fault and intend to take action by presenting new evidence and/or explaining your side of the story. This can be done via phone and in writing through a follow-up letter or email.
• Utilize the insurance company's fault dispute processes: Some insurance companies have internal policies for disputed fault investigations. They may ask you to give a statement or present your side of the story to an insurance adjuster. It is important to know your rights and consider consulting a lawyer before making any statements.
• Request an appraisal: If your policy includes an appraisal process, you can resolve disputes about the amount of damage by hiring an appraiser. The insurance company will also hire an appraiser, and both appraisers will choose a third appraiser as an umpire. The appraisers will review your claim and estimate the damage. If their estimates differ, the umpire will make the final decision.
• Ask for an amendment to the police report: If you disagree with the police report, try to speak with the investigating officer and present your side of the story. You may be able to request an addendum or correction to the report.
• Fight any tickets received over the accident: If the insurance company's determination is based on you receiving a traffic violation, you should contest the ticket in court. Even if you don't succeed, it shows the insurance company that you are serious about protecting your rights.
• Seek legal help: If you are still not satisfied with the outcome of your claim, you may need to take legal action. Consult an experienced insurance claims lawyer who can guide you through the process and protect your interests.

It is important to act quickly, as most insurance policies only provide a limited time frame to take action against a claim denial. Additionally, gathering evidence to support your case is crucial. This can include witness statements, photographs of the accident scene and vehicle damage, and any relevant documents such as medical treatment records or dashcam footage.

Frequently asked questions