Battling The Insurance Bureaucracy: Strategies For Overturning Auto Claim Denials

If your auto insurance claim has been denied, all is not lost. There are several steps you can take to fight the decision. First, make sure you understand the reason for the rejection and get it in writing. Then, gather evidence to support your claim, such as police reports, eyewitness information, photographs, and medical records. You can also submit additional evidence to support your claim or file an appeal. If you believe the denial was improper, you can appeal the decision according to the carrier's guidelines. It's important to be persistent and not delay the process, as well as to get to know the appeals process and maintain records of disputed claims. In some cases, you may need to hire an attorney or file a complaint with your state's insurance department.

Submit additional evidence, such as police reports, photos, repair estimates, and medical records

If your auto insurance claim has been denied, you can submit additional evidence to support your claim. This could include a police report, pictures of the accident, repair estimates, or medical records and bills.

The police report is an important document that can provide a detailed and unbiased account of the accident, including information such as the time and location of the accident, the vehicles involved, the names and contact information of the drivers and witnesses, and a description of the accident scene. It can also include information about any traffic violations or citations issued, as well as the officer's initial assessment of fault. If you disagree with the police report, you can try to speak with the investigating officer to present your side of the story and request an addendum or correction.

Photos of the accident scene, including the positions of the vehicles, any damage to the vehicles, skid marks, and other relevant details, can provide visual evidence to support your claim. These photos can help insurance adjusters and other professionals involved in the claims process better understand the nature and extent of the damage and how it occurred.

Repair estimates from a reputable mechanic or auto body shop can provide an estimate of the cost to repair the damage to your vehicle. This can help demonstrate the financial impact of the accident and support your claim for compensation.

Medical records and bills related to any injuries you suffered in the accident are also important evidence. They can show the extent and severity of your injuries, the treatment you required, and the associated costs. This information can be crucial in demonstrating the impact the accident has had on your health and finances.

By submitting this additional evidence, you can provide further support for your claim and potentially increase your chances of a successful appeal. It is important to gather as much relevant evidence as possible and to submit it in a timely manner to the insurance company, following their guidelines and requirements.

File an appeal or request an appraisal, following the steps outlined in your insurance policy

If your auto insurance claim has been denied, you can file an appeal or request an appraisal. Here are the steps to follow:

Review Your Claim Denial Letter

First, carefully review the denial letter from your insurance company. Understanding the reason for the denial is crucial. Sometimes, a simple mistake or missing information may have resulted in the denial. If the denial is based on a more serious issue, such as the insurance company stating that your policy does not cover your specific incident, you will need to take further steps.

Review Your Insurance Policy

It is essential to thoroughly review your insurance policy to determine your coverage. Knowing your policy limits and coverages is vital to receiving the compensation you deserve. Familiarize yourself with the terms, conditions, and coverage limits outlined in your policy. This information will help you build your case for an appeal or request for an appraisal.

Submit a Claims Appeal Letter

The next step is to submit a claim appeal letter to your insurance company. In your letter, clearly explain the reasons why you believe your claim should have been accepted. Include any relevant evidence that supports your case, such as photographs, eyewitness reports, medical records, police reports, repair estimates, and any other documentation that strengthens your position.

Request an Appraisal

If your insurance policy includes an appraisal clause, you can exercise this option. Both you and the insurance company will hire independent appraisers to assess your vehicle and review the settlement offer. The appraisers will then negotiate to reach an amount that satisfies both parties. If they cannot agree, they will select an umpire appraiser, and you and the insurer will split the cost of this additional appraisal.

Follow the Steps Outlined in Your Insurance Policy

Each insurance company and policy may have specific procedures for filing an appeal or requesting an appraisal. Be sure to carefully follow the instructions provided in your insurance policy. This may include meeting certain deadlines, providing specific documentation, or following particular formats for your appeal or appraisal request.

Hire an independent claims adjuster or consult a lawyer to help fight the denial

If your auto insurance claim has been denied, you can hire an independent claims adjuster or a lawyer to help fight the denial.

Hiring an independent claims adjuster

As a consumer, you have the right to hire an independent claims adjuster or a public insurance adjuster to provide a professional opinion on your claim dispute. A public insurance adjuster is not affiliated with any particular carrier and may be hired to help settle a claim. The adjuster should be licensed in the state where you are filing the claim. When hiring a professional, it’s a good idea to check references and recommendations. You can also call your state insurance department to confirm the adjuster’s record. While hiring a public adjuster may provide useful assistance, it usually comes at an additional cost. Public adjusters may charge up to 15% of the settlement claim, and there are no guarantees the claim will be settled. Hiring an independent party can either show support for the insurance carrier’s original denial or provide support for your claim. If the recommendation made by the public insurance adjuster supports your claim, you could consider contacting your insurance provider and requesting to speak to the claims manager.

Hiring a lawyer

If you choose to hire a lawyer, they can review the case and supporting documents to draft a demand letter requiring the insurance company to respond and defend its claim denial. While it may cost you money upfront, it could be a worthwhile expense to have the claim denial overturned if you feel your insurer made the wrong decision.

Most car insurance companies will have their own process in place for you to appeal the claim and you can ask the adjuster the steps you would need to take to dispute it. When you can show why the evidence that you collected contradicts the insurance company's decision, you might also choose to contact a lawyer if you are uncomfortable in disputing this on your own.

File a complaint with your state's insurance commissioner if you believe the denial was improper

If you believe that the denial of your auto insurance claim was improper, you can file a complaint with your state's insurance commissioner. This is typically done after you have appealed the insurance company's decision and the appeal has been denied. Here are some steps you can take to file a complaint:

• Review your claim and coverage: Understand your insurance policy, including what is covered and what is excluded. Check if there are any specific exclusions that justify the denial.
• Gather and document evidence: Collect and organise all relevant documentation and evidence to support your case, such as photographs, receipts, police reports, eyewitness information, and medical reports.
• Contact the insurance company: Notify the insurance company that you disagree with their decision and intend to dispute the claim denial. You can do this via phone, email, or letter.
• Follow up with a letter: Send a letter to the insurance company explaining why you disagree with their decision and providing detailed information about the incident, including any evidence you have gathered.
• Understand the appeals process: Familiarise yourself with the insurance company's appeals process and follow their guidelines for submitting an appeal. Be sure to meet any applicable deadlines.
• Seek legal assistance: Consider hiring an attorney or a public insurance adjuster to help you with the appeals process and guide you through your options. They can review your case and provide expert advice.
• Contact the state insurance department: If you have gone through the appeals process and are still unsatisfied with the outcome, you can reach out to the state insurance department for assistance. They can provide information on how to file a complaint and may have additional resources to support your case.

It is important to remain persistent and not give up during this process. Make sure to keep detailed records of all communication and documentation related to your claim and appeal.

Be persistent and don't delay—submit and resubmit claims promptly and follow up on any outstanding requests

Persistence is key when fighting an auto insurance claim denial. The process can be frustrating and time-consuming, but it is important to be tenacious and not delay. Here are some detailed steps to guide you through the process:

Submit and Resubmit Claims Promptly

It is crucial to act in a timely manner when dealing with insurance claim denials. Submit and resubmit your claims within the specified timeframes to avoid any negative consequences. Insurance companies often have strict deadlines for claim submissions and appeals, so be sure to review their guidelines carefully.

Follow Up on Outstanding Requests

Be proactive and stay on top of any outstanding requests or requirements. If additional information or documentation is needed, gather and provide it as soon as possible. This could include police reports, eyewitness statements, photographs, medical reports, repair estimates, or other supporting evidence. Keep copies of all documentation for your records.

Understand the Reasons for Denial

Take the time to thoroughly review the denial letter from your insurance company. Understanding the specific reasons for the denial will help you formulate an effective strategy for your next steps. Common reasons for claim denials include missing or incomplete information, lack of coverage for the specific service or incident, or exceeding coverage limits.

Appeal the Decision

If you believe the denial was improper or unfair, you have the right to appeal the decision. Each insurance company has its own appeals process, so be sure to follow their guidelines carefully. You may need to submit additional evidence or documentation to support your appeal. Stay persistent and don't be afraid to ask for help from professionals, such as an independent claims adjuster or an attorney, if needed.

Communicate and Seek Support

Don't hesitate to reach out to your insurance provider and ask questions. They can provide clarification on their decision, the appeals process, and any specific requirements or deadlines you need to be aware of. Additionally, consider seeking support from professionals or organizations specializing in insurance claim disputes. They can provide valuable guidance and help you navigate the complex process.

Frequently asked questions