Appealing Auto Insurance Decisions: Your Rights In New York

If your auto insurance claim has been denied, you can appeal the decision. The appeals process involves gathering evidence, writing an appeal letter, and sometimes, hiring an attorney. Each state has a different statute of limitations, but you usually have up to 5 years to dispute insurance claims and payouts. In New York, you can request an internal appeal, where your insurance company conducts a full and fair review of its decision, or an external appeal, where an independent third party reviews the decision.

Understand your rights and the reasons for denial

When it comes to understanding your rights and the reasons for denial of an auto insurance claim in New York State, there are several key points to keep in mind. Firstly, you have the right to appeal the insurance company's decision if they refuse to pay a claim or end your coverage. This is an essential right that allows you to seek a review of their decision by a third party.

Insurers are obligated to disclose the reasons for denying your claim or ending your coverage. They must also inform you of your right to dispute their decision and explain the process for doing so. This transparency is crucial for you to understand their rationale and determine your next steps.

To initiate an appeal, you can start by requesting an internal appeal with your insurance company. This involves asking them to conduct a full and fair review of their initial decision. They are required to expedite this process if your case is urgent. During the internal appeal, you may need to provide additional evidence, such as eyewitness reports, photographs, medical records, and police reports, to strengthen your case and address any concerns raised by the insurance adjuster.

If the internal appeal is unsuccessful, you have the right to pursue an external review. This means taking your appeal to an independent third party, who will review the case and make a decision. At this stage, the insurance company no longer has the final say over whether to pay your claim.

It is important to understand the common reasons why auto insurance claims are denied to effectively exercise your right to appeal. One reason could be that the driver involved in the accident is not listed on the insurance policy. In such cases, the adjuster may deny the claim, even if the driver had permission to use the vehicle. Another reason for denial could be insufficient coverage. If your claim exceeds the policy limits, the insurance company may deny coverage for the excess amount. Lapsed coverage due to missed payments or failure to renew the policy on time can also lead to claim denials.

Gather evidence, including photos, reports, and invoices

Gathering evidence is a critical step in appealing an insurance company decision. Here are some detailed instructions on how to gather the necessary evidence, including photos, reports, and invoices, to support your case:

• Photographs: Take photographs of any relevant physical evidence, such as vehicle damage, property damage, or injuries. These photos should be clear and well-lit, providing an accurate representation of the scene or damage. Ensure you capture a variety of angles and distances to give a comprehensive view.
• Reports: Obtain copies of all relevant reports, such as police reports, medical records, and eyewitness statements. These documents can provide valuable details about the incident and support your version of events. If there are any discrepancies between the reports and the insurance company's decision, be sure to highlight them.
• Invoices and Receipts: Gather all invoices and receipts related to the incident. This includes repair bills, medical bills, and any other expenses you have incurred as a result of the incident. Organize these documents and clearly label each item to demonstrate the costs you have had to bear.
• Additional Evidence: Depending on your specific case, there may be other types of evidence that could support your appeal. For example, if there are any expert opinions or technical assessments that contradict the insurance company's decision, be sure to include them. You can also consider gathering evidence that demonstrates your character and reputation, especially if it is relevant to the incident or your policy compliance.
• Organize and Review: Once you have gathered all the evidence, organize it into a comprehensive file. Review each piece of evidence and consider how it supports your case. Create a clear structure that presents the evidence in a logical and persuasive manner. Label and number each piece of evidence for easy reference.
• Cross-Reference with Insurance Company's Decision: Compare your evidence against the reasons provided by the insurance company for their decision. Look for any inconsistencies or discrepancies. Identify the key points of dispute and use your evidence to address these points directly. This will help you craft a compelling argument for your appeal.

Remember, the goal of gathering evidence is to build a strong case that challenges the insurance company's decision. Each piece of evidence should be relevant and support your argument. Consult with a lawyer or a professional who can guide you through the process and ensure you are on the right track.

Write a clear and detailed appeal letter

To write a clear and detailed appeal letter to an auto insurance company in New York State, you should follow a standard business letter format. Here is a step-by-step guide:

Step 1: Consult company policy

Before writing your letter, check your insurance company's policy for information on how to file an appeal and how they handle disputes. This will ensure that you are following the correct procedure and increase your chances of a successful appeal.

Step 2: Identify the recipient

Think carefully about whom to address your letter to. It is best to send it directly to the person with decision-making power over your case. Sending it to a generic address or an incorrect person may delay the resolution of your issue.

Step 3: Use a professional tone and format

An appeal letter is a formal, professional communication, so it is important to use a polite, respectful, and persuasive tone. Avoid anger or judgment in your writing. Use a standard business letter format, and consider using letterhead for a more professional touch.

Step 4: Include your contact information

At the top of your letter, include your professional contact information, such as your name, address, phone number, and email address.

Step 5: Provide a clear summary of the situation

In the first paragraph, introduce yourself and briefly explain the specific decision or situation you are appealing. For example, "I am writing to appeal the decision made by [insurance company] on [date] regarding my claim for [reason for claim]."

Step 6: Explain your side of the story

In the second paragraph, provide your side of the story and any relevant facts or details that were overlooked. For instance, "According to my records, I have not been late more than two times this year, as supported by the attached Human Resources document."

Step 7: State your desired outcome

In the third paragraph, clearly state what outcome you are seeking. For example, "In light of these facts, I respectfully request that you reconsider your decision about denying my claim."

Step 8: Express gratitude and provide contact information

Conclude your letter with a courteous "thank you" for the recipient's time and consideration. Include your contact information so they can easily follow up with you.

Step 9: Attach supporting documents

If relevant, attach any supporting documents or evidence that backs up your appeal, such as eyewitness reports, photographs, medical records, or police reports.

Step 10: Proofread and send

Thoroughly proofread your letter before sending it to ensure it is free of typos and grammatical errors. You may also want to make a copy of your letter and attachments for your records. It is recommended to send your letter via certified mail to have proof of receipt.

Step 11: Follow up

If you do not hear back within a reasonable amount of time (usually about a week), follow up with the recipient via email, letter, or phone call.

Consult a lawyer to guide and support your case

Consulting a lawyer is a good idea if you want to appeal an auto insurance decision in New York State. They can guide and support your case, and help you to understand your policy and the reasons for your claim being denied.

Lawyers can be expensive, but many offer a free initial consultation, and some work on a "no win, no fee" basis. They will be able to tell you if you have a case, and what your chances of success are. They can also advise on the best course of action, and whether you are likely to be able to handle the appeal process yourself.

An experienced lawyer will be able to review your policy, and the correspondence and evidence relating to your claim, and identify the real reasons for the denial or termination of your insurance claim. They can then recommend a course of action, and give you an idea of the costs involved.

If you decide to proceed with a lawyer's help, they will be able to support you through the appeal process, and can take on the work of gathering evidence and formulating arguments. They can also advise on the best way to present your case to the insurance company, and will know how to respond if your appeal is denied.

If your case goes further, a lawyer can represent you in court, and will be able to deal with the other side's legal representatives. They will also be able to advise you on whether the insurance company has broken any laws, and whether you have grounds to sue for breach of contract.

Submit the appeal and any additional information

When submitting an appeal, it's important to follow your insurer's instructions closely and make copies of all documents for your records. You should also keep a record of all correspondence and conversations, including the names of any representatives you speak with, the dates and times of your interactions, confirmation numbers for calls, and a summary of your discussions.

In your appeal, you will need to illustrate how your evidence contradicts the insurance company's decision. This may include providing further details or more in-depth explanations of the information they missed in the initial review. For example, you might submit documents such as eyewitness reports, photographs, medical records, and police reports, connecting each piece of evidence to your argument against the adjuster who made the decision.

If your appeal is based on a health insurance claim, you may be required to submit additional information, such as a Patient Consent Form and/or a Physician Attestation Form. The Patient Consent Form must be signed by the patient or their authorized representative, and if the patient is a minor, the document must be signed by a parent or legal guardian. The Physician Attestation Form may be required depending on the type of appeal and must be signed by a licensed and board-certified or board-eligible physician qualified to practice in the relevant area.

If your appeal is related to an auto insurance claim, it is important to review your claim denial or settlement offer letter and gather all relevant evidence, such as accident reports, photographs, witness statements, and medical records. Common reasons for auto insurance claim denials include the claim exceeding policy limits, the claimant not being named on the policy, missed payments or deadlines, and the claimant being at fault in the accident. Thus, it is crucial to ensure that none of these apply to your case before filing an appeal.

Frequently asked questions