Getting involved in a car accident is extremely stressful and traumatic, and most victims assume that once they file an insurance claim, their insurance company will automatically compensate them for the harm they have suffered. However, in some cases, a car insurance company denies their clients’ claim and doesn’t payout any medical bills, lost wages, property damage, or other costs they may be owed.
There are a number of reasons a car insurance claim denial may happen, and you may feel at a loss as to how you can go about recovering compensation following a denial. Here at The Law Place, we can help you file an appeal with your insurance office or explore other legal avenues to get you the compensation you are owed for your car accident.
Our law firm has over 75 years of combined experience in a wide range of practice areas, and we always guarantee our clients the highest standard of legal assistance. We offer a free consultation so you can speak with one of our personal injury lawyers about your claim denial with no strings attached. They can advise you on how to go about filing an appeal with your insurance company, and they can negotiate on your behalf to ensure that you get justice.
Don’t hesitate to contact us. The sooner you do, the better chance we have at getting you the compensation you are owed.
Call us today to schedule a free case review at (941) 444-4444. Our phone lines are open 24 hours a day, 7 days a week.
Insurance Laws in Florida
If you are a driver in Florida, you will know that the law requires you to have an insurance policy in place in order to legally operate your vehicle on the roads. The no-fault law in the state requires that all drivers take out personal injury protection (PIP) coverage of at least $10,000, in addition to property damage coverage of the same value.
This no-fault law provides that if you are involved in a car accident, and you have the requisite insurance coverage in place, your insurance company will compensate you for any injury or harm you have suffered, regardless of whether you were at fault for the accident.
Once you file an insurance claim with your company, your policy should pay you 80% of your medical costs and up to 60% of any lost wages you have incurred as a result of your injuries. In the event that you have sustained serious injuries, you will be entitled to file a personal injury lawsuit against the at-fault driver to recover any excess compensation for medical costs and other expenses.
Some of the damages you are able to claim through your policy include:
- Medical costs for any hospital bills and transport to and from appointments.
- Lost wages as a result of being put out of work.
- Property damage that occurs to your vehicle, including repair estimates or replacement costs.
- Pain and suffering
- Wrongful death.
Duties of a Car Insurance Company
Under Florida law, insurance companies are required to abide by certain standards and regulations during the claims process, and they legally can’t deny claims without abiding by these regulations. If an insurer denies your claim and hasn’t followed these standards, you can appeal their decision or file a lawsuit to recover the compensation you are owed:
- Insurers must conduct a reasonable investigation before making claim denials.
- There must be thorough claims investigation standards implemented.
- All communication between the driver and the driver’s insurance company must be acknowledged, and the insurer must always act in due time.
It is important that insurance companies abide by these duties under state law to ensure fairness during the claims process. However, it is not uncommon for insurance company denials to happen due to a failure to abide by these standards.
Why Was My Insurance Claim Denied?
Insurance companies usually have an insurance adjuster who assesses whether a claim is valid, and if it is, determines how much compensation the injured person is entitled to recover. When a claims adjuster denies a car accident claim, the victim is often left out of pocket for any expenses they’ve had to endure, and they will be wondering why a claim denial has happened.
Insurance companies are often reluctant to pay out their clients for any harm they have suffered, as their top priority is to make a profit. So, there may be many reasons why your insurance company denies your claim, including the following:
- Your injuries were not caused by the car crash.
- You failed to seek medical treatment within 14 days from when the accident occurred, or you failed to submit your claim on time.
- The medical treatment you received was carried out by an unlicensed practitioner.
- You were driving under the influence (DUI) or intentionally caused the car accident to happen.
- You were driving a stolen vehicle when the accident happened, or you were committing a felony at the time you crashed the vehicle.
- A previous accident or a pre-existing condition caused your injuries.
- The car accident or the injuries you sustained were not covered under your applicable insurance policy. For example, if your vehicle was damaged in a storm and you don’t have a comprehensive coverage policy.
- You caused the accident and didn’t have enough liability coverage to compensate for both your injuries and the injuries of the other driver.
- The other driver did not have an insurance policy in place, and you did not have uninsured motorist (UM) coverage.
- You lied or gave misleading statements to your insurance company about your injuries or the car accident.
Regardless of why your claim was denied, you are always entitled to file an appeal to assess why it was denied and to question the basis of the claim denial. It is important that you read your denial letter carefully and contact a car accident lawyer as soon as possible so they can help ensure that you get your denial overturned.
What Should I Do if My Car Accident Claim Is Denied?
Following a claim denial, you may be left confused about what you can do to recover the compensation you are owed. The steps you can take to recover compensation will depend on the particular scenario and the reason behind the denial:
Your Car Insurance Company Questions Liability
It is possible for insurance carriers to reduce the amount of compensation you receive by finding that you are liable for the collision or deny it completely by stating that the accident occurred due to a manufacturing defect.
However, under Florida’s comparative negligence laws, an insurer cannot deny your claim unless you are found 100% responsible for the collision. They are required to pay out damages minus your percentage of fault even if you were found 85% responsible for the collision.
In the event that a car insurance company denies a claim due to a manufacturing defect, an attorney can file a product liability case on your behalf to try and recover the compensation you are owed.
Your Insurance Policy Does Not Cover Your Injuries
Often, an insurance company may deny your claim as you do not have the requisite insurance in place, or your policy limits do not cover both your own injuries and the injuries of another driver that you have injured.
In the event that you do not have the right insurance coverage in place for your accident, it will be difficult to recover damages for your injuries. If there is another party involved, and they were at fault for the collision, you can file a claim against the other driver’s insurance company for your damages once you establish that they caused you to suffer harm.
If you have injured another driver and your policy doesn’t cover both of your injuries, you may be able to file a personal injury lawsuit against the other party also, once it can be established that they caused you to suffer harm. However, this may be difficult to prove without legal assistance, so you should contact a car accident lawyer if you are in this situation.
Your Car Insurance Company Questions Your Injuries
In some cases, a car insurance company may deny your claim as they don’t believe your injuries are as serious as you originally stated, or they don’t believe that you have suffered injuries at all. This can happen if the insurer underwriting your claim checks your social media and finds that your injuries aren’t genuine or finds that you have made previous claims with the same injury.
In this situation, you should ensure that the medical practitioners looking after you keep a proper medical record on your behalf, detailing the extent of your injuries. Once you have these records, it is unlikely for your insurer to deny your claim based on disbelief of your injuries. Similarly, once you have reported any pre-existing conditions to your car insurance company, your claim cannot be denied. You are legally entitled to recover compensation if previous injuries or conditions were made worse due to a car accident.
Your Car Insurance Company Suspects Fraud
Often, insurance companies deny claims as they suspect that the person making a claim is acting fraudulent, which can be extremely stressful when you are making a genuine claim. However, fraud is a huge problem throughout the United States, and it costs insurance companies and the state on average $40 billion per year, as estimated by the FBI.
If your insurance company denies your claim based on suspicions of fraud, you can provide additional evidence and try to resolve your insurance companies suspicions. However, if you are too pushy with your insurer, they may use this as additional evidence for denying your claim based on fraud. Alternatively, you can find personal injury lawyers who will speak with your insurer on your behalf to prove that you are not acting fraudulently.
How Do I Appeal a Car Insurance Claim Denial?
When your own insurance company denies your claim, you will receive a denial letter in the post outlining the reasons for denial and information on how you can appeal the decision. You should always read the denial letter carefully to figure out why your claim was denied, as it may be the case that your insurance company has the wrong information or doesn’t understand your claim.
If you decide to appeal or dispute the decision, you can provide any additional documentation or evidence you have, such as medical records or a police report, to prove your compensation entitlements. Once this is complete, your insurance company will designate a new claims adjuster to reassess your claim and determine whether you are entitled to compensation under your coverage policy. If the insurer believes that you are entitled to damages, you can recover the compensation you are owed.
In the event that your auto insurance company refuses your claim for a second time, we recommend that you seek legal advice from one of our personal injury lawyers as soon as possible, as you may have been wrongly denied, or the insurance office could be acting in bad faith. If an insurance company denies a claim and doesn’t give valid reasons or fails to examine the additional evidence you have provided, it is likely that they have denied the claim in bad faith. When this happens, a lawyer can file a lawsuit on your behalf to recover the compensation you are owed from your insurance company.
Should I Hire a Lawyer if My Car Insurance Claim Was Denied?
Although it is not required by law to hire a lawyer if your insurance claim is denied, it is highly recommended that you do, as trying to make an appeal on your own can be difficult and stressful, particularly if you are being accused of fraud or if an insurance company is acting in bad faith.
If you decide to hire a lawyer, they will take sole responsibility for your claim and handle everything on your behalf once you provide all of the necessary evidence and information supporting your claim. They can hire an independent claims adjuster to assess what damages you should be entitled to without taking personal interests into account.
If it is established that you should be entitled to compensation and that your insurance company has wrongly denied your claim, a lawyer can initiate negotiation on your behalf to ensure that you receive justice and that you get the compensation you are owed for your car crash.
Contact The Law Place Today
When an insurance company denies a claim, it can cause a huge amount of stress, particularly if you have suffered serious injuries or if you require compensation to repair or replace your vehicle. You can appeal this decision on your own. However, it is strongly recommended that you seek legal assistance if your claim with your insurance office has been denied.
Here at The Law Place, we offer a free consultation for you to speak with one of our lawyers with no strings attached. Our law firm has over 75 years of combined experience in numerous practice areas, and we know exactly what to do in these situations to get you the compensation you are owed. Our priority is ensuring that you are treated fairly by your insurance company and that you do not lose out on damages due to bad faith practices or unfairness on behalf of your insurance office.
Call our law firm today to schedule a free case evaluation at (941) 444-4444. Our phone lines are always open.