You’ve been involved in a motor vehicle accident and things seem to be simple at first. The police report is taken and filed, insurance information is exchanged, and you are waiting for word from the provider about the settlement offer. That’s when word arrives that your claim is denied and the other party is not accepting responsibility for the accident. What happens next? Maintain your composure and follow these steps.
Review the Reason for the Denial
Before making any assumptions, find out why the claim was denied. By law, an insurance provider is required to provide a reason for rejecting your claim. That reason will determine what you need to do next.
Denials fall into a few categories. One is known as disputed liability. This is what usually happens when the other party insists he or she did not cause all or part of the damage or injuries you are claiming. That will often be enough to reject the claim, although it would not bar you from filing an amended one if you choose.
Other reasons may have nothing to do with who is at fault. The other party’s insurance coverage may have lapsed and was not in effect at the time of the accident. Maybe the other party did not notify the provider of the accident and they are still investigating the event. There’s also the possibility that your claim is denied because aspects of the accident are not covered under the policy terms and conditions. Once you understand what is happening, it will be easier to decide how you will proceed with the case.
Filing an Appeal
Assuming the responsible party’s coverage had not lapsed and the particulars of the accident are not excluded from the coverage, filing an appeal makes sense. One thing to remember is that an appeal is not a quick process. While the appeal procedure must be in compliance with current laws, there will be many forms to fill out, a lot of detail to include, and there will likely be quite a few phone calls exchanged with the insurance adjustor or investigator. Even after all that effort, any minor detail that seems to be unclear to the provider will result in a second denial. At that point, you may want to seek help with the claim.
Hiring an Attorney
If you’ve attempted to deal with the insurance provider alone so far, now is definitely the time to seek help from an attorney. You will want to hire legal counsel who has a strong track record with taking on cases similar to yours. An attorney with this background will know all the laws related to vehicular accidents well, and will likely know quite a bit about how insurance providers process and make decisions about claims.
An attorney can look over all the information related to the event. That includes reviewing the police report, correspondence between you and the provider, and the actual claim forms and documents you submitted. The goal is to determine what type of action can legally take place and improve the chances of receiving a settlement or having the denial reversed.
As with any type of legal issue, it’s important to provide full disclosure to your legal counsel. Nothing, no matter how insignificant or irrelevant you may think it to be, should be withheld. Some stray remark or something that was done at the accident site may not be important to you, but that information could mean quite a bit to the attorney. For your own good, be as forthcoming as you possibly can. Leave it to the attorney to decide if some tidbit of information has any bearing on the case.
The denial of an insurance claim is not necessarily the end of the matter. In many instances, hiring a lawyer will make is possible to approach the claim process in a different way and lead to a different outcome. Whether the attorney recommends attempting to come to terms with the provider or pursue the matter in court, take that advice seriously. In the long run, doing so has the potential to achieve an outcome that is equitable for you and for everyone else involved.
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