Few events are more upsetting than the insurance company denying your car accident claim. You have already suffered because of someone’s negligence. It doesn’t seem fair for you to pay for an accident that was not your fault.
Insurance companies often deny legitimate claims. You could still pursue an insurance payout if you successfully appeal the insurance company’s decision.
Here are some common reasons why insurers deny claims, details about the appeals process, and your options for pursuing legal action to recover compensation.
Why Do Insurance Companies Deny Valid Claims?
The Office of Commissioner of Insurance and Safety Fire oversees insurance companies that operate or sell policies in Georgia. By law, insurance companies must send a written notification that they accept or deny a claim within 15 days after receiving all forms and information.
Common Reasons Car Accident Claims Are Denied
Georgia is a fault state for car accidents. Injured individuals file with the liable driver’s insurance. If the insurance decides the policyholder is not responsible or that you played a role in the accident, they may deny your claim.
Failure to Notify
If you waited too long to notify the insurance company about the accident, the insurer might deny your claim. Most policies require claimants or policyholders to contact the insurer within an allotted time, regardless of fault.
Non-permissive or Non-covered Driver
The insurance company might not approve your claim if the driver did not have permission to drive the car or is not covered by the policy.
Lack of Documentation
Insurance companies require proof of your injuries and damages. Most insurers would deny a claim or offer considerably less if you did not seek medical care after the crash or omitted medical documentation.
Whether your claim is with your insurer or the other party, not all policies cover every kind of accident or injury. An insurer will deny your claim if it falls outside covered injuries and damages.
No insurance company pays on a claim for a policy that was not in effect at the time of the accident. A lapsed policy is usually for non-payment.
Insurance companies also deny claims due to unfair business practices. Insurers who act with bad faith to policyholders and claimants face repercussions from state regulators.
What to Do About a Denied Claim
If the insurance company denies your car accident claim, you have a few options.
You Can Appeal or File A Complaint
If you disagree with the insurance company’s decision, you can appeal.
Should you file an appeal and the insurer refuses to reconsider, you may also file a complaint with the Office of Commissioner of Insurance. The agency notifies the insurer to determine if their denial is valid or to help resolve your claim.
In our experience, filing a complaint with the Office of Commissioner of Insurance does nothing to help resolve the case.
You Can File a Lawsuit
When an insurance company has wrongfully denied your claim, the best way to seek justice is by filing a lawsuit. In Georgia, the insurance company is not named as a defendant. Instead, the at-fault driver is the one who is sued. But the driver’s insurance company hires the lawyers and pays any verdict you may obtain against the driver (up to the policy limits).
If you are dealing with an uninsured motorist claim where there is no liability coverage, or not enough, you will still sue the other driver. But you will also need to serve your own insurance company with the lawsuit as the uninsured motorist carrier.
Filing a lawsuit does not automatically mean you are going to court. Both sides frequently continue to try to negotiate a settlement after a lawsuit is filed.
Appeals Process for Denied Claims
If you are dealing with the insurer directly and trying to appeal their decision internally, it important to submit documentation substantiating your position. Begin by reading the insurer’s explanation of why they denied your claim. Was it due to a lack of medical documentation? Do they deny liability? Your appeal should refute their argument. For denials based upon lack of documentation, submit evidence that supports your claim, such as:
Crash or police report
Evidence of liability
The insurance company will either review your appeal, offer a payout, or stand by their initial denial. Depending on their response, your next step could take you into a lawsuit and potentially a courtroom.
Get Help from The Champion Firm
Receiving a denial for a car accident claim can seem overwhelming. However, a personal injury lawyer who understands Georgia’s liability and insurance laws will give you a significant advantage in seeking full and complete compensation for your injuries.
The Champion Firm is a full-service personal injury law firm serving the greater Metro Atlanta area. Our award-winning team of attorneys specializes in car accidents, wrongful death, premises liability, and slip-and-fall cases. Learn more about our team here.