Have you ever been in a car accident and filed an auto insurance claim, only to find out that your claim was denied or delayed by your insurance company? If so, you are not alone. According to a study by the Insurance Research Council, about one in seven drivers in the US may be uninsured, and about 15% of auto insurance claims are disputed or rejected by insurers. Moreover, the average time to settle an auto insurance claim is 18.5 days, which can be a long wait for someone who needs money to pay for medical bills, repair costs, lost wages, and other expenses.
So why do auto insurance claims get denied or delayed? There are many possible reasons, such as:
- The insurance company disputes your version of the events or the extent of your damages
- The insurance company requests more information or documentation from you or other parties
- The insurance company suspects fraud or misrepresentation on your part
- The insurance company has a backlog of claims or is understaffed
Whatever the reason, a denied or delayed claim can be frustrating and stressful. You may feel helpless and angry, and wonder what you can do to protect yourself and get the compensation you deserve. Fortunately, there are some steps you can take to deal with this situation and improve your chances of getting a favorable outcome. In this article, we will provide you with some practical tips on what to do if your auto insurance claim is denied or delayed.
Step 1: Review your policy and the denial letter
The first thing you should do if your auto insurance claim is denied or delayed is to review your policy and the denial letter. Your policy is a contract between you and your insurance company that outlines what is covered and what is excluded in your auto insurance plan. Your denial letter is a document that explains why your claim was denied or delayed by your insurance company.
You should read both documents carefully and understand what they mean. Some common terms and reasons that may affect your claim are:
- Deductible: This is the amount of money you have to pay out of pocket before your insurance company pays for your claim. For example, if your deductible is $500 and your claim is $2,000, you have to pay $500 and your insurance company will pay $1,500.
- Limit: This is the maximum amount of money your insurance company will pay for your claim. For example, if your limit is $10,000 and your claim is $15,000, your insurance company will only pay $10,000 and you have to pay the remaining $5,000.
- Exclusion: This is something that is not covered by your policy. For example, if your policy excludes damage caused by floods or earthquakes, and your car was damaged by a flood or an earthquake, your claim will be denied.
- Liability: This is the legal responsibility for causing damage or injury to someone else or their property. For example, if you caused a car accident that injured another driver or damaged their car, you are liable for their damages and injuries.
- Fault: This is the degree of responsibility for causing an accident. For example, if you were 100% at fault for an accident, you are fully responsible for the damages and injuries. If you were 50% at fault for an accident, you are partially responsible for the damages and injuries.
- Subrogation: This is when your insurance company pays for your claim and then seeks reimbursement from another party who was at fault or liable for the accident. For example, if another driver hit your car and their insurance company did not pay for your damages, your insurance company may pay for your claim and then sue the other driver’s insurance company for reimbursement.
You should also contact your insurance agent or company if you have any questions or doubts about the policy terms or the denial reason. You should ask them to explain why they denied or delayed your claim and what evidence they used to make their decision. You should also ask them what you can do to appeal their decision or provide more information or documentation to support your claim.
Step 2: Gather evidence and documentation
The next thing you should do if your auto insurance claim is denied or delayed is to gather all the evidence and documentation that supports your claim. This may include:
- A copy of the police report
- Photos and videos of the accident scene and the damages
- Medical records and bills
- Repair estimates and receipts
- Witness statements and contact information
- Any correspondence with the insurance company or other parties
You should also keep a record of all the dates and times you contacted or attempted to contact the insurance company, as well as the names and titles of the representatives you spoke to. You should organize and store the evidence and documentation safely and securely, and make copies or backups if possible. You may need to present them later to support your claim or appeal.
Step 3: Appeal the decision
If you believe that your claim was wrongly denied or delayed, you have the right to appeal the decision. You should write a formal letter to the insurance company explaining why you disagree with their decision and providing evidence and documentation to back up your claim. You should also request a specific amount of compensation that you believe you are entitled to.
You should send the letter by certified mail with a return receipt requested and keep a copy for yourself. You should also follow up with the insurance company regularly until you receive a response. The insurance company may accept your appeal and approve your claim, or they may reject your appeal and maintain their decision.
Step 4: Negotiate a settlement
If your appeal is successful, you may receive an offer from the insurance company to settle your claim. However, you should not accept the first offer without evaluating it carefully. The insurance company may try to lowball you or offer you less than what you deserve. You should compare the offer with your damages and expenses and decide whether it is fair and reasonable. You can also make a counteroffer or ask for more information or clarification if needed.
You should always get any settlement agreement in writing and review it before signing it. You should also understand what you are giving up by accepting the settlement. For example, you may have to waive your right to sue the insurance company or other parties in the future, or you may have to agree not to disclose the terms of the settlement to anyone else.
Step 5: Hire a lawyer
If your appeal is unsuccessful or if you are not satisfied with the settlement offer, you may want to hire a lawyer to represent you. A lawyer can help you:
- Review your policy and the denial letter
- Gather more evidence and documentation
- Negotiate with the insurance company on your behalf
- File a lawsuit against the insurance company if necessary
- Protect your legal rights and interests
Hiring a lawyer may increase your chances of getting a favorable outcome and a higher compensation. However, you should also consider the costs and benefits of hiring a lawyer and choose one that has experience and expertise in auto insurance claims.
Conclusion
Dealing with a denied or delayed auto insurance claim can be a daunting and stressful experience. However, by following these steps, you can protect yourself and get the compensation you deserve:
- Review your policy and the denial letter
- Gather evidence and documentation
- Appeal the decision
- Negotiate a settlement
- Hire a lawyer
