Millions of accidents occur yearly in the country, with nearly two million being injury crashes. While multiple parties shoulder the costs of the injuries, private insurers are responsible for 50% of the claims. And as much as an injured person has a right to receive compensation from the at-fault party’s insurer, a significant number of the claims get denied.
However, the rejection of an insurance claim, though distressing, is not always final. One can appeal the decision by writing to the company, providing evidence to prove the claim’s validity.
If an insurance provider rejects a claim, they send a denial letter explaining their decision. However, if unsatisfied with the verdict, a claimant has a right to appeal it by following the specific insurer’s claim resubmission guidelines.
The first step is to understand why the claim was denied. The denial letter sent by the insurer usually indicates the reasons, which may include:
After understanding the reason for the denial, one should review the policy document to understand the provisions (limit, coverages, etc.) and the specific provider’s appeal guidelines. Ideally, the appeal request should address the particular reason behind the denial.
An appeal mainly involves challenging the insurance company’s decision by demonstrating why the claim is valid. To successfully appeal the denial, one must provide solid evidence countering the reason for the denial. For instance, if the rejection was due to disputed liability, getting CCTV footage of the accident scene (if available) or providing eyewitness or expert witness statements helps back up the claims.
The last step involves drafting the appeal, explaining why the claim should have been accepted. Every argument must be supported by evidence (photos, medical records, eyewitness statements, police reports, and other relevant information gathered during the investigation).
Usually, one can appeal claim denial multiple times, first to the insurer and later to the state insurance commissioner’s office.
The evidence required depends on the denial reasons. But generally, one should gather and submit all the proof necessary to demonstrate the liability of the at-fault party and the damages they have incurred due to their negligence. The information may include the following:
Besides understanding why the claim was denied in order to lodge an appropriate response, there are several measures one can take to raise their chances of a successful appeal. Here are a few examples:
Having a car accident insurance claim denied can be frustrating. However, denial is not final. Sometimes some rejections are due to data entry errors such as using the wrong insurance ID number, misspelled name, etc., while others require gathering more evidence to prove liability. Generally, a claimant has multiple opportunities to appeal the decision, first with the insurance company and then with the state insurance commissioner’s office if the insurer remains adamant.
In cases where a settlement cannot be reached out of court, one can file a lawsuit, like in the 2018 Fox V. Mize case.
If you have been injured in a car accident, our expert team can help you get the compensation you deserve. Contact us or call us at 918-359-6600 today for a free consultation.
When injury victims need a law firm with a reputation for excellence, turn to Graves McLain Injury Lawyers. We are a top-rated personal injury firm determined to be the best. With decades of award-winning representation, our clients recover the compensation they need to put their lives back together.