What Are the Top Reasons for Insurance Claim Denials?

As the victim of a bad car accident, the best way to move forward is with financial relief from an insurance claim. Unfortunately, auto insurance companies in Arizona do not make it easy to obtain fair and full compensation. To save their investors money, insurers often use tactics such as denying valid claims. Learning the most common reasons for insurance claim denials could help you spot insurance bad faith. If a car insurance company recently denied your claim, talk to an attorney about your legal options.

Top Reasons for Insurance Claim Denials

After a car accident, you will seek financial compensation from the insurance provider of the at-fault driver. Arizona’s tort-based insurance system states that the negligent driver will be financially responsible for damages. Obtaining compensation takes filing an insurance claim with that party’s provider. You will submit your damage claim along with any relevant evidence and your Proof of Loss Form. Then, you will wait for the insurance company to evaluate your claim and give you a decision. If you receive a claim denial, the insurance company must list its reason.

  • Inaccurate or incomplete information
  • Missed claims filing deadline
  • Liability dispute
  • Fault or partial fault for the accident
  • Failure to go to the hospital or receive a medical evaluation
  • No diagnosed injury
  • Pre-existing conditions
  • Lack of injury or loss documentation
  • Claim exceeds maximum coverage available
  • Lapsed or expired insurance

Be careful when dealing with insurance companies during a car accident claim. The information you give a claims adjuster could determine whether or not you receive a denial. Do not offer a recorded statement to the adjuster or admit to any amount of fault for the accident. Do not make false claims or speculate about the details of the collision. When in doubt about how to proceed with an insurance claim, have a car accident attorney in Glendale take over negotiations for you.

What to Do If Your Insurance Claim Is Denied

If the letter you receive from the auto insurance company says it has denied your claim, don’t panic. You may have options for changing the insurer’s mind or continuing with your claim in a different way. First, find out the exact reason for the denial. Read the insurance policy carefully to see if the insurance company simply made a mistake. Then, gather documentation related to your car accident. This includes police reports, medical records, photographs, witness statements and repair estimates.

Write a letter to the insurance company explaining why you believe it should pay your claim. Be specific in your reasoning and try to support it with evidence. Include further information or documentation, if necessary. Request the company to conduct a second review of your case with the new information. If the company still denies your claim, you can file an appeal.

In general, you have 180 days from the date you received your denial letter to file an appeal. An appeal starts with an internal review within the insurance company. If this does not work, you have 60 days from the internal appeal denial to request an external review. The Arizona Department of Insurance can conduct an external review of your car insurance claim. The external review board will determine whether or not the insurance company should have accepted your claim, and may change the outcome of your case.

When Is an Insurance Denial Bad Faith?

Your claim denial may be insurance bad faith if the insurance company cannot give you an accurate or valid reason for the denial. If you have satisfied the claim requirements and have the correct type (and amount) of insurance, the company may be denying your claim in bad faith. This means the company is handling your case unfairly to try to make a profit. If you suspect insurance bad faith, contact a lawyer to help you go up against the insurance company. A bad-faith insurance claim could force the insurance company to accept your case, as well as pay you an additional sum for its misconduct.