What to do if the At-Fault Insurance Denies your Claim –
There can be many reasons why a claim might be denied. The insurance company should send you a letter explaining exactly why they have made their decision. The type of reason given dictates the response.
First, all insurance companies will look for reasons to deny a claim. Denying the claim can be effective as a general business policy for an insurance company. They might have a policy of issuing a denial to most claims just to see if the claimant will put up a fight. If only 1 in 20 claimants chooses not to fight the denial, then 5% of all claims are successfully defended and cost the insurance company nothing. This is excellent for their profit margins. So, a denial does not necessarily mean that the insurance company has a good reason for doing so.
Second, if the denial is a reasonable, fact-based one, then the claimant has to evaluate it for their options to continue to pursue their case. An insurance company may be denying the claim on a basis that there is nothing the claimant can do such as when the policy at issue has lapsed. If the negligent party had failed to renew their insurance policy at the time of the incident that gives basis to the claim, then the denial is likely valid. This type of denial does not speak to the merits of the claim, just whether the company has a duty under a contract to defend the negligent party. The negligent party is still legally responsible for the harm that they have caused, but the insurance company is not obligated to take care of the negligent party due to the failure to renew the policy. Most negligent parties, however, do not have the ability to pay a claim for injuries if they don’t have insurance to do so on their behalf.
Third, sometimes the insurance company will deny on a factual basis that the claimant believes is not accurate. We have seen thousands of cases, and insurance companies will always seek to deny a claim if they believe that there is a chance their insured does not have legal liability. This scenario can take many forms. If you believe that you had a green light and the other driver also believed that they had a green light, then that person’s insurance company is likely to deny the claim on the basis that they believe what their insured has told them. Sometimes these are true “he said / she said” situations and only a jury can tell us who is to be believed. More often, however, the defense is something to the effect of the claimant sharing some degree of fault. They might allege that the claimant was speeding or not paying proper attention or could have avoided the accident even though their insured also did wrong. Every percentage point of fault that is given to the claimant is a percentage of the award that the claimant will not be receiving; if you are 50 percent at fault for causing the incident then you are only entitled to half of the full value of the case.
What to do if you have received a denial? Please consult an attorney. Personal injury attorneys almost always will offer a free consultation, and this should be taken advantage of by most claimants. Even if all you learn is that you are doing everything right and don’t need an attorney for your claim, that is still extremely valuable to know. On the other hand, if it looks clear that the opposing insurance company is not going to agree to treat you fairly, then the earlier you retain counsel the better off you will be.
Please take advantage of a free consult with Wiener and Lambka PS on your insurance denial. There is never an obligation to retain us as your attorneys and you might learn something important to help your claim.