What Happens If the Insurance Claim Is Denied

When seeking an insurance claim, you should be prepared for every outcome and that means that the insurers can deny your claim. You may argue your case in an appeal process.

However, it’s important to learn why this happens. Sometimes the insurance company will do this because they lack correct information, unanswered questions in the application, or lack due care (leaving valuable belongings in your vehicle) which might indicate that you aren’t covered under the terms of the policy. When the company denies the insurance claim, you do not have to fear that you won’t be able to pay all your bills or compensate for your lost wages. To appeal this decision, it’s important to hire a skilled New Mexico car accident attorney.

Denied Insurance Claim

The insurers must give you a copy of their Product Disclosure Statement that is part of the agreement between you and them. It sets the circumstances where the insurance company may decide to deny the claim to their clients. This statement will contain legal phrases and terms you probably aren’t familiar with. Read the statement carefully and make sure you understand it. It’s best to consult an attorney who will explain the statement to you.

If the PDS dismisses a claim, there are cases where the insurance company might be obligated to pay you a partial or complete claim.

If you failed to tell your insurer a detail about the subject of the insurance policy (a car, home, or other property), it means that you failed to comply with your duty of disclosure. In such a case, the insurers will deny the insurance claim.

Unclear Liability

Some cases are complex and it’s hard to tell who was at fault for the accident. This often happens with multi-vehicle collisions. Every driver is partially at fault, but each driver’s insurers will blame the other parties. This happens because every insurance company is trying to pay less. If you were involved in an accident where the liability isn’t clear, the best thing you can do is hire a car accident lawyer. However, if there were more parties in the accident, be prepared that at least one of the insurers will deny your claim.

Insurance Policy Could Lead to a Denied Claim 

Claim adjusters will deny insurance claims because there was no “available coverage” for the injuries of the client. Some of these policy reasons are legitimate, others are not. The insurers will call you, but you shouldn’t accept any offers on the phone. Insist to get a written explanation with the reasons why the claim was denied.

What to Do If This Happens

Before you take any steps, be sure to read your policy documents carefully. People often read the summaries and fail to read every sentence of their policies, where the answer might be. If things are poorly explained, ask the insurers to explain them better. They couldn’t deny your claim if you have provided information and answered all questions they asked in the form. The claim will be denied in case you forgot to do this. Call your insurers to ask any question you have. You can also send them a complaint formal letter. Writing it can be done in a certain way. If you don’t know how to do it, your attorney will help you with that part.

Here is what you should include in the letter:

Put the date of the letter and write down your full name and policy number. At the top of the letter write ‘complaint’ and include evidence that can support the complaint. Write clearly and provide facts about why you are writing the complaint. Explain why you think their decision is wrong and why your insurance claim should not be rejected. Honestly say that you are not content with their response and that you will take the matter to a higher instance. In case you have second thoughts and are not sure whether the outcome of your denied insurance claim will work in your favor, be sure to hire a personal injury or car accident, attorney.

We know how important it is for accident victims is to get their compensation claim. Medical bills, lost wages, car reparation costs will seriously burden your budget, but let’s not forget about pain and suffering and potential temporary or permanent disability. Our team at FBD Law has a history of various car accident cases. Call our office today and schedule your first consultation claim; we’re here for you.

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