What Should I Do If My Insurance Claim is Denied?

Insurance claim denials are not the end of the road following a car accident. By state law, the insurance company must handle your claim promptly and honestly and make a “good faith effort” to consider the insured’s interests, as well as its own, when making settlement decisions.

If you feel the insurance company is unfairly denying a valid claim, you have every right to review the decision and file an appeal. While you can deal with the insurance company directly during the standard appeals process, finding a law firm of experienced New York City car accident lawyers willing to take your case will give you a much greater chance at success.

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1. Understand why auto accident insurance claims are denied.

Hang onto the denial letter for future reference, as this will become a crucial piece of evidence in your case. Understanding the basis for the denial dictates how you or your lawyer will poke holes in their logic and strengthen your claim. Fortunately, liability is not an issue in a no-fault state like New York.

However, other common reasons for denying auto accident insurance include:

• A dispute over the seriousness of the injury – Sometimes, insurers claim your injuries could not possibly be “severe” because you failed to seek immediate medical attention. You may need expert medical testimony to enlighten the insurer.

• Preexisting conditions – If your medical records show injury or illness with the symptoms you are currently claiming, they could argue that you were already hurt before the accident, and they are not contractually liable for paying.

• You were breaking the law – To decrease their risk and limit their liability, many insurers have specific policy language stating they will not cover accidents when you are driving drunk, driving without a valid license, street racing, fleeing from the police, or otherwise breaking the law. Unfortunately, these denials are often valid. Sometimes you can dispute a particular fact to restore coverage. 

• You were acting outside your contractual obligations – If your premiums were unpaid at the time of the accident, the insurance company could say no coverage existed. If you failed to notify them within a reasonable timeframe or if you failed to follow the standard protocol to correctly file your claim, they can deny it.

Outright denial is not as commonplace as minimizing the amount paid. They might argue that the treatments you’ve received were “not medically proven.” They might say you’ve exceeded your policy limits for coverage. Whatever the case may be, you don’t have to accept rejection–or the first settlement offer they calculate, for that matter.

2. Know what to reasonably expect from your insurer.

Insurance companies must “act in good faith” when handling your claim. If the insurer denies it, they must have a legitimate, fact-based reason to do so. Certain actions under New York Insurance Law §2601 are considered improper claims practice:

• Misrepresenting pertinent facts or policy provisions related to coverage.
• Failure to acknowledge pertinent communications with reasonable promptness.
• Failure to adopt and implement reasonable standards for prompt investigation of claims.
• Not attempting in good faith to effectuate fair and equitable settlements of claims.
• Failure to submit a reasonable basis for claim denial.
• Failure to advise the policyholder of claim acceptance or denial within 30 working days. 
• Compelling policyholders to file a lawsuit by offering substantially low settlements.
• Artificially deflating or lowering cost data inappropriately.

Should your case proceed through the courts, a judge will determine whether a reasonable insurance company, under the circumstances, would have engaged in similar claims practices and decided not to pay– or if the insurer was acting in bad faith.

3. Build your case.

We assume that insurance is in place to quickly and efficiently take care of us following an accident. Yet, in reality, your case will be handled with your best interests only if you take matters into your own hands.

• Take photos of your vehicle, the other vehicle, and your injuries at the scene if you can.
• Keep all your billing and medical records in one place. If an insurance adjuster calls and asks how you’re feeling, do not say you’re “good” or provide much detail.
• Avoid signing a FULL medical records release. Consenting to a doctor’s report is better.
• Never issue a recorded statement by phone– it can be used against you in court.
• Don’t sign a settlement acceptance agreement until you have spoken with a lawyer.

Naturally, you must act in good faith to settle with the insurer as well. Stubbornly refusing to follow standard protocol could jeopardize your continued coverage. However, taking your time and applying due diligence through the process– with the help of a personal injury attorney as your advocate– is reasonable.

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4. Contact a lawyer to appeal your denial.

Don’t just take the adjuster’s word that the denial was legitimate. See for yourself by seeking the opinion of outside experts who are not beholden to the insurance company. Insurers must pay fairly on valid claims, but they are also for-profit companies with financial obligations to shareholders. Working with an attorney levels the playing field and keeps insurers honest. It costs nothing to call for a free consultation to explore the merits of your claim.

Contact us at Douglas and London Today

Should Douglas and London agree to represent your claim, our New York City personal injury lawyers will deal directly with the insurer so you don’t have to, and pay all the necessary upfront expenses to pursue a fair resolution. You only pay for our services IF and WHEN we secure money on your behalf. The standard legal fee is about one-third of the total settlement or jury award, but plaintiffs tend to receive higher sums when they are represented by personal injury law firms versus filing pro se.