Handle Denied Car Accident Claims
Automobile insurance is the very embodiment of conflict of interest. Insurance companies normally seek to minimize their payments on claims in order to maximize their own profits. This can result in customers losing sight of their options and rights while feeling pressured to settle claims as quickly and cheaply as possible. It's a precarious position for the consumer, because symptoms and actual injuries can take weeks or months to be fully felt or diagnosed following an accident. Therefore, settling quickly with an insurance company is not always in the customer's best interest. A company might repeatedly contact a customer in seeking a quick settlement. This article will discuss your options for recovering financial losses as well as healing your body. Here's what to do when you've been in an auto accident and your insurance company is reluctant to pay.
Filing the Initial Claim
- Read your policy. After the initial accident scene is cleared, you should find your policy and read it. The policy is the contract between you and the insurance company. It spells out what the insurance company is supposed to pay, under what conditions they pay, and what your duties are to get those things paid. Look for things such as:
- Covered and uncovered items
- Determination of fault
- Required documentation
- Time limits for submission
- Contact information for claim submissions
- Speak with your agent. If anything is unclear, your agent can tell you how the insurance company usually handles certain situations and how they interpret certain policy provisions. This can prepare you for potential upcoming issues. The agent can also provide any forms you need and guide you in the process of submitting your claim.
- Submit all documents right away. Your policy will likely stipulate deadlines for submitting claim forms, estimates, medical bills, and other documents. You will also be required to make your vehicle available for an adjuster's inspection. If you do not comply with these requirements, your claim could be denied, leaving you with no further recourse.
Appealing the Denial
- Re-read your policy. If your claim is denied, you should refresh your understanding of any policy provisions you believe the insurance company may be violating. Familiarize yourself, too, with the process of appealing a denial.
- List the policy provisions. As you read the policy, list any provisions that you believe require the insurance company to pay. Beside each item on that list, notate the associated bills (including amount, payee, and description of the service provided). Then note the reason the claim was denied and your reason for disputing the denial. Common causes of denial include:
- There was no complaint or treatment at the time of the accident. Some states have laws barring claims if you don’t seek treatment within a short time frame following an accident.
- Medical records don’t indicate any injury or pain. Insurance companies are not required to pay for non-existent damages, and without medical records indicating injury or pain, they are often considered non-existent even though they may later prove to be very real.
- Your injury resulted from a pre-existing condition. If the accident worsened a condition you already had, you may still be able to get your claim paid if you can show that the accident exacerbated the condition.
- You could have avoided the accident. If the insurance company believes you did something to cause the accident, that may void your coverage. An example is driving under the influence of drugs or alcohol. If your policy states that the company will not pay for an accident that was your fault, you may need to prove to them that it wasn't.
- Gather your evidence. Even if it has already been submitted with the initial claim, you will want to submit evidence of your damages or conditions of the accident with your appeal. This evidence may include:
- The police report from the officer who responded to the traffic accident and documented the scene.
- Pictures you took of the vehicles and accident scene.
- Statements of witnesses to the accident.
- Medical records and bills.
- Any bills and estimates for vehicle repair.
- Write and submit your appeal. Your appeal will most likely be written in the form of a letter with the evidence attached. Be sure you state each reason they denied your claim, why you believe that reasoning was incorrect and contrary to the policy, and which piece of attached evidence supports your position. Attach all pieces of evidence that you used to support your position. Keep a copy of your appeal, and send the original to the location provided by your policy. Your agent can help you identify the appropriate place to file the appeal if your policy is unclear.
Going to Court
- Be prepared to go to court. While most minor traffic accidents are easily settled, your insurance company may deny a claim you believe should be paid. This could include damages that the company believes may have pre-dated the accident and medical expenses the company does not believe were necessary. Insurance companies can get very creative when attempting to deny claims.
- Consider hiring an attorney. Many accident attorneys work on a contingency basis, meaning they get paid a percentage of anything they recover for you in court. However, if your claim is small, some attorneys will not take the case.
- Find your statutes. Review the statutes in your state. You will want to read statutes regarding insurance, personal-injury claims, torts (sometimes considered civil procedure), and contracts. A link to state statutes can typically be found on the websites of your state’s legislature, supreme court, and/or governor’s office. Look for the things you must prove in court, defenses the insurance company may have, and anything you must do prior to filing suit. Also look for limits to recovery. If your state does not allow you to recover court costs or the cost of any experts expected to testify, it may not be worth suing.
- Complete any steps required prior to filing suit. Your state may require you to make certain attempts at settlement prior to filing suit in court. These will be found in your state statutes. These steps may include:
- Ensuring you are within the statute of limitations. Typically you must bring suit within five years, but some state statutes of limitations are as short as one year.
- Sending a demand letter. In a demand letter you inform the insurance company exactly how much money they owe you and what provision(s) of the policy make them responsible for those charges. You should also outline the steps you have previously taken to get this debt satisfied. Do not threaten to take any specific action. Instead give a deadline (such as 30 days) after which further action will be taken. You need not define what that further action would be.
- Obtaining a medical or other expert. Some states will not allow you to file suit for medical injury unless you have already engaged a medical expert to testify on your behalf.
- Locate the appropriate court. On the website of your state’s highest court, there should be a description of the state court system. Looking at that description, locate the general jurisdiction in your state. Often there will be a division between courts based on the amount of money under consideration (a small-claims court vs. a court of general jurisdiction). Once you identify the court that handles claims for the amount you are attempting to recover, locate that same court in your county or parish. You will want to file in the county or parish in which the accident occurred or a county where the insurance company has an office if you are suing the other driver’s insurance company. You can file in the county in which you live if you are suing your own insurance company.
- Locate and complete the appropriate forms. Most states provide pre-prepared forms for some civil actions. These can usually be found on the website of your local court and/or your state’s highest court. You can often get assistance finding and completing forms at your local self-help center. Some states provide an interactive, online program that creates your documents tailored to your particular circumstances. You will likely need at least a petition and summons or citation. <refhttps://www.sccourts.org/forms/</ref>
- Prepare for filing. Once the appropriate documents have been completed, you will need to sign them. Any forms that have a notary block on them will need to be signed in front of a notary. Make copies of all documents for yourself and all defendants (insurance companies or individuals you are suing), and keep the originals secure.
- File your documents. Give the original set of documents to the clerk of the court that will hear your case. A filing fee will be charged unless you apply and qualify for a waiver. You can ask the clerk to stamp your copies with the filing date. The clerk will also need to sign your summons or citation, which s/he will return to you.
- Serve the other parties. Ask the clerk to sign your summons or citation when you file your documents. Make a copy of the signed summons or citation for your records. Attach the original summons or citation to the copy of the documents for the other party. Typically the other party must receive these documents within 90 to 120 days of the date you file your case. Methods of service are different in each state, and acceptable methods can be found by reading your state’s civil procedural rules. They usually include some of the following:
- You can pay the sheriff’s office to serve them.
- You can pay a private process server to serve them.
- You can arrange for a friend or relative (at least 18 years of age and not involved in the case) to serve them by a method listed in the civil procedural rules. This person will need to complete a Return or Proof of Service and may need to testify as to how they served the documents.
- Note that in most cases you are not permitted to serve these documents yourself.
- Wait for an answer. In most states the other party has 21 to 30 days from the date s/he was served with the petition to file a written answer. You should receive a copy of the answer, but if you do not, call the clerk and ask if one has been received. If no answer was filed, consider filing for a Default Judgment.
- Participate in discovery. If you need to gather information or evidence to support your case in court, you will do this via discovery. Read the rules governing discovery usually found in the civil procedural rules to learn about discovery techniques and processes in your state. In general you can require the other party or potential witnesses to:
- Provide you with copies of documents
- Allow you to inspect items or property
- Answer written or oral questions under oath.
- Make disclosures. Throughout the case you will be asked to make certain disclosures to the other party, and you should request these same disclosures if they are not made voluntarily. These disclosures may include medical records, lists of people expected to testify at trial and what they intend to testify about, exhibits you intend to present at trial either as evidence or for demonstration purposes. If these things are not disclosed prior to trial, and the other party objects to their use, you may not be able to present them at your hearing.
- Read the Rules of Evidence for your state. Be sure you understand them. If you have any questions about them, it is worth paying an attorney for assistance or instruction.
- Participate in mediation. Here a neutral third party attempts to bring the parties to an agreement on the issues. There is no need to bring any evidence, because the mediator does not make any decisions. The intent is for both parties to compromise a little so that the issues can be settled without the need for a trial. If mediation is successful, the mediator may prepare the proper documents, obtain the signature of each party, and submit the documents to the court. If mediation is unsuccessful, the parties simply proceed to court. In most cases statements made in mediation cannot be used in court, and the mediator makes no statements to the court other than whether mediation was successful.
- Schedule your hearing. Contact the clerk of the court to schedule your hearing. You should be able to estimate for him/her how long the hearing is expected to take. The clerk may set a scheduling conference or hearing at which the judge will ask questions to be sure all issues are ready for trial and to determine how much time will be needed for the full hearing. You will be required to provide notice of the hearing to all other parties. You can do this by preparing a Notice of Hearing or by sending a letter to the other party giving all details of the hearing (date, time, location, expected duration, and the name of the judge). Ask the clerk if your court provides a form for this. Issue any necessary witness subpoenas.
- Attend your hearing. On the day of the hearing be sure you are dressed neatly and respectfully. If you have a suit, wear it. If not, clean clothes that would be suitable office attire are acceptable. If you only have jeans, be sure they are clean and in good repair. Do not wear shorts, flip flops, tank tops, miniskirts, or sagging pants. Arrive early. Speak only to the judge, not to the opposing party or their attorney. Address the judge with respect, calling him or her “Your Honor” or “Judge”. Stand when speaking. The case will likely proceed as follows, although this can vary with circumstances:
- Opening statements of the petitioner (you). This is a roadmap of the case and what will be proven.
- Opening statements of the respondent (the other party)
- Witnesses called by the petitioner and cross examined by the respondent
- Witnesses called by the respondent and cross examined by the petitioner
- Closing arguments by the petitioner (a summary of the trial and arguments as to why the judge should rule in petitioner’s favor)
- Closing arguments by the respondent
- Rebuttal by the petitioner
- Ruling by the judge
- Be ready for the post-trial phase. After the judge’s ruling, the prevailing party is usually tasked with preparing any orders. If you submitted proposed orders earlier and now prevail at trial, the judge may use those. The judge may also have stacks of blank orders on the bench that s/he fills out and signs while making the ruling. If you are tasked with preparing the order, locate the appropriate order form from the link above and complete it. Make two copies. File the original with the court, and send a copy to the other party. Keep the second copy for your records. Once the judge signs the order, you can get a copy of the signed order from the clerk. If you disagree with the judge’s ruling, you typically have 30 days to file a Notice of Appeal with the trial court. Check your state’s rules of appellate procedure for the appropriate deadline.
- Paul Gustafson, featured in the video above, recently helped legislate change in Oregon, requiring insurance companies to cover the cost of an independent appraisal for auto value after an accident. This greatly increased consumer protection in Oregon, counteracting the tendency of insurance companies to make initial, lowball (-30%) offers for "Total-Loss" auto values.
- Do an Internet search on the laws in your state: Type "Total Loss, (your state's name)" in the search bar. The State Insurance Commission and State Bar Association will both be able to put you in touch with the right advocates in your state if you need help with an insurance dispute.
- Even though your state has a statute of limitations regarding the filing of lawsuits, many insurance companies have a notice requirement written into your policy. If there is even the possibility of needing to rely on your own insurance company, you should notify them immediately after an accident, or you could void certain coverages.
- You are legally required to have liability insurance to drive in many states. Knowing your own rights will help you get the most value from your insurance purchase.
- Be aware that either party may file pre-trial motions regarding issues that need to be resolved before trial. These may include disputes over discovery or motions asking the judge to dispose of the case before trial by either dismissing it or ruling as a matter of law.