Can I appeal an auto insurance claim? (How to Dispute and Win)
Can I appeal an auto insurance claim? Yes, it's your right. You will need to gather evidence, write an appeal letter, and in some cases hire an attorney. Winning a claims appeal depends on the reason for the denial and your ability to prove it wrong.
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UPDATED: Apr 29, 2022
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When you’ve been involved in an accident and have to file a auto insurance claim, it can be a minor inconvenience, or it can change everything in your world overnight. Certainly, the quality of your auto insurance company has a lot to do with your claims experience.
You’ve probably heard stories of denied claims, but when happens to you it can come as a shock. The good news is you can appeal an auto insurance claim decision. There is a process in place to dispute the insurance company’s decision, but first, you need to know why your claim was denied and whether or not you have grounds for an appeal.
Sound confusing? Don’t worry, we have all the information you need. Can I appeal an auto insurance claim? How do I fight an auto insurance claim denial? What are my rights? We’ve got the answers to all of these questions and more right here.
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How do you fight an insurance claim that’s been denied?
So you’ve received that dreaded denied claim letter from your insurance company. What now? Can you dispute the auto insurance claim decision? Absolutely.
Disputing auto insurance claims and payouts can be done, but you have to follow a few basic steps. In the following sections, we will cover what to do when your auto insurance denies a claim and how to win a auto insurance appeal.
Review Your Claim Denial or Settlement Offer Letter
It can be particularly troublesome if your auto insurance company denies your claim for benefits or offers you a settlement that’s much too low.
The good news is that you can and should appeal your auto insurance claim if you feel that the company is wrong.
Below are some tips that will help you get back on the road with a satisfying agreement between you and the insurance company.
Reviewing your claim denial letter or the settlement offer letter that you received is important to understand the insurance company’s stance on your claim.
It will generally point out why they made the decision they did and likely give you a starting point for refuting their denial or lowball settlement offer.
As we will discuss later in this article, some common denial reasons are that the claim exceeds the policy limits, you were not a named insured on the policy, you’ve missed a payment or a filing deadline for the claim, or that you were at fault in the accident.
If a police report was filed, you have the right to request a copy of the accident report. Insurance companies review police reports and take them into consideration when determining fault. Can you appeal an accident report? That depends. If a ticket or citation was issued, there is a procedure for appealing that decision. That doesn’t mean that the insurance company will change its fault determination, but it may help.
Research Your Auto Insurance Claim Rights
Reading over your insurance policy is important so that you know exactly what you’ve been paying your auto insurance company to cover. If you disagree with your insurance company, you have options.
There are many variables, and it might have many unfamiliar terms, so read it through and check into anything you don’t understand.
In most states, there is a version of your automobile insurance bill of rights posting online. It might be listed at the state bureau of motor vehicles site or the site for your state’s insurance commissioner, which can be found through the National Association of Insurance Commissioners (NAIC).
Find this information and read it thoroughly, as it will provide you with important points you need to know, such as filing dates and requirements.
After reading your rights as a consumer, if you feel that your insurance company didn’t fulfill their duties to you, then decide how to proceed.
Write a Claims Appeal Letter
After you’ve reviewed the information within the auto insurance claim denial, start gathering the information you need to dispute the insurance claim in a letter. To begin the process of disputing a denied claim or a settlement that’s too low, you must submit your argument to the insurance company in writing.
You can start the process without an attorney, but a lawyer can be extremely helpful in persuading an insurance company to pay more than they are willing to offer.
An attorney may also be able to provide a auto insurance claim dispute letter sample. Attach any other information to the appeal letter that the auto insurance company asks for.
What is an auto insurance claim appeal letter?
This is a letter stating your case and why your bodily injury and property damage should be covered. There may be some specific situations where the circumstances were reasonably unfair and inconvenient for all parties involved. The auto insurance provider will examine these events closely before making a final decision.
If the appeal process doesn’t work and you genuinely feel that you’re entitled to compensation, contact an attorney as soon as you can.
How should I submit my auto insurance claim appeal letter?
That would depend on the auto insurance provider’s standards. Some auto insurance companies make you send the appeal letter via certified mail, while others insist that you send an appeal via email.
The most effective and common way is through certified mail. It’ll cost a few dollars to send it.
Hire an Insurance Claims Attorney
Especially if you suffered serious injuries or your vehicle has extensive damage, or if you’re uncomfortable negotiating by yourself, you may be asking yourself: “Do I need a lawyer to deal with an auto insurance adjuster?” Attorneys with auto claims experience can be very helpful.
A strongly worded letter from an attorney can make all the difference in the insurance company’s attitude at times.
Definitely consider working with a lawyer if your company is extremely resistant to paying your claim or isn’t negotiating fairly.
Additionally, an attorney is well-versed in how the state runs its insurance commissioner’s office and will know how to take advantage of any remedies they might offer to consumers as well.
Keep in mind that going to court to enforce your claim should be your last resort, as it’s often a lengthy and expensive process.
Here are some tips from an attorney’s office that describe the steps you can take before hiring an attorney.
Legally pursuing claims can take a long time, and it’s important for anyone who is entitled to compensation to report bodily injury and property damage as soon as possible.
If you don’t, the statute of limitations could run out.
The statute of limitations is the time in which a person can make a legal claim against any party, person, or business.
Each state has a different statute of limitations. Let’s look at a summary of the statute of limitations of every state.
|State||Bodily Injury||Property Damage|
|Alabama||2 years||2 years|
|Alaska||2 years||6 years|
|Arizona||2 years||2 years|
|Arkansas||3 years||3 years|
|California||2 years||3 years|
|Colorado||3 years||3 years|
|Connecticut||2 years||3 years|
|Delaware||2 years||2 years|
|District of Columbia (D.C.)||3 years||3 years|
|Florida||4 years||4 years|
|Georgia||2 years||4 years|
|Hawaii||2 years||2 years|
|Idaho||2 years||3 years|
|Illinois||2–3 years||5 years|
|Indiana||2 years||2 years|
|Iowa||2 years||5 years|
|Kansas||1 year||2 years|
|Kentucky||1 year||2 years|
|Louisiana||1 year||1 year|
|Maine||6 years||6 years|
|Maryland||3 years||3 years|
|Massachusetts||3 years||3 years|
|Michigan||3 years||3 years|
|Minnesota||2 years||6 years|
|Mississippi||3 years||3 years|
|Missouri||5 years||5 years|
|Montana||3 years||2 years|
|Nebraska||4 years||4 years|
|Nevada||2 years||3 years|
|New Hampshire||3 years||3 years|
|New Jersey||2 years||6 years|
|New Mexico||3 years||4 years|
|New York||3 years||3 years|
|North Carolina||3 years||3 years|
|North Dakota||6 years||6 years|
|Ohio||2 years||2 years|
|Oklahoma||2 years||2 years|
|Oregon||2 years||6 years|
|Pennsylvania||2 years||2 years|
|Rhode Island||3 years||10 years|
|South Carolina||3 years||3 years|
|South Dakota||3 years||6 years|
|Tennessee||1 year||3 years|
|Texas||2 years||2 years|
|Utah||4 years||3 years|
|Vermont||3 years||3 years|
|Virginia||2 years||5 years|
|Washington||3 years||3 years|
|West Virginia||2 years||2 years|
|Wisconsin||3 years||3 years|
|Wyoming||4 years||4 years|
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You see how the statutes are different for each state. If you’re ever in an accident out of your home state, research the statute of limitations in case your claim is denied or if you have to pursue legal action.
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Provide Evidence for Your Claim Dispute
If you’re going to send a letter or make any sort of auto insurance claim, be sure to include evidence of the claim. This includes dates, receipts, physical and digital copies of documents related to your claim, photos of property damage and injuries, and invoices from medical providers and auto repair shops.
The idea is to make sure you have all the information you need to ensure that the claim process moves smoothly. Sometimes, a claim is denied due to missing information, so you need to have all the necessary documents to get what you’re entitled to.
Here’s a video that describes the process of appealing a denial from an insurance company:
Although this general information shows how a policyholder would pursue an appeal, it varies for each company. The largest auto insurance providers have agents that are always by the phone or on the internet ready to move your appeals along. Some auto insurance providers are smaller and are only available during business hours.
Holidays may further slow down the process, and sudden events such as layoffs or company restructuring could put the person pursuing an appeal in an awkward place. So do everything you can to appeal a denial as properly as possible.
If you believe your claim should be covered under your policy, you must prove the reasons why to your insurance company.
To do this, you must gather all of the relevant documents — police reports, pictures of the vehicles, insurance documents, hospital bills, and repair estimates, for example.
You or your lawyer will tell the company why each piece of your evidence refutes the adjuster’s decision.
A well-supported appeal case has an excellent chance of being approved or negotiated for a better settlement.
In cases of permanent injuries or significant property damage, it’s in your best interest to consult with an attorney before negotiating with your carrier.
Additionally, if you feel the insurance carrier improperly denied your claim or is negotiating in bad faith, an attorney can be helpful. Bad faith practices generally require complaints to your state insurance commissioner, aggressive settlement negotiations, or lawsuits.
This news report goes into detail about bad faith practices.
It’s frustrating to have an insurance claim denied after a car accident, but that doesn’t mean you simply end negotiations and take the loss. You do have options to pursue the money that you feel is rightfully owed to pay for your injuries and damages, and being persistent ensures that you’ll get a fair settlement.
What if the other driver’s insurance denied the claim?
In some cases, you may face a situation where you are not at fault and the other party’s insurance denied the claim. In this case, you will want your insurance company to go to work for you.
You should be able to file with your own insurance company (if you haven’t already) and get your repairs done under your collision coverage. You’ll have to pay the deductible, but once your insurance company is involved, they’ll start a process called subrogation. This is when your insurance company goes back to the other driver’s company and fights to get the money they paid to repair your car back.
The good thing about having your insurance company subrogate a auto insurance dispute is that they have their own experts to negotiate on your behalf. And if they have paid out on a claim they don’t agree they should have paid, you can be sure they will fight to get their money back. When you win in subrogation, you will get your deductible back.
When a Claim Is Denied by an Underinsured At-Fault Driver
Claims can be denied because the at-fault driver has a coverage limit that doesn’t cover the cost of bodily injury or property damage. Underinsured motorist coverage kicks in when this happens.
Underinsured motorist coverage (UIM) will pay you, as the no-fault driver, when the at-fault driver doesn’t have enough to cover for damages.
This can be useful when filing a claim that’s denied by an at-fault driver’s auto insurance company. Does this mean the at-fault driver and the insurance company aren’t liable? By law, the at-fault driver must pay for any damages, injuries, or both.
Why would an auto insurance company deny your claim?
There are many reasons why an auto insurance provider will deny your claim. Each reason is based on an individual basis, so an auto insurance provider will have one of their agents investigate your claim before they can deny it. But why would your claim be denied?
For this section, let’s explore the reasons why an insurance company will deny your claim. We’ll cover a few reasons why an auto insurance provider will deny your auto insurance claim. Then we’ll help you understand how to deal with a denied claim.
Auto Insurance Coverage Limits Are Too Low To Cover The Claim
When you enroll in an auto insurance policy, you’ll have something called a coverage limit or coverage rule. Each coverage limit varies by state. The Insurance Information Institute lists these coverage limits on their website, and we’ll summarize that information in a table below.
|States||Coverage Types||Coverage Limits|
|AL||BI & PD Liab||25/50/25|
|AK||BI & PD Liab||50/100/25|
|AZ||BI & PD Liab||15/30/10|
|AR||BI & PD Liab, PIP||25/50/25|
|CA||BI & PD Liab||15/30/5|
|CO||BI & PD Liab||25/50/15|
|CT||BI & PD Liab, UM, UIM||25/50/20|
|DE||BI & PD Liab, PIP||25/50/10|
|DC||BI & PD Liab, UM||25/50/10|
|FL||PD Liab, PIP||10/20/10|
|GA||BI & PD Liab||25/50/25|
|HI||BI & PD Liab, PIP||20/40/10|
|ID||BI & PD Liab||25/50/15|
|IL||BI & PD Liab, UM, UIM||25/50/20|
|IN||BI & PD Liab||25/50/25|
|IA||BI & PD Liab||20/40/15|
|KS||BI & PD Liab, PIP||25/50/25|
|KY||BI & PD Liab, PIP, UM, UIM||25/50/25|
|LA||BI & PD Liab||15/30/25|
|ME||BI & PD Liab, UM, UIM, Medpay||50/100/25|
|MD||BI & PD Liab, PIP, UM, UIM||30/60/15|
|MA||BI & PD Liab, PIP||20/40/5|
|MI||BI & PD Liab, PIP||20/40/10|
|MN||BI & PD Liab, PIP, UM, UIM||30/60/10|
|MS||BI & PD Liab||25/50/25|
|MO||BI & PD Liab, UM||25/50/25|
|MT||BI & PD Liab||25/50/20|
|NE||BI & PD Liab, UM, UIM||25/50/25|
|NV||BI & PD Liab||25/50/20|
|NJ||BI & PD Liab, PIP, UM, UIM||15/30/5|
|NM||BI & PD Liab||25/50/10|
|NY||BI & PD Liab, PIP, UM, UIM||25/50/10|
|NC||BI & PD Liab, UM, UIM||30/60/25|
|ND||BI & PD Liab, PIP, UM, UIM||25/50/25|
|OH||BI & PD Liab||25/50/25|
|OK||BI & PD Liab||25/50/25|
|OR||BI & PD Liab, PIP, UM, UIM||25/50/20|
|PA||BI & PD Liab, PIP||15/30/5|
|RI||BI & PD Liab||25/50/25|
|SC||BI & PD Liab, UM, UIM||25/50/25|
|SD||BI & PD Liab, UM, UIM||25/50/25|
|TN||BI & PD Liab||25/50/15|
|TX||BI & PD Liab, PIP||30/60/25|
|UT||BI & PD Liab, PIP||25/65/15|
|VT||BI & PD Liab, UM, UIM||25/50/10|
|VA||BI & PD Liab, UM, UIM||25/50/20|
|WA||BI & PD Liab||25/50/10|
|WV||BI & PD Liab, UM, UIM||25/50/25|
|WI||BI & PD Liab, UM, Medpay||25/50/10|
|WY||BI & PD Liab||25/50/20|
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Notice a lot of acronyms? Here’s what they stand for: BI stands for bodily injury, PD is property damage, Liab is liability, PIP is personal injury protection, medical payments are labeled is Med Pay, UM is uninsured motorist, and UIM is underinsured motorist.
By the way, you may asking: “Do you have to have auto insurance in every state?” In most states, yes. However, each state has different auto insurance requirements.
If you’re in an accident that leaves the no-fault driver injured and their property damaged, the coverage limit is supposed to cover the total cost of all injuries and damages. If it doesn’t, the auto insurance company may deny your claim or settle up to an amount they find reasonable.
However, when you’re the no-fault driver with bodily injury or property damage that exceeds the at-fault driver’s coverage limit, the auto insurance company representing the at-fault driver may deny your claim. In this scenario, you can try to appeal the insurance denial or pursue legal options to get paid for medical bills and repair costs.
The possibility of not having enough coverage in a claim situation is the biggest reason to carry more than the minimum auto insurance coverage.
Your Auto Insurance Had Lapsed at The Time of the Claim
Auto insurance providers will deny your claim if you haven’t paid your auto insurance premium. Nonpayment of auto insurance can mean letting your auto insurance lapse.
In addition to nonpayment, your insurance policy can lapse if you miss a filing deadline. As long as your policy is in a lapsed stage (considered inactive), an auto insurance provider won’t notify you.
Here’s another video that describes the steps you can take when your auto insurance policy has lapsed. While this is specific to Florida, the process is similar in most other states.
Insurance law in each state varies, so you’ll have to do some research to find out what your rights are as a consumer. A lapse in auto insurance coverage is a sure way to get your claim denied. So it’s important to make timely payments to your auto insurance policy.
The Driver Isn’t Covered on Your Policy
It’s an honest mistake for some policyholders to lend their motor vehicles to others in need. Unfortunately, accidents are unpredictable and can be costly when the person driving the vehicle is at fault and isn’t on your policy. This is known as an excluded driver.
Auto insurance companies can deny your claim because the at-fault driver involved in the accident isn’t on your auto insurance policy.
In other words, they may deny a collision claim because the driver isn’t on your policy and they were at fault in the accident.
Here’s a video that explains this particular event in detail.
To prevent this from happening, add the trusted person to your policy, and enroll in a higher coverage limit in case bodily injury and property damage are more than the minimum requirements.
You Weren’t Honest With the Insurance Company
When a policyholder gets a quote from an auto insurance company, the company will ask several questions that ultimately gives the customer the price for auto insurance per month or every six months.
If a policyholder uses their motor vehicle for business but doesn’t tell the auto insurance provider, the auto insurance provider may deny their claim.
The same would go for a policyholder who doesn’t accurately report their driving history. Auto insurance providers usually find out about these inconsistencies before they give you a policy, but if they don’t and find out the information given to them by the policyholder is inaccurate, they’ll deny any claim from the policyholder.
A business trip can go from bad to worse if you don’t alert your auto insurance company beforehand that your vehicle is being used for business. Alert your auto insurance company as soon as possible or before business trips that you’re using your insured vehicle for business as well as general commuting.
Auto Insurance Suspects a Fraudulent Claim
If an insurance provider suspects that the claim they received is potentially fraudulent, they will investigate it, or they may deny the claim altogether.
Auto insurance fraud is a very serious crime, and laws vary by state according to the Insurance Information Institute (III). The severity of the crime depends on the amount of money involved in the fraudulent claim. Not only will the insurance company deny your claim, but your insurance policy will also be dropped indefinitely.
An insurance company won’t randomly suspect insurance fraud. Each company has a checklist of what fraud looks like. When certain conditions fit within that checklist, the insurance company may start an investigation before moving forward with a claim.
How do I prevent my claim from being denied?
Maybe you’re in a position where you’re about to make a claim, or maybe you just want to anticipate the scenario of a denied claim and want to make sure your claim is approved to begin with.
There are several ways to do that. In this section, we’ll talk about how you can reduce or prevent an auto insurance claim from being denied.
Enroll in a Higher Coverage Level
This more or less protects you as the policyholder and possibly prevents long legal pursuits. As we’ve seen earlier in the guide, the state minimum for auto insurance has a coverage limit.
You can enroll in a policy that’s higher than the state minimum requirements. This will ensure that bodily injury and property damage are covered completely for the no-fault driver.
Also, consider getting full coverage insurance.
This is simply the combination of basic auto insurance coverages such as liability, collision, and comprehensive coverage. There are other added insurance coverages that help with specific events such as business trips.
Although higher coverage limits and additional coverages are more expensive, they could save you a lot of trouble and possibly reduce your chances of having your claims denied.
Add Drivers to Your Policy
Remember that if you have a licensed driver in your household, they must be listed on your policy. Auto insurance companies need to rate for all of the risks in your home, and failing to add a licensed driver can result in non-renewal. Adding every driver in your house is not optional.
You can specifically exclude a driver from your policy, but once you have gone through this process they can not drive your cars and be covered under any circumstances.
Some auto insurance policies can have additional drivers as well as other vehicles listed, even if they don’t live with you. This is a good idea if you have a friend that doesn’t own their own car (and therefore doesn’t have their own insurance) who drives your vehicle regularly. Occasional use of your car by a licensed driver that doesn’t live with you is generally covered without adding the driver.
Ask your auto insurance provider how you add a driver to your existing policy, so you can potentially avoid a situation where your claim is denied.
Update Your Auto Insurance Company With Any Changes
Tell your auto insurance provider about business trips or any other venture that involves the vehicle they insured.
Even if you didn’t tell them when you first started your policy, auto insurance agents realize that things may change since you began your policy. This may increase your auto insurance rates, but you can certainly avoid a denied claim by giving updates about your employment situation with your auto insurance provider. The same goes for adding new vehicles or drivers.
Hopefully, your insurance company is reasonable and will work with you to make sure that you’re satisfied with the outcome. If not, be sure to compare insurance companies and their claims ratings to find one that will serve you better in the future.
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