How and Why Can Insurers Deny Your Claim?
Last Updated on November 5, 2022
You’ve been involved in a collision. Fortunately, you’re covered by insurance. You make a claim through your insurance company – only to have your claim denied. Oftentimes, having your claim denied is not your fault and can be rectified, so don’t immediately fret. There are many different (legitimate and illegitimate) reasons why your claim may have been rejected by the insurance company.
But that still begs the question – why did the insurance company deny your claim? What are some of the common reasons for an insurer to deny your claim? What can you do in the future to avoid having your auto insurance claim denied? Is there anything you can do to get your denied claim eventually approved? Today, we’re explaining everything you need to know about how and why insurers deny auto insurance claims.
Top 3 Most Common Reasons Why Auto Insurance Companies Deny a Claim
Your claim can be denied for thousands of different reasons. However, there are certain common reasons why car insurance claims can be denied, including:
You might assume your car insurance policy covers everything. Unfortunately, that’s rarely the case. Car insurance policies are filled with exclusions. You might not be covered under certain conditions, for example. Or, your policy might not cover things like hail damage, vandalism, or theft – especially if you don’t have comprehensive coverage. Read your policy to make sure you understand what is and isn’t covered.
Your Policy Lapsed
Car insurance companies will likely deny your claim if your policy has lapsed. They may also deny your claim if the other driver’s insurance policy was inactive at the time of the collision. In this situation, you would need to rely on uninsured motorist coverage. A lapsed policy can occur when you forget to make a payment or fail to renew your policy.
Failure to Notify your Insurer in a Timely Manner
Ideally, you’ll notify your insurance company within hours of your incident. Your auto insurance policy will dictate how quickly an accident needs to be reported in order to be covered. If you fail to report an accident in a timely manner based on the terms of your policy, then your claim may be denied.
Other Common Reasons Why a Car Insurance Claim May Be Denied
As mentioned above, a car insurance claim can be denied for thousands of different reasons. In addition to the three common reasons listed above, here are some more common reasons why claims get denied:
You Were Driving Under the Influence
If you were driving while under the influence of drugs or alcohol, then your insurance company might deny your claim. Drivers who get into an accident while over the legal limit may face a denied claim.
You’re an Excluded Driver on the Policy
Your claim might be denied if an excluded driver was operating your vehicle at the time of the incident. If you’re an excluded driver and you were driving the vehicle, then your claim may be denied. Make sure you list all regular drivers in your household to avoid encountering this problem when you need to make a claim.
You’re Committing Fraud
Insurance companies lose billions of dollars every year to fraudulent claims. Your insurance company might deny your claim because they believe it’s fraudulent. Your claim might be denied until you provide further proof of the incident – like a police report, photos, or video footage.
You Were Driving a New or Improved Vehicle and Forgot to Tell Your Insurer
If you were driving a new vehicle at the time of the accident, then your claim might be denied. Your insurance company needs to be alerted when the value of your vehicle changes dramatically – i.e., if you recently upgraded your vehicle or purchased a new vehicle. If your agent doesn’t know about add-ons to your vehicle, then you’ll only receive compensation based on the old value of your vehicle.
You Have Insufficient Coverage
Some states have extraordinarily low requirements for basic liability plans. Drivers might only receive $10,000 in compensation for an accident, for example, if they have basic liability plans. That might be enough to cover basic repairs – but it’s rarely enough to cover hospital bills, lost wages, medical expenses, and other damages incurred as a result of an accident. Your auto insurance claim could be denied because you have insufficient coverage. In this case, you’ll likely need to cover expenses out of pocket.
You Failed to Receive Immediate Medical Attention
Above, we mentioned that insurance companies deny claims because of failing to report the incident in a timely way. Similar to that point, insurance companies can deny your claim because you failed to receive immediate medical attention after the incident. This makes it difficult to prove your injuries were the result of the incident and not some other event. If you’ve been involved in a collision, then get medical assistance as soon as possible. The sooner you receive medical attention after a collision, the easier it will be for your insurance company to link your injuries with the collision.
You Filed an Uninsured Motorist Claim on a Driver Who Has Insurance
This mistake can happen occasionally. You filed a claim under uninsured motorist insurance, but the other driver actually has insurance. Make sure you’re aware of the insurance status of the at-fault driver. If you submit a claim under uninsured motorist coverage when the other driver has insurance, then your claim will be denied.
You Live in a State with No-Fault Coverage
12 states across America have something called no-fault insurance law. This law prevents people from filing a personal injury claim against the responsible driver. If you tried to file a personal injury claim in a state with no-fault insurance, then that claim will be denied. States with no-fault insurance laws include Florida, Hawaii, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, New Jersey, New York, North Dakota, Pennsylvania, and Utah. Puerto Rico is also a no-fault territory.
Final Word on Claim Denials
Ultimately, there are countless reasons why an insurance company could deny your claim. We’ve listed some of the most common reasons above. If your car insurance claim has been wrongfully denied, then you may consider hiring a public adjuster, an attorney, or your state’s Insurance Commissioner for additional assistance.