Was Your Insurance Claim Denied? Here’s How to Fight It.


You Don’t Have to Accept a Claim Denial

An accident can take just moments to happen—but take months, if not years, to recover from. As medical bills pile up while you’re still unable to work, having a claim denied by an insurance company can be frustrating and stressful, to say the least.

The steps towards recovery after a car accident can be an experience that’s as frustrating as it is challenging. As you wait for your claim to be processed and approved, your life is on hold. Your car transports you to work, takes you to the grocery store, and plays a role in nearly every part of your daily responsibilities. As a result, having a damaged or totaled vehicle is a major inconvenience that can contribute to a serious loss of your livelihood.

Adding to this pressure are medical bills from the accident. As their due date approaches, your stress levels increase—and insurers are counting on this. Insurance companies are businesses that are ultimately seeking a profit. This means that providers will utilize several tactics to protect profits by denying your claim.

Insurance companies have built their fortunes by providing a service to others while maximizing their profits through nitpicking claims, stalling, and exploiting the general public’s ignorance regarding their policies. If your claim has been denied by an insurance company, hope is not lost. Here are the steps you can take to fight for recovery.

The Claims Process

To understand what to do when your claim is denied, it is important to know the entire claims process. The claim process may end quickly at the first settlement phase, or it can last for months or years if the insurance company forces you to hold them responsible in court. The first step is where many people endanger their chances of getting compensation: report an accident promptly to an insurance company.

Steps in the claims process include:

  • Investigation – The initial period of information gathering. Police reports, witness testimony, and medical histories are reviewed to build a case on both sides.
  • Initial Settlement – At this stage, an initial settlement may be offered by the insurance company. This early offer is typically low and designed to maximize profits for the insurance provider. An agreement accompanies the acceptance of this settlement stating that you are giving up the ability to pursue further compensation through litigation.
  • Demand Letter – This is the letter that is submitted as a counter-offer after declining an initial settlement. A demand letter must be thorough in outlining the reasons why it is being sent. These reasons include medical bills, cost of repairs, time lost from work, and mental or physical anguish.
  • Negotiation/Litigation – If your demand letter is not accepted, your attorney will attempt to negotiate with the company. After negotiations fail, litigation may be necessary. This process can take anywhere from a few months to many years.
  • Final Settlement – A settlement is only reached with the client’s final approval and any outstanding payments are made. Once a settlement is agreed upon, a release of claims is signed, eliminating the possibility of further litigation.

As mentioned above, a claim may be settled as early as the first stage of initial settlement. Though this may take just a few days and seem convenient, it is not always the wisest decision to accept the initial settlement. This first settlement is usually a low offer designed to take away your ability to legally pursue more compensation, especially in cases involving personal injury.

Reasons Your Insurance Claim May Have Been Denied

You Did Not File a Claim on Time

Most insurance policies have strict time limits for making a claim. Though specific times vary, they can be as broad as “promptly” to being within 24 hours of the accident. If both parties fail to make a claim in a timely manner, the insurance provider may deny your claim.

Just as in many other states, Pennsylvania law also places a time limit on the period in which you can pursue a personal injury lawsuit. These statutory rules state that you must act within two years from the date of the incident. Failing to meet this requirement will encourage an insurance company to deny your claim and you will be unable to dispute their decision.

Pennsylvania Is a No-Fault State

Importantly, a claim may be denied in the state of Pennsylvania depending on how you are covered by your specific type of policy. Pennsylvania is a “no-fault” state, which blocks individuals from pursuing compensation from the opposite party’s insurance, even when the opposite party is at fault. However, drivers may opt-out of the no-fault system if they have full tort insurance—which is slightly more expensive than other insurance options.

Though limited tort insurance may initially save you money, it prevents you from seeking damages from the other party, regardless of who caused the accident. Those with limited tort insurance must use their own insurance for all damages and are not able to make a claim with the at-fault party’s insurance.

Full tort policies enable holders to pursue the recovery of their damages from another person’s insurance. These policies provide additional options in the event of a serious accident. As a result, we recommend getting full tort coverage, though it costs more.

Your Vehicle’s Value Has Changed

If you modify your car in a way that adds to its value or have recently bought a new car and did not inform your provider, they may deny your claim or offer a lower settlement based on your car’s previous value.

There Was an Inadequate Amount of Record-Keeping

Recording the facts at the scene of an accident is crucial. It is important to make sure a police report was filed. In Pennsylvania, if no police were at the scene, you must complete a Driver’s Accident Report within 5 days of the accident.

When speaking to a law enforcement official who will be filing a report, be certain to provide as many details as possible. These details should include the events leading up to the accident as well as any pain that you may be feeling. Accurate reporting from a law enforcement officer will strengthen your case and make claim denial difficult.

Additionally, medical records must be thorough and timely. Delayed medical appointments may look suspicious to an insurance company and cause enough doubt for a claim to be denied. This means that, even if you are not in any initial pain, you must see a doctor as soon as possible after an accident. If a medical report is not complete or is missing information, an insurance company may also take advantage of this and deny or diminish your claim.

Your medical records are the support for any claims you are making for damage recovery.

The Best Way to Defeat Denial Is With an Experienced Car Insurance Attorney

A claim may be denied almost immediately after it is submitted. However, having a denied claim request at any point is not a sign of defeat, despite what the insurance companies may lead you to believe. Hiring a personal injury lawyer is the best way of making sure that you are not taken advantage of. No one should be expected to navigate the complicated language and practices of the insurance world alone.

The Pennsylvania car accident attorneys at HHR know that your fight isn’t over simply because a large insurance company has denied your claim. We have been proudly serving the citizens of Pennsylvania since 1922. With nearly 100 years of experience, HHR has handled tens of thousands of car accident claims. We’ve won tens of millions of dollars for people who have struggled receiving the proper compensation after serious injuries.

Our case reviews are free, so you can fully explore your financial and legal options. Our attorneys work from offices in Lancaster, Harrisburg, Carlisle, York, and Hanover and may be contacted at (888) 498-3023.

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