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Car, Bus, & Truck Crash Attorneys for Injured People

When Can an Insurance Company Rightfully Deny a Claim?


August 22, 2016

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After a car accident, it can be frustrating to do everything that you are supposed to do but have your insurance claim denied—especially if the accident was the other driver’s fault. If your insurance company is denying your claim, learn more about your options and ways that you can fight back.

When Can A Claim Be Denied?

Insurance companies have a duty to act in good faith. When a person purchases an auto insurance policy, he or she is making a contract with the insurance company that the premiums will be paid in exchange for coverage of claims under the policy. The insurance company has a legal duty to reimburse you for medical expenses, repairs, and other costs if the policy covers the accident.

If an insurance claim is denied, the insurance company must be able to justify its actions. Usually, accident claims are denied for several common reasons. These reasons include:

#1: The Accident Was Avoidable

When an accident was the fault of the insured, or could have been avoided due to the insured’s actions, most policies will not cover these claims. For instance, many insurance companies will not cover an accident which is caused by the insured driving while intoxicated.

#2: Failure to Seek Medical Treatment

If the insured is claiming that he or she was injured in the accident, then the insurance company will expect to see a record of medical treatment and doctor visits. If the insured never sought treatment or waited weeks to see a doctor, the insurance company will suspect that the insured is lying about the injury and may refuse to cover the claim.

#3: Policy Doesn’t Cover the Claim

An insurance company will only provide coverage of an accident claim if the policy covers that accident. For instance, if a vehicle was damaged due to a falling tree branch or a collision with a deer, the insured must carry comprehensive or collision coverage for the claim to be covered. Without the right type of coverage, the insurance company will have no obligation to pay the claim.

#4: The Policy Lapsed

If the auto insurance policy has lapsed, either because the insured failed to pay his or her premiums or because the policy has expired, then the insurance company will not be obligated to cover any damages.

#5: The Claim Exceeds Policy Limits

An insurance company is only obligated to pay for claims up to the limits of the policy. For example, if your insurance policy only covers up to $50,000 in medical bills, any costs exceeding $50,000 will not be covered.

After a Claim is Denied

If your insurance claim is denied, it is important to speak with an attorney. An attorney can review your auto insurance policy and check to see if your accident or costs are supposed to be covered by the policy. If they are, the attorney can help you re-file your claim, negotiate with the insurance company, or pursue a lawsuit seeking damages for your injuries and expenses.

At The Linebaugh Law Firm, our attorneys fight for injured people—not the insurance companies. If your claim was denied without reason, contact our office today by calling (281) 422-0505. We can help you get the compensation you need to cover your medical bills, lost wages, pain and suffering, and other expenses.

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