You didn’t leave the house expecting to get into a car accident. You even drove very cautiously to reduce the risk of a crash. Unfortunately, there’s no way to control another driver’s behavior. Before you know it you’ve been involved in a fairly serious crash. You’ve sustained some bodily injuries and significant damage to your car.
It’s clear to you that the other driver is at fault, so you decide to file a personal injury claim with their insurance provider. Not long after submitting the claim you’re notified that the insurer has denied your request. They don’t agree that it’s clear that their insured is to blame.
Getting into a car accident is stressful enough without the added stress of a denied insurance claim. However, you don’t have to let the insurance company have the final say. You have the right to either appeal the denied claim or file a personal injury lawsuit to get the money you need.
Why Are Insurance Claims Denied?
Insurance companies have the right to deny claims if they believe that there is a legitimate reason to do so. Reasons why insurers typically deny claims include:
- Disputes over liability and fault
- Lapse in insurance coverage
- Driver excluded from policy coverage
- Accident or damage excluded from policy coverage, and
- Failure to submit the claim within a reasonable amount of time after the accident.
Whenever an insurer reviews a claim, it must do so in good faith. This means that the company must “not do anything to unfairly interfere with the right of any other party to receive the beneﬁts of the contract.”
In other words, the insurer has to seriously and honestly review the request for benefits. Your claim can only be denied if there is a legitimate and valid reason. Denials not based on a legitimate reason are made in bad faith, which is a violation of California state law.
Appeal Your Denied Insurance Claim
Insurance companies do not have the right to unilaterally and arbitrarily deny your request for benefits. There must be some sort of appeals process in place to ensure that your claim receives the attention and analysis it deserves. If you believe that your insurance claim for benefits has been wrongfully denied, you can request a formal appeal.
The appeals process varies by insurer. Each company has a different structure in place to review denied claims. There are two primary methods used by insurers in California: internal appeals and arbitration.
Internal Appeals: The appeals process is handled in-house at the insurance company. A separate department within the agency is created for the sole purpose of considering appeals of denied claims. These internal appeals departments must be independent and consider all cases in good faith.
Arbitration: Many insurance companies prefer to resolve disputes and appeals through arbitration. Arbitration is essentially a private trial. You and the insurer present your arguments to a neutral third party, known as an arbitrator. The arbitrator acts as a judge and considers all arguments and evidence. Once all arguments have been presented, the arbitrator makes a final decision. This decision is final and binding on all parties.
File a Personal Injury Lawsuit
You also have the option of filing a personal injury lawsuit against the driver who caused your accident and injuries. This may be the best choice if:
- The driver’s insurance company refuses to accept responsibility
- The insurance company wrongfully denies your claim, or
- Your accident-related costs exceed the benefits available through the driver’s insurance policy.
Filing a lawsuit can be more expensive and time-consuming than an insurance claim. However, this process also allows you to take the insurer out of the driver’s seat. They don’t get to call the shots when you file a lawsuit. Instead, you allow the case to unfold in a San Diego civil court.
Most cases are settled privately at some point during the lawsuit process. At-fault parties and insurers may be eager to avoid a trial, knowing that they’re unlikely to win. This can encourage them to engage in meaningful and productive negotiation discussions.
If the at-fault driver or insurer still refuses to cooperate, you can decide to take your case to trial. Here, your experienced attorney will present your case to a judge and/or jury. The final decision will ultimately rest in their unbiased hands, unless you are able to settle the dispute before the verdict comes in.
Have you been injured in a San Diego accident? Do you need help getting the compensation you deserve? Contact Injury Trial Lawyers to schedule a free consultation with our experienced legal team.