After suffering an injury in a car accident, receiving a letter denying your insurance claim can come as quite a shock. However, a denial isn’t necessarily the end of the road with the insurance company. With the help of an experienced car accident attorney in San Antonio, you may still be able to appeal your denial and receive a fair settlement for your losses. Let’s take a look at the steps this would typically involve.
Understand Why Your Claim Was Denied
Firstly, it’s a good idea to review the denial letter carefully and establish exactly why the insurer is refusing to pay. On occasion, claims are denied in error, or your claim may have been denied because a policy exclusion exists for the type of accident you experienced. Alternatively, the types of damages you’re claiming may be excluded. A claim might also be denied because of a dispute with regard to either the other driver’s liability or your damages.
A delay in reporting the incident to the insurer can also be used to justify a denial. Sometimes insurers even deny claims in bad faith, meaning they simply don’t have any real reason for denying your claim except a general disinclination toward paying settlements. After carefully reviewing the denial letter, if you’re still unsure about the reason for the denial, you can call the insurer for clarification.
Review Your Insurance Policy
Once you’ve established the reason for the denial, the next step is to review your insurance policy with care. Try to figure out whether or not the denial has any validity under the terms of the policy’s coverage.
The complex fine print in insurance policies can be difficult to understand. If necessary, a car accident attorney can review it for you and help determine what grounds for appeal you may have.
Prepare Evidence To Support Your Claim
When accident victims file insurance claims without legal guidance, they sometimes neglect to gather and present sufficient evidence to support their claims. This may result in wrongful denial due to a lack of proof. In order to successfully appeal a wrongful denial, you’ll need to collect concrete evidence to support your account of events and the value of your damages.
In a typical car accident case, evidence might include the police report, photos and videos of the accident scene, eyewitness statements, medical bills, doctor’s reports, and more. Prepare as much evidence as you can, or ask your attorney to investigate the accident and gather evidence for you.
Speak to the Insurance Adjuster
With sufficient evidence in hand, you may be able to persuade the insurance adjuster to overturn the denial. This would require showing the adjuster that you can clearly prove the denial was wrongful and the claim is valid.
However, be wary whenever communicating directly with an insurance adjuster. They may seek to lead you into admitting to a degree of fault for your injuries or reducing the value of your claim in some other way. It’s usually safest to leave all communications with the insurance provider to your attorney.
Submit a Formal Written Appeal
If talking to the adjuster proves fruitless, follow the insurer’s official process for formally appealing the denial decision. The process for appealing the decision will usually be outlined in the denial letter. Appealing a denial will usually entail submitting a formal letter of appeal, in which you’d explain why you believe the denial was wrongful and include evidence to support your position.
You’ll need to follow the insurance company’s appeals process precisely, which may be a deliberately difficult and time-consuming process. Once again, it’s usually best to have an experienced attorney draft the letter and carry out the full appeal process for you.
Ask the Texas Department of Insurance for Help
If your formal appeal is denied, you can file a complaint with the Texas Department of Insurance. They can offer you guidance on how to proceed and even investigate your claim to determine whether or not the denial was wrongful. If the Texas Department of Insurance decides that your claim is indeed valid, they can force the insurance company to overturn the denial and provide you with fair compensation.
Consult With a Car Accident Attorney in San Antonio
In almost all car accident cases, the sooner the injured victim consults with an attorney, the better. Neglecting to hire an attorney increases the risk of having a claim denied and also having a subsequent appeal denied. Car accident attorneys usually offer a free consultation during which they can figure out the strength of your claim and outline your options for appealing the denial.
Once hired, your attorney can then take over the entire appeal process and negotiate for a full settlement. They can review your denial letter and insurance policy with an expert eye, gather evidence to strengthen your claim, speak to the insurance adjuster on your behalf, draft your appeal letter, and take over all communications with the insurer thereafter. Learn more here about how an experienced Texas car accident attorney helps maximize compensation for their clients.
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While having an insurance claim denied can be stressful, it’s not the end of the world. The steps laid out in this article give you a chance of overturning the denial and recovering a fair insurance payout for your losses.
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