Can Your California Auto Insurance Company Deny Your Claim?

Posted on: 11Feb,2016

Here is a very real scenario to consider. Let’s say that you are involved in an auto accident and will be filing a claim with your California auto insurance company. Once the claim is filed, you start anticipating and even counting on the money that you are going to receive. The money will pay for the damage to your vehicle as well as any medical expenses that may arise. So you contact your insurance agent to ask them when you can expect your money and then you get the one response you had not anticipated – your insurance claim has been denied.

So what do you do now? You can’t drive your vehicle without it being repaired first, you think you may have a spinal injury as a result of the accident but you can’t afford to go to the doctor, and you are missing time on the job. Obviously the denial of your claim is becoming a costly and disappointing experience, not to mention completely frustrating. However, you still need to make sure that the denial of your California auto insurance claim was justified. After all, insurance companies are not immune to making mistakes.

Reasons for the Denial of Claims

By denying your claim, your insurance company has saved a considerable amount of money. This doesn’t necessarily mean that your insurer is dishonest. It simply means that whenever they have any doubts about a claim, they are going to deny in order to protect their interests. However, you do not have to accept that denial and in many cases, you can challenge them and possibly discover that the facts of your claim do not support the denial.

If you are going to challenge a claim denial, it is important to understand why they denied in the first place. Knowing the reason for the denial can work in your favor and help you decide if you have a valid reason for disputing it. Some of the more common reasons for a denial include:

• Making an uninsured/underinsured motorist claim when the other driver was insured
• Not having the proper coverage for the claim you presented
• The damage amount exceeds your coverage limits
• The insurance company was not notified when you purchased a new vehicle, so it was not added to your current policy
• You fail to qualify as the named insured listed on the policy
• Your policy has lapsed

Although these are the more common reasons for denying your claim, there are others that could arise in the claims approval process including:

• The accident could have been avoided
• There is a pre-existing condition which the insurance company felt has caused your injury and pain
• You were injured but did not complain immediately or seek treatment
• Your medical records do not reveal any evidence of an injury or pain

The bottom line is that you need to determine why your claim has been denied in order to challenge the decision.

What can You do?

If you honestly feel that you have a valid reason to challenge your claim denial, there are a few things to consider doing:

• Get detailed repair estimates from only high-quality, reputable vehicle repair shops.

• Know what your rights are before challenging the denial or the settlement they offered.

• Make sure the estimates you get are based on OEM (original equipment manufacturer) equipment and parts.

• Take all of the evaluation information that you have received to the California Insurance Commissioner’s office.

• If you still do not agree with the insurance company’s reasoning for the denial or the settlement they have offered, you may have to consider mediation

If you have taken all of the above steps, including going to the insurance commissioner’s office and your claim is still denied or you do not feel that the amount of the settlement is fair, you should consider discussing your situation with an attorney. If you feel that you have a strong case for challenging the denial or settlement amount, an experienced attorney whose specialty who specializes in these matters can help you. They can evaluate your circumstances and determine whether or not you have reason to file a law suit.