Reasons Why Insurance Claims Are Denied

Finding out that your car insurance claim has been denied can be a tough pill to swallow. But understanding the reasons why it happened can help you navigate the situation and prepare your next steps.

Some of the reasons your claim is denied could be:

• The event does not meet the definition of a covered loss: If you review your car insurance policy, you should see what is considered a covered loss. For example, losses due to storm damage are typically covered under a comprehensive policy. But if you’ve been using the vehicle for an excluded purpose, such as ride-hailing work, it may not be covered.
• There has been a violation of your contract: An insurer provides information about coverage and procedures as part of your policy. If you violate any of the processes laid out in this information, your claim could be denied. An example of this could be having your car fixed before filing a claim.
• Your insurer suspects fraud: Your claim may be denied if your insurer suspects fraud at all. They may be suspicious of fraud if it seems like your explanation of the accident doesn’t align with the insurance adjuster’s findings or if the damage looks unrelated. It may be up to you to provide proof that things happened the way you say they did.
• An excluded driver was driving: If you had previously taken steps to exclude a driver from your insurance policy but then let them drive, any claims for damage they caused could be denied.

It is important to note that a claim denial for the above reasons is different from being denied because you’ve reached your coverage limits. A claim denial is when an insurer decides it will not cover your damages at all.

Reaching your policy limits means you may owe the difference between, for example, your $20,000 of coverage and the $30,000 of damage you caused. Your insurer will still assist you up to your coverage limits in these cases.

How to Appeal a Car Insurance Claim Decision

If you think your car insurance claim has been unfairly denied, you can submit an appeal. Your insurer likely has a process in place for doing so. You can contact it or your agent directly to request information about appealing.

Steps you can take to appeal a car insurance claim decision include:

• Submit a letter asking for an appeal: Appeals often involve a letter stating your reason for requesting the appeal. You’ll also want to include any supporting evidence you have.
• Document the evidence: Keep all documents relating to the accident safely filed to provide as supportive evidence. This may include photos from the scene, a police report or medical information.
• Consider hiring legal counsel to help with your appeal: If you need legal advice after an accident, hiring a representative to help with your appeal could get you better results.

It may be difficult to get a car insurance denial overturned. But if you feel strongly that you have supporting evidence showing the decision was made incorrectly, you can try filing an appeal.

Tips for Filing a Car Insurance Claim

If you want to make sure your car insurance claim will be accepted and paid out fairly, make sure you follow the filing instructions from your insurer. Some common steps for filing your car insurance claim include:

• Contact your insurer: You can typically call or contact your insurer online. If they have an app, you may notify them of damage to your vehicle there. You can often start the claims process in the app or even submit your photos of the damage.
• Make a police report: If the damage to your vehicle occurred due to an accident or vandalism, it’s important to document it correctly. Any accident documentation or eyewitness statements may help you as your insurer determines fault.
• Put together supporting documentation: Make sure you’ve got all other related documents, including accident photos, recent photos of the car before the damage, related repair records and anything else that can help make the case that the damage to your vehicle should be covered under your insurance policy.

As you finalize filing the claim, make sure to clarify any expectations about the timeline of the claims process or the availability of a rental car. Your assigned representative can walk you through expected timeframes and details of the coverage you are entitled to.

The Bottom Line

Reconsidering your current car insurance after a claim denial? Shopping around may help you find better coverage and better rates.

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