Your car insurance company can deny your claim for various reasons. This can be either a simple paperwork mistake or policy cancellation due to missed payments. In addition, insurance providers can use manipulative tactics to discourage you from pursuing your claim, which can make it harder to seek compensation. However, a denial letter shouldn’t stop you from getting the settlement you’re entitled to.
Many of our clients successfully overturned denied claims simply because they knew their rights and took the appropriate actions. You can challenge the denial and win your case, too. Here’s what you can do about your claim.
Key Takeaways
- A car insurance claim denial letter isn’t a final verdict — you have the right to challenge a denied claim.
- Common reasons for denied insurance claims are expired policies, policy exclusions, insufficient coverage, and bad faith practices.
- In Massachusetts, drivers must first use their own PIP insurance to cover medical expenses and lost wages.
- If your medical bills exceed $2,000, or you have severe injuries, you can file a claim against the at-fault driver’s insurance.
- After receiving a denial, you should understand exactly why the car insurance claim was denied and note the deadlines for writing an appeal letter.
- Police reports, medical records, photographs, traffic camera footage, and witness statements can strengthen your case.
- You may opt for arbitration or mediation before heading to court.
- You can file a complaint with the Massachusetts Division of Insurance, which will evaluate your case and give the insurer 30 days to respond.
- An experienced attorney can help not only in court but also with appeals, evidence collection, and negotiations with insurance companies.
- In Massachusetts, you have three years from the accident date to file a lawsuit with the insurance company.
What Is a Car Insurance Claim Denial Letter?
A claim denial letter is a formal notice from your car insurance company explaining why they won’t cover your accident costs. This document must specify the reasons behind the claim rejection.
A denial doesn’t mean you should give up. First, read the letter thoroughly to understand the reasons. Then, gather any additional evidence that supports your case. Finally, draft an appeal outlining why your claim deserves to be approved.
Also, make sure you can easily find this document later. You’ll need to refer to it when you prepare your appeal. Plus, it will serve as proof should you decide to file a lawsuit against insurance adjusters.
Why Do Insurance Companies Deny Claims?
Once you know why your claim was denied, you’ll know exactly what steps to take to fight for the coverage. Here are the most frequent reasons for claim denial in Massachusetts.
Car Insurance Policy Cancellation
Your policy can be canceled if you stop paying your insurance premiums for a certain period of time. This can also happen if your driver’s license is suspended or revoked.
Your auto insurance company is required to notify you at least 20 days before canceling your policy for missed payments, so you have enough time to make the payment and retain coverage. If you miss this grace period, your policy lapses, and you lose protection.
If your policy is canceled, you still have options. You can contest this decision through the state’s Board of Appeal. However, this doesn’t guarantee reinstatement of your policy. Yet, you get the chance to present your case in a formal hearing.
In addition, Massachusetts mandates that all drivers maintain active insurance coverage. So, there can also be legal consequences for driving without coverage, including fines starting at $500 for the first violation.
Coverage Limits
Some situations aren’t covered by your insurance, and this can be another reason for claim denial. If you choose a basic coverage that fits the compulsory or mandatory coverage criteria required by Massachusetts, you’ll pay the lowest premiums. However, you will also have limited compensation in case of an accident.
This can expose you to high expenses if the policy does not cover that type of accident or certain damages. If your claim aligns with the basic mandatory coverages but is still denied, you have solid grounds for an appeal.
Insufficient Coverage
While policy exclusions mean you have no coverage for certain accidents, insufficient coverage indicates that while you have the right insurance, the amount you’re entitled to won’t cover all of your costs.
Here’s how it works: Every insurance policy has limits, which is the maximum amount your insurance will pay for a claim. In Massachusetts, your Personal Injury Protection (PIP) covers up to $8,000 in medical expenses. After you reach this limit, any extra costs fall to you or the responsible parties (in case you meet certain criteria).
Act of Bad Faith
By law, insurers must deal with claims in a timely and just manner. Failure to do so is considered bad faith, and sometimes, this behavior can be the only reason behind the claim rejection. For instance, insurance companies may deny your claim yet not explain the reasons why. Or they may change their reasons for denial multiple times, which makes it harder to address these concerns.
If you suspect your claim was denied due to bad faith, collect all the records of your interactions with insurance adjusters. In Massachusetts, you can sue your insurer for bad faith practices, and these records may come in handy later.
Claim Denial by At-Fault Driver’s Insurance
Massachusetts operates under a no-fault insurance system. So, in case of an accident, you must first turn to your own PIP insurance for initial coverage, even if you’re not responsible for an accident. However, according to Section 6D of Massachusetts law, car accident victims can also claim against the at-fault driver’s insurance if their medical bills exceed $2,000 or if they’ve suffered severe injuries, such as a body part loss or broken bones.
When you submit a claim to the at-fault driver’s insurance, they may deny it, even if another driver was clearly at fault. This is because insurance companies tend to act in their own interest. They may suggest you share some responsibility for the accident or argue that there isn’t enough evidence of who was actually at fault.
In this case, it’s recommended to work with a lawyer so they can help you collect the necessary proof, handle all negotiations on your behalf, minimize the degree of your fault, and maximize your settlement.
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Steps to Take When Car Insurance Denies Your Claim
If you believe your car accident insurance claim was denied by mistake or suspect your insurance company acted in bad faith, you can contest their decision. Here are some solutions.
Consult a Car Accident Attorney
This cooperation can be useful not only in extreme situations like going to court. Appeal letters, evidence gathering, arbitration, mediation, and complaints — to find the best approach, you require either basic legal knowledge or considerable time to learn everything. Not to mention paperwork and negotiations, all within specific deadlines.
Any case involving an auto insurance denial calls for well-thought-out actions. A reputable attorney can support you from start to finish, guiding you from the initial appeal of the decision to the legal actions in court if needed.
Furthermore, if you have to deal with a negligent driver’s insurance company, the strong negotiation skills of a lawyer will be indispensable here. Plus, they know how to correctly calculate damages in personal injury claims, including non-monetary ones.
Examine the Denial Letter with Your Attorney
After receiving a denial, thoroughly read the entire letter. Focus on the specific reason for the denial, as this will determine your next steps.
Sometimes, denials occur because insurance companies require more information. The letter will indicate what documentation you need to support your car insurance claim.
Additionally, look for any mentioned deadlines in the letter, since you have a limited time to appeal the decision of insurance companies. Miss these deadlines, and you’ll decrease your chances of reversing the denial.
Collect Additional Evidence
Gathering evidence is one of the main steps to take after a car accident, so you likely have already presented some pieces of evidence to your auto insurer. However, they may request more proof.
Every new piece of information will strengthen your case and make it more difficult for the insurance company to deny. Here’s what you can attach to your appeal letter:
- A police report
- Photos of the accident scene demonstrating skid marks and property damage
- Traffic camera footage, if available
- Medical reports from all your doctor visits related to the accident, along with bills for your treatment
- Pay stubs indicating lost wages due to injuries
- Witness statements with contact information.
You can also link evidence to specific dates and events, creating a timeline, which will let the insurance company see the bigger picture of the accident and, thus, make your case more compelling.
Appeal the Claim Denial
When you file an appeal, the insurance company has to reassess your case, particularly if you provide new evidence or demonstrate they made a mistake. In the appeal letter, you should specify why you think the denial was wrong and connect each piece of evidence to specific points in their denial letter.
Initiate Arbitration or Mediation
If your appeal doesn’t bring the desired outcome, you still have options before going to court. Your insurance policy may include, or even mandate, arbitration for resolving car insurance claim disputes.
Arbitration is a process where a neutral expert, the arbitrator, listens to both sides of the case. You can provide evidence, call witnesses, and explain why you should receive coverage. The car insurance company will present its side as well, and the arbitrator will then make a final decision.
You can also try mediation. Mediators don’t make decisions, but they help both sides understand each other and reach a settlement that satisfies both parties.
Submit a Complaint
You can also file a complaint with the Massachusetts Division of Insurance (DOI). This state agency monitors whether insurance companies treat customers fairly. You’ll need to provide basic information like your insurance policy details, claim numbers, and member ID.
After you submit your complaint, DOI will review it within two weeks to confirm they can handle your case. They will inform you if they received everything they need or if additional information is necessary. Then, DOI will send your complaint to the insurance company, which has 30 days to respond.
File a Lawsuit
Your last option is to sue the insurance company. This may sound intimidating, however, just letting insurance providers know you’re getting ready to go to court can make them quickly change their mind. They realize that legal disputes can be costly and lengthy, so most insurance companies opt to settle claims fairly rather than go to trial. Plus, your attorney will handle most of the work if you choose to take legal action.
Deadlines for Appealing a Denied Car Insurance Claim in Massachusetts
When it comes to deadlines for appealing a denied car insurance claim, your denial documentation should specify how long you have to file an appeal.
If you need to take legal action in Massachusetts, you have three years from your accident date to file a lawsuit. This maximum time limit set by law is called the statute of limitations. If you miss this deadline, you may lose your right to sue, even with a solid case.
That’s why it’s so critical to act swiftly — strong claims take time and numerous details. They can also have pitfalls, especially if you deal with an insurance company yourself, without the assistance of experienced lawyers.
How Can Legal Experts Help Me If the Insurance Company Denied My Car Accident Claim?
Insurance companies have adjusters and lawyers protecting their interests. That’s why it’s essential to have your own legal expert to protect your rights and achieve a settlement that is fair for you, not reasonable for a car insurance company. While an average car accident settlement is around $50,000 in Massachusetts, with lawyers, you get the opportunity to recover significantly more.
A car accident lawyer offers not just legal knowledge but also experience with similar cases. They know what evidence is crucial and what arguments are effective. Here’s how a legal professional can assist you if a car insurance company denies your claim:
- Review the denial letter and policy to find any errors or recognize any bad faith an insurance company may follow.
- Collect and organize the right evidence, like camera footage and eyewitness statements, for your appeal. Personal injury attorneys understand which documents are most impactful and how to present them correctly.
- Handle all communication with the car insurance company. A lawyer knows the terminology and can avoid statements that might jeopardize your claim.
- Draft a persuasive appeal letter that addresses every denial reason with solid evidence and legal reasoning.
- Assist you through mediation or arbitration, ensuring you don’t accept less than what’s fair. An experienced car accident attorney can identify unfair settlement offers and negotiate better terms.
- File complaints with the Massachusetts Division of Insurance if necessary, making sure that all paperwork is complete and deadlines are met.
- Prepare and file a bad faith lawsuit if it comes to that. Many cases settle once the car insurance company sees you have legal representation.
- Most importantly, your attorney will bring you peace of mind. You can rest easy knowing your case is in the right hands.
Moreover, legal experts, like Michael Kelly Injury Lawyers, often offer a free legal consultation for car insurance claim denials. They can quickly evaluate your situation and clarify your options, helping you determine if you actually need legal assistance.
Conclusion
Car accidents create many difficulties. While your health is the main concern, unexpected medical bills and lost wages increase stress. Luckily, Massachusetts’ no-fault system lets you receive quick coverage from your own insurance company.
However, insurance claims may be denied for several reasons, and even if your insurance pays, it might not cover all expenses for serious injuries. This leads to another challenge: getting compensation from the at-fault driver’s insurance company, where denials are even more common.
The most reasonable way to resolve these issues and simplify your recovery is to work with an experienced lawyer. At Michael Kelly Injury Lawyers, we specialize in Massachusetts law and personal injury cases. Our team knows how to manage insurance claims and deal with denials. Our average personal injury settlement reaches hundreds of thousands of dollars.
Contact us for a free consultation, and let us achieve the best possible outcome for your case!
FAQ
Should I Hire a Lawyer After My Car Accident Claim Was Denied?
You can appeal a denied claim by yourself, but a lawyer can simplify the entire process and improve your chances of success. Insurance companies have legal teams to defend their interests, so having your own lawyer gives you an advantage. They know Massachusetts insurance laws, can collect the right evidence, and recognize bad faith practices of insurance companies.
What Should I Do If My Car Accident Claim Is Denied Again?
If your car accident claim is denied multiple times, you still have options. In Massachusetts, every denial must include a specific reason, and you can contest each one. Insurance companies may deny claims, hoping you’ll give up, but with the right evidence and legal support, many denied claims can ultimately be approved.
You need to understand the reasons for each denial and address these issues in your appeals. Plus, you can always engage third parties, like arbitrators or mediators, file a complaint with the Massachusetts Division of Insurance, and go to court.
Is There a Limit to How Many Times I Can Appeal an Insurance Denial?
There’s no strict limit on the number of times you can appeal a denied car insurance claim in Massachusetts. However, you must still meet specific deadlines. Your denial letter will state how much time you have to appeal the denial.
When it comes to lawsuits, you have three years from the date of your accident due to the statute of limitations. Therefore, while you can appeal numerous times, you should make each appeal as effective as possible.
