Steps to Take if Your Car Insurance Claim Is Denied

It’s a common scenario: you get in a car accident and report the accident to the insurance company, hoping for some financial assistance. But instead of issuing a settlement, the insurance company has denied your claim. Now what?

There may be a reason for your insurer to deny your car accident claim, but refusing to pay without a valid reason violates Ohio law. You have the right to appeal a claim denial, and if you don’t get a satisfactory answer, you can ask the courts to intervene.

Let’s take a look at why your auto insurance claim may have been denied and the steps to take to get that decision reversed. At Amourgis & Associates, Attorneys at Law, our car accident lawyers can help if an insurer is not dealing with you in good faith. We fight for people like you who have been seriously hurt in accidents and help them get the compensation they deserve.

Contact Amourgis & Associates in Akron, Ohio, for a free consultation. We can help you fight for the results you deserve.

Common Reasons Car Insurance Claims Get Denied in Ohio

Here are some potential reasons an insurer might deny your car accident claim:

• Policy Lapses – If you missed a payment, your coverage may have been cancelled.
• Policy Exclusions – You may be seeking compensation for something your insurance policy does not cover.
• Disputed Liability – If you were at fault for the car crash, your car insurance may not pay you.
• Pre-existing Damage – If an insurer believes your vehicle’s damage happened in a prior accident, they won’t pay the current claim.
• Inadequate Documentation – Your insurer will require certain information, such as the police report, your medical records, and other documents, to understand and approve a claim.
• Delay in Reporting – There are deadlines for accident victims to file a claim. If you took too long, this could jeopardize your claim.
• Alleged Fraud or Misrepresentation – When a claim has been denied, review everything you have submitted to the insurer. Even small mistakes may trigger a denial. Larger errors can cause you legal problems.

Step-by-Step: What to Do If Your Car Accident Claim Is Denied in Ohio

The claims process is complex, and a single misstep could result in delayed or denied claims. Here’s how to respond to a denied insurance claim:

• Step 1: Read the Denial Letter Carefully. The insurance company should explain to you in writing why they’ve denied your claim. If a denial has not been clearly explained, contact the insurance company for further information. If you understand their reason for denying your claim, you may be able to show that they are mistaken.
• Step 2: Gather All Supporting Documentation. Once you’ve identified where you and the insurer disagree, you need to give them the additional information to prove your case. Evidence in a car accident claim might include:
• Police report
• Photos and video of vehicle damage or injuries
• Medical records
• Doctor’s bills
• Car repair bills
• Copies of cashed checks
• Any traffic tickets issued to the other driver
• Eyewitness statements
• Surveillance or traffic camera video.
• Step 3: Contact the Insurance Company. If a minor issue with your claim has led to a denial, you may be able to contact the insurance company and offer to make a correction. You may be able to resubmit your claim with corrected information or with previously missing information.
• Step 4: File an Internal Appeal. The insurance company will have a process for appealing denials. The process may vary from one auto insurance company to another, but it generally requires asking the insurer to reconsider your claim, potentially based on additional evidence. Review your policy or the company’s website, or contact the insurer to find out what’s required to appeal a decision.
• Step 5: File a Complaint with the Ohio Department of Insurance. The Consumer Services Division at the Ohio Department of Insurance can take action if its analyst decides that the insurance company broke state insurance laws or administrative rules. Phone 800-686-1526 for help or start online here to file a complaint.
• Step 6: Consult an Ohio Car Accident Lawyer. If the insurance company continues to deny your claim, you can file a lawsuit asking the court to order them to pay you. An experienced car accident attorney can conduct a detailed investigation of your accident to gather proof of fault and fight for the compensation you deserve.

Ohio Law on Insurance Denials: Know Your Rights

In Ohio, the law requires insurers to act in good faith when they receive and evaluate claims. Section 3901.21 of the Ohio Revised Code and related statutes define unfair and deceptive acts or practices in the insurance business and make it illegal to engage in unfair claims practices.

When an insurer licensed in Ohio refuses to pay without a valid reason or delays payment without justification, it is acting in bad faith. The law also requires insurers to investigate claims and makes it illegal to use a “pattern settlement,” or a predetermined formula, to assign liability for an accident or to calculate a settlement offer.

Additionally, the Supreme Court of Ohio has ruled that an insurer owes a duty of good faith to its insured in the processing, payment, satisfaction, and settlement of the insured’s claims (Hart v. Republic Mut. Ins. Co. (1949), 152 Ohio St. 185, 87 N.E.2d 347). If an insurance company violates its legal duty, the policyholder (the “insured”) may sue the insurance company.

Therefore, if an insurance company has denied your car accident claim, that is not the end of the road — you still have options, and an attorney can help you determine them.

When to Hire an Ohio Car Accident Lawyer

If you have been significantly injured in a car accident that was someone else’s fault, you deserve compensation for your medical bills and other losses, including your pain and suffering. Ohio drivers must carry liability insurance, which pays injured parties when the policyholder is responsible for a car accident.

An experienced car accident attorney from Amourgis & Associates, Attorneys at Law, in Akron, Ohio, can help you demand compensation you have been denied. Contact us if:

• You’re dealing with serious car accident injuries or high medical bills to go beyond coverage limits.
• The insurer isn’t responding to you or is delaying action on your claim.
• Your appeal of a claim denial has been rejected.
• You suspect bad faith or deception.

Contact Amourgis & Associates for a free, no-obligation initial legal consultation. If we can pursue a claim for you, we will do so at no charge unless we recover compensation for you. Call today!