Getting an insurance claim denied after a car accident can be frustrating, especially when you are already dealing with medical bills, vehicle repairs, missed work, and the physical consequences of an injury.
You may believe the facts are obvious. Perhaps the other driver received a ticket. Maybe the police report supports your version of events. You may have photographs showing the damage, witnesses who saw the collision, and medical records documenting your injuries.
Yet the insurance company still says it will not pay.
A denial does not necessarily mean you do not have a valid claim. Insurance companies evaluate claims based on the information available to them, and disagreements can arise over fault, the severity of an injury, the amount of damages, available insurance coverage, or whether the accident actually caused a particular medical condition.
If your claim has been denied after a collision in San Diego, Chula Vista, Escondido, El Cajon, Oceanside, Carlsbad, La Mesa or another San Diego County community, there are steps you can take to understand what happened and determine what to do next.
Find Out Why the Claim Was Denied
The first step is to understand exactly why the insurance company rejected the claim.
A denial letter or communication from an insurance adjuster may identify the reason the insurer believes it does not owe compensation. The explanation could involve disputed liability, questions about your injuries, an allegation that you contributed to the accident, insufficient documentation, a policy issue or another coverage-related argument.
Do not simply file the denial away and assume the matter is over.
Read the explanation carefully.
If the insurance company says its insured was not responsible for the collision, ask what evidence supports that position. If the company questions your injuries, look at what medical records and other documentation have actually been provided. If the insurer is raising a coverage issue, determine precisely what provision it is relying on.
The reason for the denial can help determine what needs to be investigated next.
A Denial Is Not the Same as a Court Decision
This distinction is important.
An insurance adjuster does not have the final authority to determine whether another driver is legally responsible for your injuries.
An insurer can make a claim decision based on its investigation. You can disagree with that decision.
If the parties cannot reach an agreement, a personal injury lawsuit may ultimately be necessary to resolve the dispute.
That does not mean every denied claim should immediately become a lawsuit. Many claims can be resolved through further investigation and negotiation.
But an insurance company’s initial position should not automatically be treated as the final answer.
Insurance Companies May Dispute Who Caused the Crash
One of the most common reasons for a denial is disagreement over liability.
Imagine a collision at a busy San Diego intersection. You believe the other driver ran a red light. The other driver tells the insurance company that the light was green.
Now there are two different versions of the same event.
The insurance adjuster may look at the police report, statements from the drivers, witness accounts, photographs, vehicle damage and other available evidence.
But what happens if the evidence is incomplete?
This is where accident investigation becomes important.
Evidence might include:
- Photographs from the accident scene
- Damage to the vehicles
- Witness statements
- Police reports
- Traffic-camera footage
- Surveillance video
- Dashcam footage
- Vehicle data
- Cell phone records when legally obtainable and relevant
- Accident reconstruction evidence
- Roadway and traffic conditions
Not every case requires all of these forms of evidence. The appropriate investigation depends on what happened.
The key point is that liability should not necessarily be determined by whichever driver gives the insurance company the most convincing statement.
The Other Driver May Blame You
Another common situation involves comparative fault.
The other driver may admit that they made a mistake but argue that you contributed to the accident.
For example, an insurer might claim that you were speeding, following too closely, changing lanes improperly or otherwise contributed to the collision.
California follows comparative fault principles. That means an injured person can potentially recover damages even when that person is found partly responsible, although the amount recovered can be reduced based on the person’s share of responsibility. California Courts explain that comparative negligence can affect the amount of compensation awarded in a personal injury case.
So a statement such as “you were partially at fault” does not automatically mean you have no claim.
The actual evidence needs to be examined.
The Insurance Company May Question Your Injuries
Liability is not the only issue an insurance company can dispute.
The insurer may accept that its driver caused the collision but argue that your injuries are unrelated, exaggerated, pre-existing or less serious than you claim.
This can become particularly complicated when symptoms develop gradually.
Suppose you are involved in a rear-end collision in San Diego. You initially experience some soreness but continue working. A few days later, your neck pain becomes substantially worse. Your doctor recommends additional treatment.
The insurer might argue that because you did not seek emergency treatment immediately, the injury must not have been caused by the crash.
That conclusion is not necessarily correct.
The medical history needs to be evaluated as a whole.
Your medical records, diagnostic testing, treatment history, prior medical records when relevant, statements to healthcare providers and the timing of your symptoms may all help establish what happened.
This is one reason it is important to accurately tell your medical providers about the accident and your symptoms.
Pre Existing Conditions Do Not Automatically End a Claim
Another issue that sometimes arises is a pre-existing medical condition.
An insurance company may argue that your pain was caused by something that existed before the accident.
But an accident can potentially aggravate a pre-existing condition.
For example, someone may have experienced occasional back pain before a collision but then develop substantially greater pain, require additional treatment or experience a significant change in their condition after the accident.
The question is not simply whether you had ever experienced pain before.
The important questions can include what your condition was before the collision, what changed afterward, what your doctors have determined, and whether the accident contributed to the new or aggravated condition.
These cases can require careful medical documentation.
You Should Not Assume the First Settlement Offer Is the Final Value
A denied claim is one problem.
A very low settlement offer can be another.
An insurance company may accept that its driver was responsible but offer an amount that does not adequately account for the injuries and losses you have experienced.
For example, the insurer may focus heavily on the medical bills that have already been incurred while giving little consideration to future treatment, lost earning capacity or the broader impact of a serious injury.
That does not necessarily mean the insurer is acting improperly. It means that the parties may disagree about what the claim is worth.
The appropriate response depends on the facts.
Before accepting a settlement, understand what rights you may be giving up. A settlement generally involves an agreement to resolve the claim, and signing a release can prevent additional recovery for the same accident.
Once you settle, you generally cannot go back later because your injuries turned out to be more serious than expected.
The Value of a Claim Is Not Determined by Vehicle Damage Alone
A badly damaged vehicle does not automatically mean someone has a high-value injury claim.
Likewise, a vehicle that looks relatively good after an accident does not necessarily mean the occupants escaped serious injury.
Modern vehicles can absorb substantial crash forces while showing less visible damage than someone might expect. Injuries can also occur without catastrophic vehicle damage.
The San Diego Injury Law Center’s published results demonstrate the range of compensation amounts and the variety of circumstances involved in automobile injury cases. The examples illustrate why an injury claim needs to be evaluated based on the complete picture rather than simply looking at the appearance of the vehicles.
Gather the Information the Insurance Company Is Missing
If your claim has been denied, review what information the insurer actually had when it made the decision.
Sometimes the problem is not that the evidence does not exist. The problem is that the insurance company does not have it.
Medical records may be incomplete.
A witness may not have been contacted.
Photographs may not have been provided.
A police report may contain information that was overlooked.
An employer may have documentation of lost wages that was never submitted.
There may be additional evidence that changes the picture.
This is why it can be useful to organize your documentation rather than simply arguing with the adjuster.
Create a file containing the accident report, photographs, medical records, bills, insurance correspondence, repair estimates, wage-loss information and witness details.
Keep copies of everything you send.
Be Careful With Recorded Statements
An insurance adjuster may ask you to provide a recorded statement. Sometimes an insurer genuinely needs information about the collision. But a recorded statement can also create a permanent record of exactly what you said about the accident and your injuries. If you are already dealing with a disputed liability or injury claim, it is reasonable to understand why the statement is being requested and what purpose it serves before agreeing to it.
Do Not Give the Insurance Company Your Entire Medical History Without Understanding Why
Medical records can be important evidence in an injury claim.
But there is a difference between providing relevant documentation and giving an insurer unrestricted access to every medical issue you have ever experienced.
The relevance of prior medical information depends on the circumstances.
For example, if the insurer claims that a back injury existed before the collision, prior records concerning your back may become relevant. That does not necessarily mean every medical record from your entire lifetime is relevant to the dispute.
A personal injury attorney can help determine what medical information may be appropriate to provide and how it relates to the issues being disputed.
What If the Other Driver Has No Insurance?
A denial can become even more complicated if the other driver has little or no liability insurance.
In that situation, your own insurance coverage may become important.
Uninsured motorist and underinsured motorist coverage can potentially provide a source of compensation in certain circumstances, depending on the policy and the facts of the collision.
Do not assume that the other driver’s lack of adequate insurance automatically ends the matter.
Your own policy should be reviewed carefully.
This is one reason it is useful to preserve all insurance documents after a serious collision.
What If More Than One Driver Was Involved?
Some San Diego County accidents involve multiple vehicles.
A chain-reaction collision on a freeway may involve several drivers. A vehicle may strike another vehicle, which then hits yours.
Determining responsibility can become much more complicated in these situations.
Each driver’s actions may need to be examined.
The investigation may consider vehicle positions, impact points, photographs, witness statements, traffic conditions and other evidence.
Multiple insurance companies may also become involved.
In a complicated collision, it can be particularly difficult for an injured person to determine which insurer is responsible for which portion of the claim.
What If the Accident Happened While You Were Working?
The circumstances can change if you were driving as part of your employment.
A collision involving a commercial vehicle, delivery driver, rideshare driver or another employee may involve additional insurance policies and potentially additional responsible parties.
For example, if you were struck by a commercial truck, the trucking company, driver, vehicle owner, maintenance provider or another entity could potentially become relevant depending on the facts.
That type of case is different from an ordinary two-car collision.
If your accident involved a commercial vehicle, it may be useful to review our San Diego truck accident information for more information about the issues that can arise in trucking cases.
Do Not Let a Denial Cause You to Miss a Legal Deadline
Perhaps the biggest mistake someone can make after a denied claim is assuming that the insurance company’s decision gives them plenty of additional time.
It does not necessarily work that way.
California generally provides two years from the date of injury to file a personal injury lawsuit, although exceptions can apply. Claims involving government entities can have substantially different requirements and deadlines. The deadline generally does not begin when the insurer denies your claim.
If your accident happened months ago and you have been negotiating with an insurance company ever since, do not assume that those negotiations automatically extend the applicable statute of limitations.
A lawyer can evaluate the specific timeline and determine what deadlines may apply.
When Should You Talk to a Personal Injury Lawyer like San Diego Injury Law Center?
There is no requirement that you wait until an insurance company denies your claim before speaking with an attorney. In fact, contacting a car accident attorney for legal advice can be particularly useful when:
- The insurance company denies liability
- The other driver blames you
- You suffered a serious injury
- Your treatment is continuing
- The insurer questions whether the accident caused your injuries
- You have significant lost income
- Multiple vehicles were involved
- A commercial vehicle was involved
- The other driver has inadequate insurance
- The insurance company offers a settlement you believe is inadequate
- You are approaching a potential filing deadline
The San Diego Injury Law Center focuses on personal injury cases and has published substantial automobile accident results involving fractures, back injuries, head injuries and other serious injuries. They speak Spanish and offer free consultations for people who want to discuss a potential injury claim.
The goal of an initial consultation is not necessarily to file a lawsuit.
It is to understand what happened, what evidence exists, what issues the insurance company is raising and what options may be available.
What Can Happen After an Insurance Claim Is Denied?
A denied claim does not have only one possible outcome.
Depending on the circumstances, an attorney may gather additional evidence and submit a demand to the insurance company. The insurer may reconsider its position. Negotiations may continue.
In other situations, litigation may be necessary.
A lawsuit can involve discovery, depositions, expert testimony, medical evidence and other legal procedures. Many personal injury cases settle before reaching trial, but an attorney should be prepared to take the appropriate steps if negotiations do not produce a reasonable resolution.
The right approach depends on the facts of the individual case.
There is no single strategy that works for every San Diego car accident claim.
What You Should Do If Your Claim Has Been Denied
If an insurance company has denied your San Diego car accident claim, do not assume the denial means your case is over.
- Start by obtaining the denial and understanding exactly why the insurer says it will not pay.
- Preserve your evidence.
- Continue appropriate medical care.
- Keep your records.
- Avoid making unnecessary statements about your accident or injuries.
- Review your insurance coverage.
- Pay attention to the applicable legal deadlines.
And if the dispute involves significant injuries or substantial financial losses, consider having an experienced personal injury attorney review the situation.
The San Diego Injury Law Center represents people injured in automobile accidents throughout San Diego County. If an insurance company has denied your claim, you do not have to accept that decision without understanding your options.
Contact the San Diego Injury Law Center for a free, confidential consultation and no cost unless we win your case under a contingency fee model. The firm can review the circumstances of your collision, the reason for the denial and the evidence available to determine what legal options may be available.
Frequently Asked Questions (FAQ’s)
Can I still sue if the insurance company denied my car accident claim?
A denial by an insurance company does not automatically prevent you from pursuing a personal injury lawsuit. Whether you have a viable claim depends on the facts, evidence, applicable insurance coverage and legal deadlines. An attorney can review the reason for the denial and explain your options.
Why would an insurance company deny a car accident claim?
An insurer may dispute who caused the accident, question whether the injuries were caused by the collision, challenge the severity of the injuries, raise coverage issues or argue that the available evidence does not support the amount being claimed. The specific reason should be identified before determining how to respond.
What should I do if the insurance company says I was partly responsible?
Do not assume that partial responsibility automatically prevents recovery. California follows comparative fault principles, which can allow an injured person to recover compensation even when that person bears some responsibility, although the recovery can be reduced according to the person’s share of fault. (selfhelp.courts.ca.gov)
How long do I have to file a lawsuit after a car accident in California?
The general California deadline for a personal injury lawsuit is two years from the date of injury. However, exceptions and different deadlines can apply, including situations involving government entities. Do not assume that insurance negotiations extend the applicable deadline. (selfhelp.courts.ca.gov)
Can I afford a San Diego car accident lawyer if my claim was denied?
The San Diego Injury Law Center offers personal injury representation under a contingency fee model, meaning there is no attorney fee unless the firm wins your case under the terms of the representation agreement. Contact the firm for a free, confidential consultation to discuss your particular circumstances.