If you were in a car accident that was someone else’s fault, you expect a quick and reasonable settlement from that driver’s insurance company to pay for your damages. If your car was hit and the other driver’s insurance won’t pay, it’s a slap in the face. It also may mean serious financial hardship as you struggle with medical bills, lost income and repairing or replacing your automobile.
It’s not a lost cause. There are options to get the at-fault driver’s insurance company to pay a fair car accident settlement. To do so, you must have all your ducks in a row, from understanding why the claim wasn’t paid to how to proceed from there.
Hiring a car accident attorney who knows the ropes can also go a long way toward negotiating a fair settlement, or even filing a lawsuit, if that’s what it takes to get the at-fault driver’s insurance to pay.
“There are many factors that play a part in negotiating fair compensation,” Louis Patino, of The Patino Law Firm, in Texas, said. “If you are representing yourself against a seasoned adjuster or attorney, you will get taken advantage of in many ways.”
Find Out Why Their Insurance Won’t Pay
When an at-fault driver’s insurance company denies your claim, they should tell you why in writing. If they don’t, call the insurance company and ask for a written explanation. You can’t fight a claim denial unless you fully understand why your accident claim was denied.
Even a written explanation, though, may not make sense to anyone but a claims adjuster. Car insurance claims can be complicated and the jargon dense. Make sure you can have it explained in a way you fully understand it. If the at-fault driver’s company won’t explain, there are others who can help.
Since your own car insurance company was also involved – you had to notify them of the accident – you should discuss the denial with your insurance company. A representative there can explain the denial. It’s possible that the reasons for it being denied are legitimate, and they can help you understand them.
If you’re not happy with your insurance company’s explanation, a car accident attorney can also help.
Most offer free consultations, in which they can explain the denial to you, as well as whether you have a case to fight it. If they agree to take on your case, they will likely do it on a contingency basis, which means you pay nothing and the attorney gets their fee if they win the case.
Reasons the Insurance Company Would Refuse to Pay
There are many reasons an at-fault driver’s insurance company would refuse to pay. They may have to do with your role in the accident, but could also have to do with the at-fault driver’s coverage, and even the state you live in and its policies. Some of these reasons may end up being a brick wall, but most of them can be disputed.
Let’s take a look at some of the most common reasons and what you can do if the at-fault driver’s insurance won’t pay.
You Didn’t File Correctly
If you didn’t include required documentation when you filed, you can appeal, and this time, include what you missed. Missing the filing deadline may be harder to appeal, but it’s worth trying. Follow the insurance company’s guidelines to the letter and include everything that’s needed.
The At-Fault Driver’s Insurer Denies Liability
If the other driver’s insurer disputes fault, it doesn’t mean they’re right. You can appeal through the company’s appeal process, and include evidence that proves their driver is at fault. They have reason to believe they can back up their determination, so it’s wise to hire an attorney, who can prove your case.
The At-Fault Driver Was Using the Car for Ride Share
If the at-fault driver was driving for a ride-share company (like Lyft or Uber), their liability coverage likely won’t cover it. If they have separate insurance for rideshare activity, you can file a claim with that insurance company. You can also seek uninsured motorist coverage with your own insurance (if you have it), or file a lawsuit against the rideshare company or the driver.
The At-Fault Driver’s Behavior Nullified Coverage
If the at-fault driver was doing something that nullified their insurance coverage – breaking the law (driving under the influence, excessive speed, driving to endanger etc.), driving a stolen car or even deliberately caused the accident, their insurance can refuse to pay.
You can file an uninsured motorist claim with your own insurance or file a lawsuit against the driver.
The At-Fault Driver’s Insurance Lapsed
If the at-fault driver hasn’t paid his premiums and his insurance was canceled before the accident, the insurance company will deny your claim on the basis that the insurance lapsed. This is another case where your own uninsured motorist coverage can pay, or you can sue the driver.
Shared Liability
If you in a state with shared liability, which makes you partially responsible for damages, you may not get a full payout from the insurance company of the driver who hit you. Contributory negligence states – Alabama, Maryland, North Carolina, Virginia, Washington, D.C. – hold that drivers even 1% negligent don’t get paid by the at-fault driver’s insurance. Other states have comparative negligence, which means you may be liable for a percentage of the damages. You can appeal, but seek help from a car accident attorney, who knows the law.
You Live in a No-Fault State
In the 12 no-fault states, drivers must have Personal Injury Protection (PIP) coverage, which is the primary payer when the driver is injured in an auto accident. You can only seek damages from the at-fault driver if you reach a threshold, either monetary or by injury. If the at-fault driver’s insurer believes you didn’t, they’ll deny your claim. You can appeal if you can prove that you’ve met your state’s PIP threshold.
Insurance Company Questions Your Injury, or Accuses You of Fraud
The at-fault driver’s insurance company may claim your injury isn’t as severe as you say it is, or that your entire claim is fraudulent. If you have good documentation of your medical bills and can prove your injuries resulted from the accident, you can counter this claim. Hiring an attorney is vital in this situation, particularly if you have a pre-existing condition, didn’t seek medical treatment right away or can’t access your medical records.
Your Options When the At-Fault Driver’s Insurance Won’t Pay
There are options if your car was hit and the at-fault driver’s insurance won’t pay. The one that’s right for you depends on your case and the reasons for denial. Car accident law can be tricky, so if your claim was denied, consulting an attorney is always a good idea.
If the at-fault driver’s insurance company didn’t investigate properly, ignored information you supplied, or didn’t give you a valid reason for denial, that’s a bad-faith denial. An attorney has the tools to fight this. It’s also a good idea to contact your state insurance department and report them.
If it wasn’t a bad-faith denial, it’s still a good idea to hire an attorney to pursue you case.
“If the insurance company sees that a claimant does not have a lawyer, they may try to make lowball settlement offers or issue frivolous denials of claims,” Don Wruck, founder ofWruck Paupore PC Injury Firm, said. An attorney knows how to communicate with the insurance company and all the tasks that go with appealing or negotiating a settlement, he said.
Studies show that cases handled by an attorney are more likely to be resolved successfully, and result in larger settlements or judgements for the claimant.
Whether you hire an attorney or not, the options, once a claim is denied, are:
Filing a Claim with Your Own Insurance
If you have collision insurance, you can file a claim for your car’s damage with your own insurance. This helps if you need repairs or a new car, given that insurance disputes can last months or more. Your out-of-pocket deductible will be reimbursed if your insurance company pursues subrogation – the process through which they pay your damages, then seek reimbursement through the at-fault driver’s insurance. If you’re in a comparable negligence state, your deduction reimbursement may be reduced, depending on your percentage of liability.
Generally, your auto insurance won’t pay your medical bills, then seek reimbursement. If the other driver wasn’t insured, and you have uninsured motorist coverage, it will cover some of your medical bills. Health insurance will cover your immediate medical bills. Keep in mind, if you do get a settlement or court judgment, your health insurance will be reimbursed.
If you have PIP, required in no-fault states, or MedPay, an option in most states and required in Maine, your insurance company will pay your medical bills up to your coverage limit. How much your insurance company will get back from the at-fault driver’s insurance – if anything – depends on the state, some of which don’t allow subrogation for PIP or MedPay, or only allow a certain amount to be reimbursed. This may result in higher insurance premiums for you.
Negotiating a Settlement with the Insurance Company
You may want to negotiate a settlement if the at-fault driver’s insurance won’t pay when you first file a claim. Find out what the insurance company’s appeals process is, since that will be your starting point.
It can take anywhere from four weeks to years to negotiate a settlement. Some settlements, after a lawsuit is filed, happen almost literally on the courthouse steps the day of trial.
The first step is to hire an attorney, since they know how to work with insurance companies, know the law and are experienced in these types of negotiations. The next steps, any of which can lead to a settlement, are:
- Notify the insurer of the appeal
- Send a demand letter with specifics of your case, including documentation
- Say no to the first offer
- Make a counteroffer
- File for arbitration, which is binding; or mediation, which is not
- File a lawsuit
- Agree to a settlement and sign a release that prohibits you from seeking more money.
Filing a Lawsuit Against the At-Fault Driver
If attempts to settle for the amount you need to cover your medical expenses and other losses from the accident fail, file a lawsuit. This option is more likely to lead to a settlement than a day in court – more than 90% of cases settle. It helps your case, and your pocketbook, to be represented by an attorney. Studies show that clients represented by an attorney are more likely to have a positive outcome in a car accident case, and also more likely to get a bigger settlement.
Keep your eye on the clock – it starts ticking from the day of the accident, and you only have so much time to file a lawsuit. The statute of limitations on personal injury lawsuits after car accidents range from 1 year in Kentucky to 6 years in Maine and North Dakota. In most states, it’s 2-4 years. The deadline can differ in a state for personal injury claims and property damage claims. In Rhode Island, for example, it’s 3 years for personal injury, but 10 years for property damage.
Once your lawsuit is officially filed in court, the attorney will start an investigative process, including getting reports and records (police reports, medical records, witness statements etc.), depose witnesses, seek expert testimony and more.
Pros of Filing a Lawsuit
- It’s likely to trigger a settlement offer from the at-fault driver’s insurance company
- It can help you recoup more out-of-pocket expenses than a settlement would
- Lawsuits allow the plaintiffs in most states to seek pain and suffering compensation
Cons of Filing a Lawsuit
- Your lawyer’s contingency fee will increase from around 33% to 40% or more, and extra costs will also increase
- If you lose, you’ll get much less money than you were likely offered, or no money, from the insurance company
- If you sue an individual with no insurance coverage, the likelihood of getting reimbursed is low.
Should You Hire an Attorney if the At-Fault Driver’s Insurance Won’t Pay?
If you were hit, but the at-fault driver’s insurance won’t pay, an initial free consultation with a car accident lawyer will give you a good idea of whether you have a solid case. If the attorney takes your case, they will likely agree to do it on a contingency basis in which they get 25% to 45% of the settlement or judgment (depending on the cases complexity and whether it goes to court).
After the consultation, you can also hire an attorney on a limited basis to send a demand letter, review a settlement offer or perform other tasks that take some legal expertise. They attorney would charge you a flat fee or hourly rate in these circumstances.
If you’ve been denied a claim from the at-fault driver’s insurance company, your first step should be to consult an attorney.
FAQs
What to do if insurance doesn't pay enough? ›
Public adjusters work for you, not your insurance company. They fight to get you every penny you need to fix the damages at your home all while taking the stress of dealing with a claim off of your hands. They know what to do when your homeowners insurance company won't pay enough to fix the damages.
Can you argue with an insurance claims adjuster? ›Negotiate with your insurance adjuster
If you feel that the vehicle appraisal from your car insurance company is too low, you can opt to negotiate with your claims adjuster.
You can do this by notifying your insurance company and contacting the agent on your case. Most insurance carriers have an internal appeal process for policyholders to fight back against decisions they believe were wrong or unfair.
What to do if car insurance won't answer your calls? ›You should immediately try to contact your insurance company as aggressively as you can, and if they still will not call you back or talk about your claim, you may have the right to sue them for what we call bad faith practices and unfair claims practices.
How do I challenge an insurance adjuster? ›- Understand Your Rights. ...
- Read the Letter Carefully and Understand Your Policy. ...
- Collect Evidence and Documentation. ...
- Ask the Adjuster to Reconsider. ...
- File a Complaint. ...
- Contact an Insurance Bad Faith Lawyer.
It's rare for life insurance not to pay out. In the vast majority of cases, insurers pay the lump sum as the policyholder intended. But it's worth knowing why a handful are declined and what you can do to help make sure yours isn't one of them. Holly Bennett Last updated on 02 August 2022.
What not to say to insurance adjuster? ›- admitting fault,
- saying that you are not hurt,
- describing your injuries,
- speculating about what happened, or.
- saying anything on the record.
If you cannot easily reach a resolution with your insurance company you may consider mediation or other form of alternative dispute to reach a satisfactory decision. If the matter still remains unsatisfactory from your point of view you may have to consider taking your insurer to court.
Can you argue with your insurance company? ›If your health insurer refuses to pay a claim or ends your coverage, you have the right to appeal the decision and have it reviewed by a third party. You can ask that your insurance company reconsider its decision. Insurers have to tell you why they've denied your claim or ended your coverage.
How do you make a successful insurance claim? ›- File the claim as soon as the incident occurs. Some policies have a time limit to launch claims when the incident arises.
- Make a record of everything. Do your best to record accurate times and dates of the incident(s).
Can I reject my car insurance offer? ›
you don't have to accept any offer that's made to you. If you do accept an offer it might be lower than the compensation you would have got if you'd used a solicitor or gone to court instead. don't feel under any pressure to make a decision quickly.
Why do insurance adjusters never answer the phone? ›Unreturned Calls Is a Common Problem
Unfortunately, insurance companies for the at-fault driver rarely operate that way. It's generally not anything personal. Rather, the adjusters are overloaded with claims and saddled with a system that is designed to slow down claims in an effort to reduce the number of claims.
The insurance adjuster also decides the terms of paying out auto claims and for how much. Interviewing over a recorded line enables them to go back to the conversation if they need to evaluate the case further. Recording calls are normal and sometimes are used for training purposes as well.
Can Car Insurance listen to phone calls? ›If there is evidence that you were talking on the phone, sending text messages, or otherwise distracted, your insurance company may seek to confirm those facts in order to deny your claim. They may also request records if they suspect you're involved in any form of insurance fraud.
What should I say to my own insurance adjuster? ›- Be courteous. ...
- Provide your name, address and phone number. ...
- Talk about the generalities of the accident. ...
- Do not sign anything until you understand exactly what you are signing.
- Remain Calm and Polite. ...
- Identify the Person You Speak With. ...
- Give Only Limited Personal Information. ...
- Give No Details of the Accident. ...
- Give No Details of Your Injuries. ...
- Take Notes.
Companies will refuse to approve your request for compensation if your claim lacks support and evidence. The insurer may justify its denial by claiming that it believes your injuries were pre-existing at the time of the accident or that your own conduct made the injuries worse.
How long should it take for an insurance company to pay out? ›Once an insurance company has admitted liability and agreed to process the claim, they tend to move quickly. Some claimants receive their compensation in a few days. More commonly, the claimant will receive their compensation payment within 2 and 4 weeks.
Why do insurance companies drag out claims? ›Dragging Out a Case
The insurance company knows that you need money. It might want to wear you down by delaying settlement so that you give up and accept a lower offer so that you can get money in your pocket. The other reason for delaying a case might be to create a statute of limitations defense.
And you can't seem to get a decision on whether your claim is covered, or if they are going to deny the claim? Insurers can be sued for unreasonable delay in the claim process even prior to giving you an adverse claim decision.
What not to say when claiming car insurance? ›
If you're in an accident you should: not admit at the scene that it was your fault. exchange names and other details with the other drivers and get details of any independent witnesses.
What not to say when filing a claim? ›- It was my fault. This may be common knowledge for many, but it's worth reiterating that you should never admit fault. ...
- I think. ...
- I'm fine. ...
- Names. ...
- Recorded statements. ...
- Unnecessary details. ...
- We don't have an attorney. ...
- Yes, I accept your offer.
This job gave me great experience in communicating effectively with clients and in handling conflict. I am excited to step into this role because it utilizes these communication skills while offering me more opportunities for variety and growth.
How much can I claim for stress and inconvenience? ›There is no hard and fast rule in respect of how much will be paid for distress and inconvenience claims. The level of damages awarded by the court is generally determined by the specific incident circumstances, the extent of inconvenience suffered by the policyholder and the duration of the inconvenience.
How can I negotiate more from insurance settlement? ›- Initiate a Claim as Soon as Possible After an Auto Accident.
- Keep Accurate Records About the Accident.
- Calculate a Fair Settlement.
- Send a Detailed Demand Letter to the Insurance Company.
- Do Not Accept the First Offer.
- Emphasize the Points in Your Favor.
- Get Everything in Writing.
If you disagree with your insurance adjuster after a car accident, you do not simply have to accept his or her determination of liability. Instead, you can – and should – dispute the outcome of your claim. Your claim is not over when an adjuster informs you of his or her decision.
How do you raise a grievance against an insurance company? ›Can send the complaint through Email to complaints@irdai.gov.in. 3. Can call Toll Free No. 155255 or 1800 4254 732.
What is a good settlement offer for a car accident? ›A good car accident settlement offer is one that fully covers your medical expenses, property damage, and time off from work. It compensates you adequately for the pain and trauma you have experienced related to the accident. A skilled attorney can evaluate your settlement offer and advise you if it is reasonable.
How often do insurance appeals work? ›' As in our previous analysis of claims denials, we find that consumers rarely appeal denied claims and when they do, insurers usually uphold their original decision. In 2021, HealthCare.gov consumers appealed less than two-tenths of 1% of denied in-network claims, and insurers upheld most (59%) denials on appeal.
How do you answer a insurance claim question? ›- Do not comment on your injuries. ...
- Only answer the questions asked. ...
- Do not agree to have your statement recorded.
- Stick to the facts. ...
- Write down the adjuster's name and information.
What should I say in an insurance claim? ›
For example, you can say what day and time the accident happened, where it happened, and who was with you. You should also give the adjuster the name and contact information of the other party. Anything other than the most basic information should not be shared with an adjuster.
What is the highest insurance claim? ›- 9/11 terror attack insurance claims - US$40bn. ...
- The Indian Ocean and Tsunami disaster - US$1.5bn. ...
- Hurricanes Katrina, Rita, and Wilma - US$130bn. ...
- The Sichuan Province earthquake - US$86bn. ...
- The Swine flu pandemic - US$1.6bn. ...
- Floods in Europe and Pakistan - US$4bn.
Your contract of insurance will or should say ” We indemnify you UPTO the market value of your vehicle. You are completely in your rights to insist on having your car repaired UPTO the market value as stated in your contract of insurance.
What are three reasons you can be denied car insurance? ›- Have too many moving violations.
- Have too many at-fault accidents.
- Are too old or young (unless you're in a state where age-based insurance decisions are prohibited).
- Have a poor CBI score.
- Own a fast or expensive car.
- Live out of the insurer's coverage area.
If you are planning to sell your car, or have already sold the vehicle, you may want to cancel your insurance policy, as it is no longer required. If you are selling your car and not replacing it with a new one, you will need to contact your insurance provider to make them aware that you want to cancel.
Do insurance adjusters follow you around? ›The answer is yes, the insurance company can and will spy on you after an auto accident and even hire private investigators to film you at home and around town. Over the years, our firm has seen many insurance companies spy on our clients after auto accidents or work injuries.
What can I expect from a claims adjuster? ›Adjusters inspect property damage or personal injury claims to determine how much the insurance company should pay for the loss. They might inspect a home, a business, or an automobile. Adjusters interview the claimant and witnesses, inspect the property, and do additional research, such as look at police reports.
What questions should I ask a claims adjuster? ›- Will they admit fault for the accident? ...
- Will they pay for your car repairs, your rental car, and your medical bills?
- How much insurance did their driver carry?
- This is all information that you're entitled to ask and you're entitled to know in an accident case.
The insurance company may also request access to your text messages and social media accounts to look for evidence of distracted driving. Lastly, the insurance company may request access to your location data to track your movements before the accident.
Can insurance investigators track your phone? ›Can an Insurance Investigator Tap My Phone? No, an insurance investigator cannot tap your phone – ever. Tapping a phone involves using electronic equipment to secretly listen to someone's phone conversations, and it is illegal.
Do you have to talk to insurance investigators? ›
You have to provide the adjuster with the names and contact details of anyone capable of providing information relevant to your claim. However, it is not your duty to compel anyone to answer questions from the insurance adjuster.
Are all insurance calls recorded? ›The ruling (called the Final Ruling for Contract Year 2023) requires that third-party marketing organizations, including insurance agents, record all consumer calls in their entirety.
What triggers an insurance investigation? ›Car accidents, personal injury, workplace injury and property damage are all common insurance claims that require an investigation.
How long do insurance companies keep phone recordings? ›It includes communications that are intended to result in a transaction, even if ultimately they do not. Once recorded, firms must keep such tapes and electronic communications for a period of at least six months from the date the record was created.
Can you ask for more money if you don't need insurance? ›Most companies are not willing to negotiate extra pay for people who forego benefits. If you bring this up before your offer is firm, it might even hurt your chances a little to bring this stuff up.
Can I insist that an insurance company repairs my car? ›You can choose to have your vehicle fixed by a vehicle repairer of your choice. Your insurer, or a Company appointed to handle your claim, may recommend a repairer but they cannot insist that you use such a repairer. It is always your right to control what happens with your vehicle.
Why do insurance companies refuse to pay out? ›Insurance claims are often denied if there is a dispute as to fault or liability. Companies will only agree to pay you if there's clear evidence to show that their policyholder is to blame for your injuries. If there is any indication that their policyholder isn't responsible the insurer will deny your claim.
What do insurance companies don't want you to know? ›- Your car insurance may not be tied to the driver.
- The type of car you drive matters.
- Prior claims and questions raise rates.
- You can check your report for errors.
- Your credit score impacts your car insurance costs.
Unfortunately, you cannot make an insurance company pay beyond its policy limit. You do, however, have the right to sue the at-fault driver for more than the value of his or her insurance policy. This would mean directly filing a lawsuit directly against the driver who caused the accident and not the insurer.
What insurance company says only pay for what you need? ›Thomas, a reader in Chicago, wrote: “Liberty Mutual Insurance television commercials which state, 'Only Pay for What You Need' appear to suggest that other insurance companies will sell you coverages you don't need. I'll bet a lot of people wonder what they mean.”
Can I keep the money from an insurance claim? ›
As long as you own your car outright, you can do whatever you want with the claim money you receive from your insurer. This means that you can keep any leftover money from your claim. However, it is very important to never intentionally overestimate the cost of repairing your car.
What happens if my car can't be fixed? ›If you have purchased or leased a vehicle under warranty and discovered within a certain time period that the car has a problem, you may have the right to file a lemon law claim. If your car under warranty cannot be fixed you are very likely entitled to compensation.
What happens if a garage can't fix your car? ›If the garage won't do the work
You could ask another garage to give you a written quote or estimate for the work. This will prove that the repairs or service need to be done again, and could help you negotiate with the original garage for the problem to be fixed.
- Technicalities: missing codes or authorizations, claim filing mistakes.
- Medical: treatment not considered a medical necessity or is considered experimental/investigational.
As in our previous analysis of claims denials, we find that consumers rarely appeal denied claims and when they do, insurers usually uphold their original decision. In 2021, HealthCare.gov consumers appealed less than two-tenths of 1% of denied in-network claims, and insurers upheld most (59%) denials on appeal.
What are 3 other common reasons that car insurance claims can be denied? ›- You were driving while intoxicated or driving under the influence at the time of the accident.
- The insurer believes the accident was avoidable.
- You were driving without a valid license.
- You were driving without valid auto insurance.