How to successfully appeal an insurance denial
Personal Injury - January 4, 2024 by Horwitz, Horwitz & Associates
After you’ve been injured in an accident you didn’t cause, you’re probably checking the mail each day for the check from the at-fault driver’s insurance company.
You’ve done everything right: filed an accident report with the Chicago police and let your insurance company know about the accident and your plan to seek compensation from the other driver. You provided the other driver’s insurance adjuster with documentation about your injuries and damage to your vehicle.
However, instead of a check, the insurance company next sends you an insurance claim denial. Is there anything you can do?
Today, we’re looking at how to appeal an insurance denial successfully. It’s a process that can be made much easier with the help of an experienced Chicago personal injury attorney from Horwitz, Horwitz & Associates.
Why has my claim been denied?
Insurers in Illinois must provide a reason for a denied claim. The first step in learning how to appeal an insurance denial is understanding why. Check your letter carefully for one of the following:
Dispute of liability
The insurance company states that either their customer did not cause the accident or the accident did not cause your reported injuries or property damage.
Damages are excluded from the policy
Most insurance policies have a long, specific list of damages excluded by the policy (check your fine print). “Intentional actions” are common, as are other exclusions, like “acts of God.” The insurance company may deny that the policy doesn’t cover your claims.
Failure to notify
If the other driver didn’t tell their insurance company about the accident, the insurer could assert that it did not have adequate time to investigate the accident. Therefore, it denies the claim.
Policy lapse
If the other driver didn’t pay their premium, then the insurance company is not obligated to pay anything – the driver isn’t their customer. Unfortunately, suppose you want money from the driver who hit you. In that case, you and your Chicago personal injury lawyer may have to file a lawsuit to seek compensation for your damages directly.
Is the insurance company acting in good faith?
Customers pay a policy premium in exchange for coverage for themselves or someone they harm through their actions. This is a contract between the insurance company and the insured.
So, if the insurance company denies your claim, they could be acting in bad faith. An insurance bad-faith claim may be filed by the injured party – you – against the at-fault party’s insurance company.
Illinois insurance law stipulates specific improper claims practices for insurance companies. If one of these applies, contact a Chicago personal injury lawyer:
- The insurer misrepresented policy or coverage information
- The insurer failed to respond to your communications within a reasonable time
- The company did not attempt to settle the claim when liability was reasonably clear
- The insurer did not conduct a reasonable investigation into the accident and denied your claim without sufficient information
- The insurer offered a settlement that is less than your claim is worth
If an insurance company discovers, after investigating the incident, that its customer caused the accident, then it is contractually obligated to pay the claim. If it fails to do so, it could be considered acting in bad faith or violating its own contract.
Appealing insurance denial in Chicago
So, how do you appeal a claim denial? Your first step should be talking to a lawyer to help you build a case that the other party was to blame for the accident.
An experienced Chicago car accident lawyer can read the policy and determine where the insurance company acted in bad faith. They can also independently investigate the cause of the accident and show how the at-fault driver caused the collision.
This may not be the end of the matter. You may have to attend a mediation session to achieve a settlement with the insurance company. Sometimes, you may have to go through arbitration, an out-of-court dispute resolution process that can be legally binding.
In any case, if your claim is denied, you should call a lawyer right away.
Do you need help with a Chicago personal injury insurance denial?
Have you had a valid Chicago car accident claim denied? Do you need help getting the compensation you’re entitled to from the at-fault party?
We can help. Contact Horwitz, Horwitz & Associates today at (800) 985-1819 for a free consultation with a Chicago personal injury lawyer.
