What if My Insurance Company Refuses My Claim?

When you get an insurance policy for your automobile, you start paying premiums on the plan immediately and do so, either in the hopes that your insurance company will be there for you when you need them, or because the law forces you to have basic liability insurance and you’re just that type of law-abiding citizen. Either way, in the unfortunate event that you find yourself needing to file a claim with your insurance company, there is no guarantee that the insurance company is going to honor your claim if the circumstances surrounding it do not comport with your policy or its limits.

Filing an Insurance Claim

After you have suffered an accident or some other type of loss for your insured vehicle, the first thing you will want to so is file an insurance claim with your auto insurance company. Filing a claim is just the technical way of saying that you are telling the insurance company that there has been a problem that you believe they are responsible for paying for, if not fully then at least partially. Once your claim has been filed, the insurance company will likely assign an insurance adjuster to your case, who is someone that specializes in investigating claims and making determinations about the issue and deciding whether or not the claim will be honored by the insurance company.

What if My Claim is Denied?

If an insurance adjuster finds what they believe is sufficient reason to deny your claim, they will notify you of the reason why and present you with options for filing an appeal directly to the insurance company. This should be your first step after your claim is denied – filing an appeal with the insurance company, which should cause them to (re) open the case and have it examined by a member of a management team who will review the facts and factors surrounding your case and the adjuster’s reasons for denying the claim the first time. You should also be given an opportunity to express your side of the issue and explain any extraordinary circumstances that you believe should be considered in the case before they make their determination.

If your Claim is Denied Again

You may still have recourse available to you depending on what state you live in. You may file a formal complaint with the state’s insurance commission. Visit your state’s insurance commissioner’s website and find the proper form for filing a complaint against an insurance company. How your report will be handled will depend largely upon how much factual information you are able to present to the commission surrounding the circumstances of your case. The more information you bring, and the more professional you are in presenting your case, the more likely you are to receive a positive response and having your case moved forward.

Under most circumstances, filing a complaint with your state’s insurance commission is not going to lead to a re-opening of your case or the insurance company having their hand forced in the matter, unless there is a clear and demonstrable case of fraud or something else illegal going on with your issue. If you believe you have been illegally discriminated against for some reason, you may also seek the advice of other official state agencies or consult with an attorney for assistance.