What Happens If a Claim Gets Rejected: Appealing Claims

Published on Jun 21, 2014
What Happens If a Claim Gets Rejected: Appealing Claims Image

You pay for your car insurance, so when a claim is rejected it can be very frustrating. The majority of rejected claims wind up that way for a few simple reasons, and in most cases the reasons are legitimate. There are occasions however when then rejection of a claim is in error; if this has happened to you there is some recourse. Insurance companies provide all of their insured customers with an appeals process that allows them to have a rejected claim reviewed.

Reasons for Claims Being Rejected.

The most common reasons for rejecting a claim are that the policy is out of force or that it does not have the required coverage for the claim. If the policy is out of force, the usual reason is that payment has not been made. In some cases it can be an error that can be easily corrected. However, if you did not pay your premiums and the policy was cancelled as a result, the insurance company has no obligation to provide you with coverage.

If you chose to leave off an optional coverage and the claim in question falls under that coverage, the insurance company can also reject your claim. For example, if you choose not to carry collision coverage and have an at-fault accident, the insurance company can reject any claim for damages to your vehicle.

Aside from these main reasons for claim rejection, there are many other possible reasons why a claim might be denied. When a claim is denied erroneously, this is usually because of incorrect information or a mistake in the processing of the claim. This can usually be reversed through the appeals process. A claim may also be denied if the insurance company suspects it is fraudulent.

Appealing your Rejected Claim.

If you believe that you have grounds for an appeal on a rejected claim, the first thing you should do is to contact your insurance company and find out what the appeals process is and how you can get an appeal started. You should also gather together all of the evidence that you need to back up your argument against the denial of the claim.

Once your appeal has been filed, the claim will be reviewed and all of the information reconsidered. In some cases this review is all it will take in order to have the insurance company reverse the decision and pay the claim. In other cases you will need to pursue it further and may even wind up in court fighting for your claim. Bear in mind that this process can take some time, and that you will require legal help in some situations.

Before you decide to go further than the initial appeal in fighting the insurance company, it is a good idea to get some legal advice to find out how strong your case is and how likely it is that you will win. This will prevent you from wasting a lot of resources on a losing battle. For some people the principle matters more than the outcome, and if that is the case you may wish to continue the process no matter what the experts tell you.

Most claims are denied on legitimate grounds, but for those that are in error the insurance company has a process set up to help you with your appeal. Insurance companies do not make it their goal to refuse legitimate claims, but in order to keep rates lower for everyone they can and will deny a claim when they find grounds. Make use of the appeals process; it exists to uncover those situations where the insurance company does make a mistake. Most cases can be settled to the satisfaction of both parties.

Learn more about Auto Insurance.

Insurance can be tricky but we can make it simple. Our auto insurance team can explain everything in simple terms. We are here to give you the information you need to make the best decisions


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