When you're involved in car accident, your first reaction after the dust settles might be to take a deep breath and be thankful that you have insurance. You might make a claim a short time later only to find that your insurer doesn't want to pay. But wait — isn't this what you've been paying premiums for all these years?
It is, but insurance companies may try to avoid paying claims if they have a legitimate reason for doing so. An adjuster will be assigned to review your case and decide whether the company must pay your claim. It may decide not to pay, based on several factors.
You didn't seek treatment
You might give your insurer a reason to deny your personal injury claim if you don't seek medical treatment immediately. If you wait too long you might be able to substantiate that you have an injury but not necessarily that it happened as a result of the accident. Anything might have transpired to hurt you between the date of the accident and the time you sought medical care. Your insurer may also take the position that if you were seriously hurt you would have wanted treatment as soon as possible.
You had pre-existing injuries
Another loophole for insurers is to establish that you were already injured at the time the accident occurred. The company may assert that you're not in pain because of the accident but instead because of something else that happened to you some time ago. This may not be grounds for denying your personal injury claim entirely, but it could affect the amount of your damages. You'd have to prove that the accident made your pre-existing condition worse and your compensation would be reduced because the previous injury plays some part in your pain and suffering.
The accident was avoidable
Your insurer may decline to pay a personal injury or property damage claim if it believes that you took some action that either caused the accident or contributed to it in some way. Driving under the influence of drugs or alcohol is a perfect example. The company could make a reasonable argument that you would not have had an accident if you weren't impaired. The same would apply if you let someone else drive your car who was either impaired or otherwise shouldn't have been driving; as one example, because he or she didn't have a license.
You weren't insured for what happened
Insurers are only required to pay claims if you've been paying for the proper coverage. For example, your insurer doesn't have to pay for repairs to your car because a tree fell on it if you didn't have comprehensive coverage. It doesn't have to pay for property damage from a fender bender if you haven't been paying for collision coverage. Does the person who was driving at the time of the accident live in your household, but you never added him to your policy? If that's the case, the company can (and will) deny your claim.
The insurer is acting in bad faith
Sometimes claims are denied because an insurance company is acting in bad faith, or simply not acknowledging the contractual responsibility. Contact the insurer immediately if you're denied and find out the basis for its decision. Maybe the problem is something you can fix or resolve. If you're sure the reason isn't valid and the insurance company is not cooperative, contact an attorney. If the attorney determines that the company is indeed acting in bad faith he or she will often take your case on a contingency basis. This means he doesn't get paid unless you get paid, and you may be entitled to additional damages over and above the amount of your claim.